腔内修复术治疗破裂型腹主动脉瘤的效果评价  

Effect Evaluation of Endovascular Aortic Aneurysm Repair for Ruptured Abdominal Aortic Aneurysm

作　　者：庄晖[1] 郭平凡[1] 张金池[1] 蔡方刚[1] 刘学强[1] 吴捷[1] 戴贻权[1] 詹腾辉[1] 

机构地区：[1]福建医科大学附属第一医院血管外科,福州350005

出　　处：《中国现代手术学杂志》2014年第6期416-420,共5页Chinese Journal of Modern Operative Surgery

摘　　要：目的分析破裂型腹主动脉瘤（ruptured abdominal aneurysm,r AAA）行腔内修复术（endovascular aortic aneurysm repair,EVAR）与开放手术早期结果,评价EVAR治疗的效果。方法回顾性收集我院2004年1月～2014年1月收治的48例r AAA患者临床资料,根据其手术与否、手术方式的不同分为术前死亡组（n=20）、EVAR组（n=14）和开放手术组（n=14）,三组性别、年龄等一般资料比较无统计学差异（P〉0.05）,EVAR组和开放手术组在瘤体直径、收缩压、舒张压方面比较差异均无统计学意义（P〉0.05）。结果 EVAR组入院至检查时间为（1.2±0.8）h,与开放手术组（7.5±7.1）h比较差异有统计学意义（P=0.006）;EVAR组检查至手术时间为（1.8±1.3）h,与开放手术组（16.8±17.7）h比较差异有统计学意义（P=0.007）。死亡组入院至死亡时间与EVAR组比较差异有统计学意义（P〈0.009）。EVAR组手术时间为（2.3±0.7）h,与开放手术组（5.6±2.0）h比较差异有统计学意义（P〈0.001）;EVAR组的术中出血量为（142.9±279.3）ml,与开放手术组的（3 528.6±3 252.3）ml间差异有统计学意义（P〈0.001）;EVAR组的输血量为（985.7±2 148.7）ml,与开放手术组的（3 100.0±2 285.1）ml间差异有统计学意义（P=0.018）;EVAR组的住院时间为（7.1±2.7）d,与开放手术组的（13.7±4.9）d间差异有统计学意义（P〈0.001）;EVAR组的总费用为（20.9±5.8）万元,与开放手术组的（10.1±11.5）万元间差异有统计学意义（P=0.005）。两组并发症率比较,差异无统计学意义（P=0.430）。结论缩短院内抢救准备时间,是r AAA成功救治的要点。EVAR应作为r AAA的一线治疗方案。Objective To evaluate the effect of endovascular aortic aneurysm repair （EVAR） used in the treatment of ruptured abdominal aortic aneurysm （rAAA）. Methods The data of 48 rAAA patients ad- mitted in our hospital from January 2004 to January 2014 were analyzed retrospectively. Three groups as death group, EVAR group and open group were divided according to repair or not and the repair method, with 20, 14 and 14 cases for each. There were no significant differences in ages and sexes among three groups （ P 〉 0.05 ） , and no statistic differences in diameters of the aneurysm, systolic pressures and diastolic pressures between EVAR and open repair group （ P 〉 0.05 ）. Results There was statistic difference in preparation time of ex- amination between EVAR group and open repair group （ 1.2±0.8 vs. 7.5 ± 7.1 hours, P = 0. 006 ）. There was statistic difference too in preparation time after examination between EVAR group and open repair group （ 1.8 ±1.3 vs. 16.8 ± 17.7 hours, P = 0. 007 ）. Statistic differences were found in the intervals between the admission times and the death times of the death groups and the intervals between the admission times and the operation times of the EVAR group （ P 〈 0. 009 ）. The operating time was 2.3 ± 0.7 hours in EVAR group and less than 5.6± 2.0 hours in open repair group （P 〈 0.001 ）. The blood loss was 142.9 ± 279.3 ml in EVAR group and less than 3 528.6 ± 3 252.3 ml in open repair group （P 〈 0.001 ）. The volume of blood transfusion was 985.7 ± 2 148.7 ml in EVAR groups and less than 3 100.0 ± 2 285.1 ml in open repair group （P = 0.018 ）. The duration of hospitalization were 7.1 ± 2.7 days in EVAR group and less than 13.7 ±4.9 days in open repair group （P 〈0. 001 ）. The hospitalization expense was 209 ~58 thousand Yuan in EVAR group and higher than 101 ± 115 th6usand Yuan in open repair group （P = 0. 005）. There was no statistic differ- ence in complication rate between the EVAR group and open repair group （ P =

关 键 词：主动脉瘤 腹 腔内修复术 开放手术 

分 类 号：R654.3[医药卫生—外科学]