腹主动脉瘤开腹手术与腔内修复术的对照研究

Comparison of open surgery with endovascular treatment for abdominal aortic aneurysms

目的对比分析腹主动脉瘤病人开放手术与腔内修复术的治疗效果。方法收集新疆维吾尔自治区人民医院血管外科2012年7月至2017年6月收治的腹主动脉瘤病人,对比开放手术与腔内治疗病人的一般情况、住院情况、术后及随访期间并发症情况。结果 176例接受手术的腹主动脉瘤病人均获成功,其中腔内修复术(endovascular aneurysm repair,EVAR)156例,开放手术(open surgery,OS)20例,平均年龄(68.8±9.9)岁,平均随访时间(25.9±16.2)个月。OS组住院期间输注红细胞量、输注血浆量、术后重症监护室治疗时间、住院时间明显多于EVAR组(P<0.05)。EVAR术后髂支闭塞、支架感染等问题值得重视。结论尽管腔内治疗效果优于开放手术的循证资料十分有限,EVAR仍然是一个令血管外科医生及病人容易接受的手术方式。

Objective To comparatively analyze open surgery with endovascular treatment for abdominal aortic aneurysms. Methods The patients with abdominal aortic aneurysms were collected from July2012 to June 2017 in the Department of Vascular Surgery,Xinjiang Autonomous Region People＇s Hospital. The general condition,hospitalization andcomplications postoperation and during the follow-up period were compared between open surgery and endovascular treatment. Results Of 176 patients with abdominal aortic aneurysms successfully undergoing surgical operations,26 patients were treated with endovascular therapy（ EVAR） and 20 patients were treated with open surgery（ OS）. Of all patients,the mean age was 68. 8 ±9. 9 years,and the mean follow-up period was 25. 9 ± 16. 2 months. The infusion of erythrocytes and the amount of infusion in the OS group were significantly increased as compared with those in the EVAR group（ P〈0. 05）. Theattention should be paid to iliac artery occlusion and stent infection following EVAR. Conclusions Whether the efficacy of endovascular treatment is superior to open surgery is unclear,but EVAR is an accepted surgical procedure for vascular surgeons and patients. Early effect of endovascular treatment may be better than open surgery during hospitalization,and the long-term effect should be studied further.