复杂瘤颈腹主动脉瘤开放手术治疗单中心体会

Single-center experience of open surgical repair of abdominal aortic aneurysm with hostile neck

目的分析总结开放手术治疗复杂瘤颈腹主动脉瘤短期及远期疗效。方法回顾性分析2017年6月至2019年9月四川大学华西医院血管外科行开放手术治疗的21例复杂瘤颈腹主动脉瘤患者的临床资料。其中男性12例,女性9例;年龄为(64.33±12.46)岁。先兆破裂10例。首要结局指标为术后30 d死亡率,次要结局指标为术后3年总生存率及再干预率。结果21例复杂瘤颈腹主动脉瘤患者中,短瘤颈或肾周动脉瘤15例,大瘤颈动脉瘤3例,瘤颈严重成角9例。动脉瘤直径为(66.54±17.34)mm。3例行肾动脉重建,2例行肾动脉成形。中位住院时间为16(12,19)d,1例死于肺部感染,术后30 d死亡率为4.76%(1/21)。中位随访时间为40(40,67)个月,2例死于心血管事件,术后3年总生存率为85.71%(18/21)。随访期间未观察到主动脉相关再干预或主动脉相关死亡病例。结论开放手术治疗复杂瘤颈腹主动脉瘤安全有效,虽然术后短期存在肺部和肾脏并发症风险,远期再干预率低且生存率稳定。

Objective To analyze and summarize the short and long-term results of open surgical repair(OSR)of abdominal aortic aneurysm(AAA)with hostile neck.Methods The clinical data of AAA patients with hostile neck who underwent OSR from June 2017 to September 2019 in the Division of Vascular Surgery,West China Hospital of Sichuan University were retrospectively analyzed.A total of 21 patients were included,with a mean age of(64.33±12.46)years,12 male patients,and 10 impending ruptures.The primary outcome was 30-day mortality,secondary outcomes included 3-year overall survival and reintervention rate.Results Among 21 patients,15 were short neck or pararenal aneurysms,3 were large-neck AAAs,and 9 were AAAs with severe neck angulation.The aneurysm diameter of the patients was(66.54±17.34)mm.Three underwent renal artery reconstruction,and 2 underwent renal artery angioplasty.The median length of stay was 16(12,19)days.The 30-day postoperative mortality rate was 4.76%(1/21),and the patient died of severe pulmonary infection.During a median follow-up of 40(40,67)months,2 patients died of cardiovascular events.The 3-year overall survival rate was 85.71%(18/21).No aortic-related reintervention or death was observed during follow-up.Conclusion OSR of AAA with hostile neck is safe and effective.Although there is a short-term risk of postoperative pulmonary complications,the long-term results are stable with a low risk of reintervention and mortalit.