破裂腹主动脉瘤腔内修复与开放手术效果的比较

Comparison of effect between open surgical and endovascular repair on ruptured abdominal aortic aneurysm

目的:比较破裂腹主动脉瘤(rAAA)开放手术(OR)与腔内治疗(EVAR)的治疗效果。方法:回顾性分析确诊rAAA并采取OR或EVAR治疗患者的临床资料。比较两组患者及其中游离破裂患者术前指标及合并症、术中指标、围术期死亡率、术后并发症、术后住院天数及生存率等。结果:共61例r AAA患者,男性50例,女性11例,年龄37~86岁,平均(69.74±9.22)岁。OR组36例,EVAR组25例。两组在年龄、性别、合并症及血肌酐方面无显著性差异(P>0.05),而在术前血流动力学稳定性方面存在显著性差异(P<0.05)。OR组与EVAR组围术期死亡率,术后30 d、6个月及12个月生存率均无显著性差异(P>0.05);OR组与EVAR组在术中出血量[(2116.67±1655.52)、(339.58±786.29)m L],术中输血量[(1413.33±978.29)、(416.67±562.35)m L],手术时长[(279.33±66.87)min、(161.46±82.81)min]及ICU天数[5.0(IQR:2.0~6.0),1.0(IQR:0.0~2.0)]方面存在显著性差异(P<0.001)。其中两组间游离破裂患者各指标均无显著性差异(P>0.05)。结论:EVAR在解剖结构合适、指征明确的患者中的应用,可显著改善预后并具有微创优势,同时在血流动力学不稳定患者中疗效不亚于OR,故EVAR可作为r AAA治疗的一线手段;而OR在解剖结构不适用于EVAR等病例中仍发挥着不可替代的作用。

Objective:To compare the therapeutic outcomes of open surgical repair(OR)and endovascular repair(EVAR)of ruptured abdominal aortic aneurysm(rAAA).Methods:Clinical data of patients diagnosed with rAAA and treated with OR or EVAR were analyzed retrospectively.Outcome parameters included preoperative characteristics and commodities,intraoperative indicators,perioperative mortality,complications,survival,and length of hospital stay of two groups and those of free-ruptured aneurysm.Results:Sixty-one consecutive cases(50 males;mean age,69.74±9.22,range,37~86 years)with rAAA treated with OR(n=36),or EVAR(n=25)approaches were presented.While baseline characteristics of age,gender,comorbidities,and preoperative serum creatinine level were similarly distributed(P>0.05),hemodynamic stabilities between two groups,however,were significantly different(P<0.05).There was no significant difference in perioperative mortality as well as survivals at 30 days,6 months and 12 months between two groups(P>0.05).And operative blood losses were significantly different(2 116.67 mL±1 655.52 mL and 339.58 mL±786.29 mL),so were operative transfusion(1413.33 mL±978.29 mL and 416.67 mL±562.35 mL),duration(279.33 min±66.87 min and 161.46 min±82.81min),and median length of ICU stay[5.0(IQR 2.0~6.0)and 1.0(IQR 0.0~2.0)days],respectively(P<0.001).And no significant difference in parameters between two groups of free ruptured patients was found(P>0.05).Conclusion:For rAAA patients with proper anatomy and specific indications,EVAR could be the first-line treatment which can improve prognosis and has the advantage of microinvasiveness.Meanwhile,its efficacy is no less than OR for patients with unstable hemodynamics.However,OR is still irreplaceable for patients with complicated anatomy.