摘要
目的对比腔内支架修复和开腹手术治疗肾下腹主动脉瘤的疗效、费用和完全性。方法回顾性分析首都医科大学宣武医院血管外科2002年1月至2011年12月治疗的218例腹主动脉瘤患者资料。开腹手术组86例，平均年龄65．5岁，动脉瘤直径平均为5．4cm。腔内介入（EVAR）组132例，平均年龄76．8岁，动脉瘤直径平均5．6cm。结果开腹组采用倒“Y”型人工血管83例，直型人工血管3例；手术成功率98．8％，围死亡率期2．3％，手术出血平均450ml，输血量平均320ml。手术时间平均230min。住院时间平均（30±3）d，住院费用平均58000元。EVAR组手术成功率100％，围手术期死亡0．8％，采用分体型带膜支架121例（91．7％），直型带膜支架4例（3％），一体式支架7例（5．3％），手术时间平均150min，术中出血量平均为140ml。住院时间平均15．5d，住院费用平均10．48万。EVAR组在手术时间、失血量、住院天数等方面明显优于开腹手术（P〈0．05），而住院费用，EVAR组明显高于开腹手术组（P〈0．05）。随访开腹组80例（94．1％），平均时间46个月。79例人工血管保持通畅（98．8％），死亡8例（10％）。EVAR组125例（94．7％），平均时间32．5个月；移植支架通畅120例（96％），死亡10例；并发症发生8例（5．6％），包括主体支架移位2例和6例髂动脉分支闭塞。二组远期疗效差异无统计学意义（P〉0．05），而并发症发生率，EVAR组明显多于开腹组（P〈0．05）。结论EVAR和开腹手术二种方法治疗肾下腹主动脉瘤，EVAR组在手术时间、失血量、住院天数等方面，明显优于开腹手术；而住院费用，EVAR组明显高于开腹手术组；而且EVAR组的远期并发症明显高于开腹手术组，需要再次干预。
Objective To compare the efficacy, cost and safety of endovascular aortic repair （EVAR） versus open surgery in the treatment of infrarenal abdominal aortic aneurysms. Methods Retrospective analyses were conducted for the clinical data and follow-up information of 218 cases from January 2002 to December 2011 at our hospital. Open surgery group included 86 patients with an mean age of 65.5 years and a mean aneurysm diameter of 5.4 cm. In EVAR group, there were 132 cases with an average age of 76.8 years and a mean aneurysm diameter of 5.6 cm. Results Among 86 open cases, there were inverted ＂Y＂ type artificial graft （n = 83 ） and straight artificial graft （n = 3 ）. The surgical success rate was 98.8%, perioperative period mortality rate was 2.3%, a mean volume of blood loss 450 ml and a mean transfusion volume 320 ml. The mean operative duration was 230 min, a mean hospitalization time （30 ＋ 3 ） days and a mean hospitalization cost RMB yuan 58 000. In EVAR group, the surgical success rate was 100% and perioperative period mortality rate 0.8%. Separating stent graft （ n = 121,91.7% ）, straight stent graft （n =4, 3% ） and one-stent-graft （n=7, 5.3% ）. The mean operative duration was 150 min, a mean volume of blood loss 140 ml, a mean hospitalization time 15.5 days and a mean hospitalization cost RMB yuan 104 800. The operative duration, volume of blood loss and length of hospital stay of EVAR group were superior to those of open surgery group （P 〈 0.05 ）. But the cost of group EVAR was significantly higher than that of group open surgery （P 〈 0.05）. In group open surgery, 80 cases （94.1% ） received a mean follow-up period of 46 months. And 79 artificial grafts maintained patency （98.8%） and 8 cases died （10%）. There were 125 cases in group EVAR （94.7%） with a mean time of 32.5 months; stent graft patency in 120 cases （96%）, 10 death; 8 complication cases （5.6%） involved stent migration （n = 2） and iliac artery branch occlusion （n = 6）. Long-term effects had no significant difference between two groups （P 〉 0.05）. In terms of the incidence of complications, group EVAR was significantly more than group open surgery （P 〈 0.05）. Conclusion In terms of operative duration, volume of blood loss and length of hospital stay, EVAR and open surgery treatment for infrarenal abdominal aortic aneurysms group EVAR is significantly better than group open surgery. As far hospitalization cost, group EVAR is significantly higher than group open surgery. But, in terms of incidence of long-term complications, group EVAR is significantly higher than group open surgery while the latter often requires further interventions.
出处
《中华医学杂志》
CAS
CSCD
北大核心
2013年第9期644-648,共5页
National Medical Journal of China
关键词
主动脉瘤
腹
外科手术
疗效比较研究
腔内支架修复
Aortic aneurysm, abdominal
Surgical procedures, operative
Comparativeeffectiveness research
Endovascular stent-graft repair
