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Treatment of Lymphatic Complications after Common Femoral Artery Endarterectomy.

股总动脉内膜切除术后淋巴并发症的治疗。

  • 影响因子:1.14
  • DOI:10.1016/j.avsg.2019.06.011
  • 作者列表:"Uhl C","Götzke H","Woronowicz S","Betz T","Töpel I","Steinbauer M
  • 发表时间:2020-01-01
Abstract

BACKGROUND:This study analyzes the outcome of lymphatic complications after a standard vascular procedure. METHODS:This is a retrospective study including patients who had a lymphatic complication after endarterectomy and patch of the common femoral artery in our clinic between March 2007 and June 2018. Therapy of choice was selected according to wound situation and amount of lymphatic liquid. If signs of a wound infection occurred, a surgical therapy was performed; in all other cases a nonsurgical treatment (conservative treatment, radiotherapy) was chosen. RESULTS:We performed 977 index operations, a lymphatic complication occurred in 112 cases (11.5%). In 69 cases the lymphatic complication presented as lymphatic fistula (Group 1), in 43 cases as lymphorrhea from the wound (Group 2). Nonsurgical treatment was done in 66 cases (Group 1: 76.8% vs. Group 2: 30.2%; P < 0.000), and a surgical treatment was necessary in 46 cases (Group 1: 23.2% vs. Group 2: 69.8%; P < 0.000). Indication for surgery was Szilagyi 1 infection in 25 cases, Szilagyi 2 infection in 11 cases, and Szilagyi 3 infection in 10 cases. Patients with Szilagyi 1 infections received negative wound pressure therapy (NWPT). A muscle flap in combination with an NWPT was performed in patients with Szilagyi 2 infections. In Szilagyi 3 infections, the patch was replaced; additionally, a muscle flap and an NWPT were performed. The median hospital stay was 13 days in the nonsurgical group and 22.5 days in the surgical group. We had no bleeding complications and no reinfection during follow-up. The median observation period was 23.0 months. Age ≥80 years was associated with an increased risk for lymphatic complications. CONCLUSIONS:The therapy of lymphatic complications should be done in accordance with clinical symptoms. A nonsurgical treatment is often sufficient. However, in cases of a wound infection different surgical treatments are necessary.

摘要

背景: 本研究分析了标准血管手术后淋巴并发症的结果。 方法: 这是一项回顾性研究,包括 2007 年 3 月至 2018 年 6 月在我们诊所接受股动脉内膜切除术和补片术后出现淋巴并发症的患者。根据伤口情况和淋巴液量选择治疗方案。如果出现伤口感染迹象,则进行手术治疗; 在所有其他情况下,选择非手术治疗 (保守治疗,放疗)。 结果: 我们进行了 977 次指数手术,发生淋巴并发症 112 例 (11.5%)。69 例淋巴并发症表现为淋巴瘘 (组 1),43 例表现为伤口淋巴漏 (组 2)。非手术治疗 66 例 (组 1: 76.8% vs.组 2: 30.2%; P <0.000),46 例需要手术治疗 (组 1: 23.2% vs.组 2: 69.8%; P <0.000)。手术指征为Szilagyi 1 感染 25 例,Szilagyi 2 感染 11 例,Szilagyi 3 感染 10 例。Szilagyi 1 感染患者接受伤口负压治疗 (NWPT)。对Szilagyi 2 感染患者行肌瓣联合NWPT。在Szilagyi 3 感染中,更换了补片; 此外,还进行了肌瓣和NWPT。非手术组中位住院时间为 13 天,手术组为 22.5 天。随访期间无出血并发症,无再感染。中位观察期为 23.0 个月。年龄 ≥ 80 岁与淋巴并发症风险增加相关。 结论: 淋巴并发症的治疗应根据临床症状进行。非手术治疗通常是足够的。然而,在伤口感染的情况下,不同的手术治疗是必要的。

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影响因子:2.42
发表时间:2020-02-01
DOI:10.1007/s12011-019-01715-5
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影响因子:2.42
发表时间:2020-02-01
DOI:10.1007/s12011-019-01720-8
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囊肿方向

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