- 期刊
Surgical Repair of Infected Pseudoaneurysm Originating from Native Arteriovenous Fistula for Hemodialysis: Report of a Case
手術治療自體洗腎瘻管形成之感染性僞動脈瘤：病例報告
摘要
由自體血管通路發生之次發性感染，就發生率而言並不常見，但是病程可能會快速惡化。我們報告一個病案，病人爲27歲女性，來院病徵表現爲寒顫併發燒，左手臂有一顆在三天內快速增大之脈動性腫塊。我們便高度懷疑，這是源自血管通路之感染性偽動脈瘤。她的情況快速惡化，轉至加護病房繼續接受治療，我們也進行了急診手術。血管縫合結紮和抗生素治療並不足夠，因爲她的患部組織脆弱及充滿膿液。我們做了清創，感染部位瘻管之節段切除，並使用腿部大隱靜脈對左臂動脈之繞道手術。治療成功且無後遺症。此篇報告之目的在於強調科際問及時照會和正確外科重建手術之重要性，腎臟科醫師和心臟血管外科醫師問之密切合作，對感染性偽動脈瘤之病患才有最大益處。
關鍵字
無資料並列摘要
Infection secondary to an autogenous vascular access, or an arteriovenous fistula (AVF), is low in terms of incidence, but its course may be fulminant. We report a case of a 27-year-old female, presenting with chills, fever, and a rapidly-progressive pulsatile mass on her left elbow within three days. Infected pseudoaneurysm from hemodialysis vascular access was highly suspected. Her condition went downhill at the intensive care unit and emergent surgery was carried out. Suture ligation and antibiotics were not adequate due to her friable and pus-flooded tissue. We performed debridement, segmental resection of the infected fistula, and bypass surgery for the left brachial artery with a saphenous vein graft. The postoperative course was smooth. The purpose of this article is to show the importance of timely consultation and proper surgical reconstruction by cardiovascular surgeons for the maximum benefits of the patients with infected pseudoaneurysms.
延伸閱讀
- Wang, B. F., & Chang, C. P. (2001). 以較低傷害性之Step套管施行後腹腔鏡腎上腺切除術治療Conn氏症候群－兩病例報告. The Changhua Journal of Medicine, 6(2), 113-118. https://www.airitilibrary.com/Article/Detail?DocID=16801504-200104-6-2-113-118-a
- Hsiao, H. L., Li, C. C., Chang, T. H., Wu, W. J., Chou, Y. H., Shen, J. T., Jang, M. Y., & Huang, C. H. (2007). 以Acucise內視鏡輸尿管內切開術治療腎臟移植後之輸尿管狹窄－病例報告及文獻回顧. The Kaohsiung Journal of Medical Sciences, 23(5), 259-264. https://www.airitilibrary.com/Article/Detail?DocID=02575655-200705-23-5-259-264-a
- Tzeng, P. T., Wang, C. T., Hsu, S. L., Lin, V. C., & Lee, Y. H. (2005). 使用純腹腔鏡腎輸尿管切除術及根除性膀胱攝護腺切除術治療男性尿毒症病患之多發性泌尿上皮癌：病例報告及文獻回顧. 臺灣泌尿科醫學會雜誌, 16(4), 158-162. https://www.airitilibrary.com/Article/Detail?DocID=10163220-200512-16-4-158-162-a
- Tsai, Y. C., Chen, I. C., Lai, C. S., Lu, C. T., Yen, J. H., & Song, D. Y. (2015). 發生於腎移植病患之無功能動靜脈廔管處之惡性類上皮血管肉瘤－病例報告及文獻回顧. 臺灣整形外科醫學會雜誌, 24(1), 51-58. https://www.airitilibrary.com/Article/Detail?DocID=a0000593-201503-201504140013-201504140013-51-58
- Chen, W. M., Yang, C. R., Lee, F. C., Lin, J. S., Shih, H. W., Kao, Y. L., Ho, H. C., Ou, Y. C., Cheng, C. L., & Chen, J. T. (1999). 腎細胞癌延伸至橫膈上下腔靜脈的切除手術－兩病例報告. 中華民國泌尿科醫學會雜誌, 10(4), 173-176. https://doi.org/10.7024/JUAROC.199912.0173