血栓切除术成功治疗真菌性中枢性血栓性静脉炎1例

Journal of Trauma and Injury Pub Date : 2023-09-01 Epub Date: 2023-01-31 DOI:10.20408/jti.2022.0063
Eun Ji Lee, Jihoon T Kim
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引用次数: 0

摘要

真菌性血栓性静脉炎是一种罕见的危及生命的疾病,发病率和死亡率都很高。它需要立即去除中心静脉导管和静脉抗真菌治疗,在某些情况下联合抗凝或积极的手术清创。一名70岁男性患者被重达1000公斤的坠物砸伤,被转送至我院。一例腹主动脉破裂伴腹膜后血肿患者行主动脉修补术,一例小肠穿孔伴肠系膜撕裂伤患者行切除吻合术。经计算机断层扫描,患者被诊断为左颈内静脉和头臂静脉血栓性静脉炎。尽管抗真菌治疗,发烧和念珠菌病持续存在。因此进行了紧急清创和血栓切除术。术后给予口服抗真菌药物和直接口服抗凝血药物治疗。在1年的随访中,没有观察到念珠菌复发的迹象。对于复发的真菌性中枢性血栓性静脉炎没有最佳的手术治疗时机。早期恢复应考虑手术治疗。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Successful treatment of fungal central thrombophlebitis by surgical thrombectomy in Korea: a case report.

Fungal thrombophlebitis of the central vein is a rare, life-threatening disease associated with significant morbidity and mortality. It requires immediate central venous catheter removal and intravenous antifungal therapy, combined in some cases with either anticoagulation or aggressive surgical debridement. A 70-year-old male patient injured by a falling object weighing 1,000 kg was transferred to our hospital. A contained rupture of the abdominal aorta with retroperitoneal hematoma was treated with primary aortic repair, and a small bowel perforation with mesenteric laceration was treated with resection and anastomosis. After a computed tomography scan, the patient was diagnosed with thrombophlebitis of the left internal jugular vein and brachiocephalic vein. Despite antifungal treatment, fever and candidemia persisted. Therefore, emergency debridement and thrombectomy were performed. After the operation, the patient was treated with an oral antifungal agent and direct oral anticoagulants. During a 1-year follow-up, no signs of candidemia relapse were observed. There is no optimal timing of surgical treatment for relapsed fungal central thrombophlebitis. Surgical treatment should be considered for early recovery.

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