摘要目的 探讨胸主动脉腔内修复术(TEVAR)后支架感染外科治疗的效果.方法 回顾性分析2016年1月至2018年12月因TEVAR术后支架感染在海军军医大学长海医院心血管外科接受外科治疗的7例患者的临床资料.男性6例,女性1例;年龄(51.5±16.7)岁(范围:25~68岁).降主动脉瘤5例,Stanford B型主动脉夹层2例;主动脉病变未累及膈肌平面以下的腹主动脉.7例患者中2例术中行左锁骨下动脉"烟囱"技术植入支架.支架感染发生在TEVAR术后5(3)个月[M(QR),范围:1~24个月].所有患者存在反复发热,血培养阳性者6例.2例合并主动脉‐食管瘘伴消化道出血患者行急诊手术,5例行择期手术.所有患者于全身麻醉非体外循环下行人工血管旁路移植+感染血管段切除、局部旷置引流术,合并食管瘘者1例行同期修补,1例行食管局部切除、二期行胃代食管手术.术后继续给予敏感抗菌药物治疗6~8周.结果 住院死亡1例,死因为术后早期发生感染性休克.另6例患者术后恢复良好出院.随访6~24个月,曲霉菌感染者术后3个月发生相应胸椎体曲霉菌感染而再次手术,1例患者术后1个月发生髂骨脓肿于骨科接受手术治疗,其余患者随访期间无感染复发.结论 TEVAR术后感染行人工血管旁路移植+感染段主动脉切除、局部引流联合后期的正规抗感染治疗可获得良好的预后.对于存在主动脉食管瘘的患者,可根据食管损伤范围及程度行同期修补或二期手术治疗.

abstractsObjective To examine the results of surgical treatment for endograft infection after thoracic endovascular aortic repair (TEAVR). Methods Clinical data of 7 patients underwent surgical treatment for endograft infection after TEAVR at Department of Cardiothoracic Surgery, Changhai Hospital, the Navy Medical University between January 2016 and December 2018 were analyzed retrospectively. There were 6 males and 1 female, aging (51.5±16.7) years (range: 25 to 68 years). The origin of the aortic disease was descending aortic aneurysm in 5 cases, and Stanford B aortic dissection in 2 cases. Abdominal aorta below the level of the diaphragm was not involved in all patients. Two patients received "chimney technology" for left subclavian artery procedures. Time to infection was 5(3) months (M(QR)) (range: 1 to 24 months). Aortic endograft infection was diagnosed with a combination of microbiology (positive blood cultures, except one with mycotic), radiological evidence and clinical evidence of sepsis. Two patients suffered from aorto‐esophageal fistula received emergency surgery, others were treated with elective surgery. Extra‐anatomic prosthetic graft bypass was used for reconstruction of aorta, infected endogarft and aorta was removed, sac drainage was performed. Aorto‐esophageal fistula was procedured according to the degree of lesions. All patients received antibiotics with specialist advice for 6 to 8 weeks. Results One patient died due to septic shock. In the follow‐time (range: 6 to 24 months), 1 patient suffered from thoracic infection in 3 months after surgery, an other patient got iliac abscess after a month. Conclusions Endograft infection after TEAVR is high risk but may be curative. Appropriate selection of patients for infected endograft explantation could get a satisfied results.