破裂腹主动脉瘤开放手术与腔内修复早期效果单中心回顾性分析

Endovascular versus open repair for ruptured abdominal aortic aneurysm

目的比较急诊行腔内修复（endovascular aneurysm repair，EVAR）与开放手术（open repair，OR）在破裂腹主动脉瘤处理中的效果。方法回顾性分析2005至2015年北京安贞医院血管外科手术干预的46例破裂腹主动脉瘤患者病例资料，比较EVAR组和OR组在围手术期死亡率．手术时间，ICU停留时间，住院时间，围手术期输血量，围手术期并发症发生率的区别。结果EVAR组18例，平均年龄（68±9）岁。OR组28例，平均年龄（70±11）岁。两组患者围手术期死亡率分别为21．0％和28．6％（P〉0．05）。EVAR组平均住院天数（15．3±9．5）d，OR组平均住院天数（23．9±10．5）d（P〈0．05），EVAR组平均输血（3210±3780）ml，OR组平均输血（4814±3392）ml（P〈0．05），EVAR组SICU平均停留时间为（7．7±4．2）d，OR组为（4．2±2．5）d（P〈0．05）。死亡率EVAR组21．0％．OR组28．6％（P〉0．05）。EVAR组围手术期并发症发生率为38．89％，OR组为39．28％（P〉0．05）。结论EVAR是急诊救治破裂腹主动脉瘤的一种可靠的手段。

Objective T0 compare the effect after endovascular repair （EVAR） or open repair （OR） of ruptured abdominal aortic aneurysm （rAAA） in Department of Vascular Surgery, Beijing Anzhen Hospital. Methods Clinical data of 46 repaired rAAAs patients was retrospectively analyzed from 2005 to 2015. The difference between the EVAR group and the OPt group in perioperative mortality,operation time, ICU stay, blood transfused, length of stay （LOS） , complication rate were compared by Х^2 test and t test. Results 18 rAAA patients were repaired by EVAR, aged from 51 to 91 with a mean of （68 ±9）. 28 were repaired by OR, aged from 41 to 83 with a mean of （70 ± 11 ）. Perioperative mortality was 21.0% for EVAR and 28.6% for OR （P 〉0. 05）. LOS was （ 15.3 ±9. 5） days for EVAR, and （23.9 ± 10. 5） days for OR （ P 〈 0.05 ）. Blood transfused was （ 3 210 ± 3 780） ml for EVAR and （4 814 ± 3 392） ml for OR （P〈0.05）. ICU stay time was （7.7 ±4.2） d for EVAR and （4.2 ±2.5） d for OR （P〈0.05）. Conclusion EVAR is a reliable approach for the treatment of acute rAAA.