覆膜支架腔内隔绝和开腹手术治疗腹主动脉瘤破裂疗效比较

COMPARISON OF ENDOVASCULAR REPAIR AND OPEN REPAIR FOR RUPTURED ABDOMINAL AORTIC ANEURYSM

目的比较开腹手术和腔内隔绝术治疗腹主动脉瘤破裂的手术效果。方法 2000年3月-2011年7月,收治48例腹主动脉瘤破裂患者,其中40例行腹动脉瘤切除、人工血管移植术治疗(开腹组),8例行覆膜支架腔内隔绝术治疗(腔内隔绝组)。两组患者性别、年龄、瘤颈长度≤2 cm构成比、瘤颈成角≥60°构成比、髂外动脉严重扭曲构成比、术前收缩压、术前合并症组间比较差异无统计学意义(P>0.05),具有可比性。术后对两组患者输血量、手术时间、重症监护时间、术后并发症、二期手术率、术后24 h内死亡率和术后30 d内死亡率进行比较。结果两组术后24 h死亡率、术后30 d死亡率以及非移植物相关并发症发生率比较差异均无统计学意义(P>0.05);但组间手术时间、输血量、重症监护时间、二期手术率及移植物相关并发症发生率比较差异均有统计学意义(P<0.05)。结论腔内隔绝术对解剖条件良好的腹主动脉瘤破裂患者是一种可行的手术方式,在输血量、手术时间、重症监护时间方面与传统开腹手术相比具有明显优势。

Objective To compare the effectiveness between conventional open repair （OR） and endovascular repair （EVRAR） for ruptured abdominal aortic aneurysm. Methods Between March 2000 and July 2011, 48 cases of ruptured abdominal aortic aneurysm were treated by conventional OR in 40 cases （OR group） or by EVRAR in 8 cases （EVRAR group）. There was no significant difference in age, sex, the neck length （less than 2 cm）, the neck angulation of aneurysm （more than 60°）, iliac severe tortuosity, preoperative systolic pressure, and preoperative comorbidity between 2 groups （P 〉 0.05）. The blood transfusion volume, operation time, intensive care unit （ICU） stay, postoperative complications, reinterventions, and mortality were analyzed. Results There was no significant difference in 24-hour and 30-day mortality rates and non graft-related complications between 2 groups （P 〉 0.05）. EVRAR group was significantly better than OR group in blood transfusion volume, operation time, and ICU stay （P 〈 0.05）, but OR group was significantly better than EVRAR group in reinterventions and graft- related complications （P 〈 0.05）. Conclusion EVRAR has obvious advantages in blood transfusion volume, operation time, and ICU stay, so it is feasible for ruptured abdominal aortic aneurysm in patients with precise anatomical suitability.