腹主动脉瘤开放手术和腔内修复术的短期随访研究  

Comparison of endovascular versus open repair of abdominal aortic aneurysms:a randomized trial

作　　者：张征[1] 陈忠[1] 吴章敏[1] 唐小斌[1] 刘晖[1] 寇镭[1] 吴庆华[1] 

机构地区：[1]首都医科大学附属北京安贞医院-北京市心肺血管疾病研究所血管外科,北京100029

出　　处：《心肺血管病杂志》2012年第6期658-662,共5页Journal of Cardiovascular and Pulmonary Diseases

基　　金：首都医学发展科研基金(2007-1027);北京市自然科学基金(7102046)

摘　　要：目的:比较腹主动脉瘤(AAA)腔内修复术(EVAR)和开放手术(OR),术后6个月内的疗效。方法:选择同时满足OR和EVAR手术条件的AAA患者共100例,随机分配接受OR或EVAR手术,随访至术后6个月,记录分析两组术中情况、病死率、全身并发症及手术相关并发症。结果:至术后6个月,仅OR组死亡1例,两组病死率差异无统计学意义。EVAR组中位手术时间更短、出血量及输血量更少(P<0.05)。EVAR组患者可以更早出院,但是花费也远高于OR组(P<0.05)。EVAR组围术期全身并发症发生率略低于OR组(16.4%vs.20.5%),但手术相关并发症高于OR组(29.5%vs.12.8%),差异无统计学意义。随访至术后6个月,两组各项并发症情况差异无统计学意义。结论:对于AAA来说,OR与EVAR手术都是安全有效的治疗方法。EVAR手术在围术期显示出微创手术的优势。Objective：To compare postoperative outcomes up to 6 months after endovascular or open repair of AAA.Methods：A randomized,single center clinical trial of 100 patients with eligible AAA who were candidates for both elective endovascular repair and open repair of AAA.Patients were randomized to receive either EVAR（endovascular aneurysm repair） or OR（open repair） of AAA.All-cause deaths,systemic and surgery-related complication were documented.Intraoperative data was also collected.All patients were followed up to 6 months after surgery.Statistical analysis was applied to process collected data.Results：Fifty patients were assigned to EVAR group and 50 to OR group.Thirty-nine patients underwent OR and 61 underwent EVAR eventually.Perioperative mortality was zero for both groups.When followed up to 6 months,all-cause mortality was lower for EVAR（0 % vs.2.6%）,but there was no significant difference between the 2 groups.Patients in the EVAR group had reduced median procedure time,blood loss,transfusion requirement,hospital stay,but required much more expensive cost（P〈0.05）.There were no significant differences between the 2 groups in major systemic complication,surgery related complication,secondary therapeutic procedures,but EVAR showed a better outcome during perioperative period.Conclusion：In this report of short-term outcomes after elective AAA repair,perioperative mortality and mobility was low for both procedures.Both EVAR and OR are safe and effective options for AAA.Longer-term outcome data are needed to fully assess the relative merits of the 2 procedures.

关 键 词：腹主动脉瘤 腔内修复术 开放手术 随机对照研究 

分 类 号：R54[医药卫生—心血管疾病]