中国实用外科杂志

中国实用外科杂志

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破裂腹主动脉瘤行腔内修复术与开放手术早期结果比较研究

许永乐，郭    伟，刘小平，熊    江，贾    鑫，马晓辉，张宏鹏，张    佳，张敏宏，杜    昕，王立军   

  1. 中国人民解放军总医院血管外科，北京100853
  • 发布日期:2012-11-29

  • Published:2012-11-29

摘要：

目的    比较破裂腹主动脉瘤行腔内修复术与开放手术早期数据，评价两种方式的优劣。方法    回顾性分析2009年1月至2012年5月期间中国人民解放军总医院血管外科收治的37例破裂腹主动脉瘤病人，根据处理方式分为腔内治疗组（rEVAR）和开放手术组（rOR）。比较分析两组的临床资料及主要观察指标。结果    rEVAR组24例病人，rOR组13例病人。围手术期病死率分别为16.7%（rEVAR组）、30.8%（rOR组），P=0.413。次要观察目标中，平均手术时间分别为174 min（rEVAR组）、372 min（rOR组），P=0.000；平均失血量分别为213 mL（rEVAR组）、4008 mL（rOR组），P=0.000；平均输血量分别为1849 mL（rEVAR组）、4692 mL（rOR组），P=0.002；在重症监护室治疗的时间分别平均为2.6 d（rEVAR组）、8.6 d（rOR组），P=0.012；平均总住院时间分别为12.5 d（rEVAR组）、21.4 d（rOR组），P=0.025；住院总费用差异无统计学意义。结论    腔内修复术是治疗破裂腹主动脉瘤的一种安全、有效的治疗方式。对于有经验和条件的单位，可以考虑作为首选治疗方式。

关键词: 破裂性腹主动脉瘤, 腔内修复术, 开放手术

Abstract:

Endovascular versus open repair of ruptured abdominal aortic aneurysm: early term results of a single centre             XU Yong-le, GUO Wei, LIU Xiao-ping, et al. Department of Vascular Surgery, General Hospital of PLA, Beijing 100853, China
Corresponding author: GUO Wei, E-mail：pla301dml@vip.sina.com
Abstract    Objective    To compare perioperative mortality and other important early term data after endovascular repair (EVAR) and open repair (OR) of ruptured abdominal aortic aneurysm (rAAA), and evaluate the different procedures. Methods    Thirty-seven records were retrospectively reviewed from January 2009 to May 2012 in Department of Vascular Surgery, General Hospital of PLA for repair of rAAAs. The patients were divided into two different groups by the repair method, which were rEVAR vs rOR. Results Twenty-four rAAAs were repaired by rEVAR and 13 by rOR. Perioperative mortality was 16.7% for rEVAR and 30.8% for rOR (P=0.413). Operating time was 174 min for rEVAR and 372 min for rOR (P=0.000). Blood to lose was 213mL for rEVAR and 4008mL for rOR (P=0.000). Blood to transfuse was 1849mL for rEVAR and 4692mL for rOR (P=0.002). ICU stay was 2.6 days for rEVAR and 8.6 days for rOR (P=0.012). LOS was 12.5 days for rEVAR, and 21.4 days for rOR (P=0.025). The hospitalization charges were similar between the two groups. Conclusion    EVAR is a safe and effective option for treatment of rAAAs compared with open repair. EVAR should be considered as the first-line treatment of rAAAs if adequate skills, facilities and protocols are available.

Key words: ruptured abdominal aortic aneurysm, endovascular repair, open repair