腹主动脉瘤腔内修复与开腹手术治疗的疗效分析  

Efficacy analysis of endovascular aneurysm repair and open surgery repair in patients with abdominal aortic anenrysm

作　　者：唐佃俊 张健[1] 辛世杰[1] 伦语[1] 沈世凯[1] 宋建博[1] 姜晗[1] 段志泉[1] 

机构地区：[1]中国医科大学附属第一医院血管外科,沈阳110001

出　　处：《中华消化外科杂志》2015年第9期717-722,共6页Chinese Journal of Digestive Surgery

基　　金：基金项目：国家自然科学基金（30471706）

摘　　要：目的分析腹主动脉瘤腔内修复与开腹手术治疗的临床疗效。方法回顾性分析2004年1月至2014年12月中国医科大学附属第-医院收治的271例行手术治疗的腹主动脉瘤患者的临床资料。153例患者行腔内修复治疗设为腔内修复组，118例患者行开腹手术治疗设为开腹手术组。患者术前先行超声检查初筛；三维计算机断层摄影血管造影检查明确诊断；病情急重者行腹部增强CT检查明确诊断。腔内修复治疗方法：经股动脉切口进入腹主动脉，选择分支覆膜支架行腔内修复治疗。开腹手术治疗方法：取腹正中切口，切开腹主动脉瘤，清理内侧附壁血栓及硬化斑块，取Y型人工血管行腹主动脉端端吻合及髂动脉端侧吻合。采用电话方式随访，随访时间截至2014年12月31日。观察患者手术情况、术后30d、术后近期（术后3个月至术后3年）并发症、中远期（术后〉3年）并发症、患者死亡情况、生存率。符合正态分布的计量资料以元±s表示，采用t检验。计数资料比较采用，和Fisher确切概率法检验。采用Kaplan-Meier法绘制生存曲线，Log-rank检验进行生存分析。结果271例患者术前均行三维计算机断层摄影血管造影检查明确诊断。腔内修复组患者手术时间、术中出血量、术中输血量、术后离床活动时间、术后住院时间和治疗费用分别为（179±64）min、（79±36）mL、0、（5．7±3．1）d、（12±6）d、（179018±65796）元，开腹手术组患者分别为（205±40）min、（402±297）mL、（410±367）mL、（8．3±2．1）d、（18±11）d、（77853±21164）元，两组比较，差异有统计学意义（t=-32．464，-51．719，-294．350，-11．833，-10．957，2778．748，P〈0．05）。腔内修复组患者术后30d并发症：低氧血症、心肌缺血、心律失常、腹泻、阴茎阴囊压迫性水肿、输尿管结石、急性尿潴留、血栓形成、感染、腹膜后�Objective To analyze and compare the clinical efficacies of endovascular aneurysm repair （EVAR） and open surgery repair （ OSR ） in patients with abdominal aortic aneurysm （ AAA ）. Methods The clinical data of 271 patients with AAA who received surgery at the First Hospital of China Medical University between January 2004 and December 2014 were retrospectively analyzed, Of the 271 patients, 153 patients undergoing EVAR were allocated into the EVAR group and 118 patients undergoing OSR into the OSR group, respectively. All the patients underwent a primary screening of preoperative uhrasonography and were diagnosed by three-dimensional computed tomography angiography （CTA） , then urgent and severe patients were confirmed by abdominal enhanced CT. The procedures of EVAR： guide wire was inserted into the abdominal arota from femoral artery incision and branched stent was placed. The procedures of OSR： AAA was resected by median abdominal incision, thrombi and sclerosis plaques in endovascular wall were cleared, and end-to-end abdominal aortic anastomosis and end-to-side iliac aortic anastomosis were performed using Y-shaped blood vessel prosthesis. All the patients were followed up by telephone interview up to December 31, 2014. The operation situation, complications at postoperative day 30, short-term complications （ between postoperative 3 months and 3 years ）, medium-and long-term complications （more than postoperative 3 years）, mortality and survival rate were observed. Measurement data with normal distribution were presented as x -＋ s and analyzed using the t test, and count data were analyzed using the chi-square test or Fisher exact probability. Survival curve was drawn by the Kaplan-Meier method, and survival rate was analyzed using the Log-rank test. Results All the patients were confirmed as with AAA by preoperative three-dimensional CTA. The operation time, volume of intraoperative blood loss, volume of intraoperative blood transfusion, time for out-off-bed activity, duration o

关 键 词：腹主动脉瘤 腔内修复治疗 开腹手术 疗效 

分 类 号：R654.3[医药卫生—外科学]