摘要
目的评估腹主动脉瘤腔内和开腹修复术在治疗腹主动脉瘤患者的安全性和有效性。方法回顾性分析华西医院血管外科2006年1月至2011年1月期间收治的371例行择期手术的腹主动脉瘤患者，比较腔内修复术治疗患者（EVAR组，n=174）与开腹手术治疗患者（OR组，n=197）的围手术期资料、并发症和死亡率情况。结果腔内组的平均年龄为（72±8）岁；手术组的平均年龄为（60±14）岁，两组差异有统计学意义（P〈0．05）。腔内组患者合并COPD的比例为31．0％高于OR组的比例为21．8％（P〈0．05）。腔内组患者术中失血量为（125±43）ml少于手术组为（858±602）ml（P〈0．05）。腔内组患者术中无输血，手术组术中有140例患者输血。腔内组术后ICU时间和禁食时间分别为（15±5）h和（7±4）h均低于手术组分别为（31±11）h和（90±32）h（P〈0．05）。腔内组手术时间为（146±39）min短于手术组为（210±24）rain，（P〈0．05）。腔内组术后带呼吸机时间的中位数为（90±23）min短于手术组（220±132）min，（P〈0．05）。腔内组88例（50．6％）全身麻醉、52例（30．0％）硬膜外阻滞麻醉、34例（19．4％）局麻，手术组全部选择全麻。腔内组术后平均住院时间为（9．1±2．7）d与手术组（9．2±2．6）d相似（P=0．798）。围手术期并发症发生率EVAR组为12．6％低于手术组27．0％（P〈0．05）。EVAR组30d围手术期死亡率1．15％，手术组30d围手术期死亡率2．0％。结论腹主动脉瘤腔内修复术比开腹手术具有创伤小、术中失血少、术后恢复快，围手术期死亡率低等优点，使部分高危不能耐受开腹手术患者能够获得有效治疗，长期生存率有待进一步随访观察。
Objective To evaluate the outcomes of endovascular repair （EVAR） versus open repair （OR） in the patients with abdominal aortic aneurysm （AAA） and compare their perioperative rates of morbidity and mortality. Methods The clinical data of 371 AAA patients from January 2006 to January 2011 were collected and analyzed. Endovascular （ n = 174 ） and open （ n = 197 ） repairs were performed. The relevant parameters included preoperative status, intraoperative blood loss, procedure time, intensive care unit （ICU） stay length, ventilatory support time, postoperative fasting time and duration of postoperative hospital stay and anesthesia methods. The perioperative rates of morbidity and mortality were presented. Results The patients of EVAR group were elder than those of OR group [ （72 ＋ 8 ） vs （60 ＋ 14） years old, P = 0. 000 ]. The comorbidity rate of chronic obstructive pulmonary disease （COPD） in EVAR group was higher than that in OR group （31.0% vs 21.8% , P =0. 045）. As compared with OR group, the EVAR group had less blood loss [ （ 125 ± 43 ） vs （ 858 ± 602） ml, P = 0. 000 ], a lower rate of blood transfusion （0 vs 71.1%, P = 0. 000）, shorter ICU stay length [ （ 15 ± 5 ） vs （31 ± 11 ） h, P = 0. 000 ], shorter postoperative fasting time [ （7 ±4） vs （90 ±32） h, P =0. 000], shorter procedure time [ （ 146 ± 39） vs （210 ±24） min, P =0. 000] and shorter ventilatory support time [ （90 ±23） vs （220. 0 ± 132. 0） min, P = 0. 000 ]. In EVAR group, general （ 88, 50. 6% ）, epidural （ 52, 30. 0% ） and local （ 34, 19.4% ）anesthesia were used. General anesthesia was used for all OR group patients. The duration of postoperative hospital stay was similar in two groups （9. 1 -＋ 2.7 ） d vs （9.2 -＋ 2. 6） d （ P = O. 798 ）. The perioperative complication rate was lower in EVAR group （ 12. 6% vs 27. 0%, P =0. 001 ）. And the 30-day mortality rate was 1.15% in EVAR group and 2. 0% in OR group. Conclusion Endovascular repair is less- invasive in AAA patients and offers significant advantages over open surgery. Especially it is indicated for those patients non-suitable for open surgery. And a long-term survival rate is expected.
出处
《中华医学杂志》
CAS
CSCD
北大核心
2012年第47期3324-3328,共5页
National Medical Journal of China
关键词
主动脉瘤
腹
腔内修复术
外科手术
Aortic aneurysm, abdominal
Endovascular repair
Surgical procedure
