腔内修复治疗破裂性腹主动脉瘤合理性、有效性、安全性研究

Rationality,effectiveness and safety of endovascular aortic repair for ruptured abdominal aortic aneurysm

目的探讨腹主动脉腔内修复(EVAR)治疗破裂性腹主动脉瘤(RAAA)的合理性、有效性和安全性。方法回顾性分析2005年8月至2020年1月首都医科大学附属北京安贞医院收治的112例RAAA病人资料,对EVAR组和开放手术(OSR)组围手术期结果进行比较分析。结果EVAR组和OSR组30 d病死率分别为12.3%(8/65)和12.8%(6/47),两组差异无统计学意义(P=0.942),围手术期各种并发症发生率及二次手术干预率两组差异均无统计学意义。EVAR组和OSR组手术时间分别为(3.5±1.7)h和(7.2±3.1)h,差异有统计学意义(P<0.01);EVAR组和OSR组术中出血量分别为(267.7±433.9)mL和(2721.3±2112.1)mL,差异有统计学意义(P<0.01);EVAR组和OSR组术中输红细胞量分别为(2.2±4.2)U和(7.2±3.1)U,差异有统计学意义(P<0.01);EVAR组和OSR组术中输血浆量分别为(147.7±324.6)mL和(1121.3±754.1)mL,差异有统计学意义(P<0.01)。EVAR组ICU时间为(6.9±8.0)d,低于OSR组(8.6±8.4)d,但差异无统计学意义(P=0.285);EVAR组住院时间为(13.3±10.4)d,低于OSR组(21.8±11.1)d,差异有统计学意义(P<0.01)。结论EVAR治疗RAAA有与OSR相似的30 d病死率和并发症发生率,而EVAR有更短的手术时间,更少的术中出血量和输血量、更短的住院时间。EVAR治疗RAAA是合理、有效、安全的。

Objective To investigate the rationality,efficacy and safety of endovascular aortic repair(EVAR)in the treatment of ruptured abdominal aortic aneurysm(RAAA).Methods The clinical data of 112 patients with RAAA who were admitted from August 2005 to January 2020 in Department of Vascular Surgery,Beijing Anzhen Hospital,Capital Medical University were analyzed retrospectively.The perioperative results of EVAR group and open surgical repair(OSR)group were compared.Results The 30-day mortality rates of EVAR group and OSR group were 12.3%(8/65)and 12.8(6/47),respectively.There was no significant difference between the two groups(P=0.942).There was no significant difference between the two groups in the incidence of complications and the rate of re-intervention.The operation time of EVAR group and OSR group was(3.5±1.7)hour and(7.2±3.1)hour respectively,and there was significant difference between the two groups(P<0.01).The intraoperative blood loss of EVAR group and OSR group was(267.7±433.9)m L and(2721.3±2112.1)m L,respectively,with a significant difference between the two groups(P<0.01).The intraoperative red blood cells transfusion volume of EVAR group and OSR group was(2.2±4.2)U and(7.2±3.1)U,respectively,with a significant difference between the two groups(P<0.01).The intraoperative plasma transfusion volume of EVAR group and OSR group was(147.7±324.6)m L and(1121.3±754.1)m L respectively,with significant difference between the two groups(P<0.01).The ICU stay time of EVAR group was(6.9±8.0)d,lower than that of OSR group(8.6±8.4)d,but there was no significant difference(P=0.285).The length of stay in EVAR group was(13.3±10.4)d,lower than that of OSR group(21.8±11.1)d,and there was significant difference between the two groups(P<0.01).Conclusion EVAR has a similar 30 day mortality and complication rate with OSR,while EVAR has shorter operation time,less intraoperative hemorrhage and blood transfusion,and shorter length of stay.EVAR is reasonable,effective and safe in the treatment of RAAA.