腹主动脉瘤开放手术和腔内手术治疗的近期疗效分析  

Early efficacy of open surgery and endovascular surgery for abdominal aortic aneurysm

作　　者：徐超 余朝文[1] 任天才 陈世远[1] 孙勇[1] 高涌[1] Chao Xu;Chaowen Yu;Tiancai Ren;Shiyuan Chen;Yong Sun;Yong Gao(Department of Vascular Surgery,the First Affiliated Hospital of Bengbu Medical College,Bengbu 233004,China)

机构地区：[1]蚌埠医学院第一附属医院血管外科,安徽省蚌埠市233004

出　　处：《中华解剖与临床杂志》2021年第6期658-662,共5页Chinese Journal of Anatomy and Clinics

摘　　要：目的对比分析腹主动脉瘤开放手术(OSR)与腔内修复手术(EVAR)的近期疗效。方法回顾性研究。纳入2008年1月—2020年12月蚌埠医学院第一附属医院血管外科接受手术治疗的腹主动脉瘤患者118例,其中男102例、女16例,年龄(70.5±9.6)岁。根据手术治疗方式的不同,分为OSR组23例和EVAR组95例。观察指标:(1)比较两组患者的年龄、性别、不良生活习惯、合并症、瘤体最大径、复杂瘤颈形态等基线资料。(2)比较两组患者手术时间、术中出血量、术后禁饮食时间、术后卧床时间、住院时间,以及术后并发症和死亡发生情况。(3)术后定期复查CT血管成像(CTA),观察有无再干预、支架内血栓形成、支架内再狭窄、移植物感染、各型内漏等发生。结果OSR组和EVAR组的基线资料比较差异均无统计学意义(P值均>0.05)。患者均顺利完成手术。EVAR组的手术时间、术中出血量、术后禁饮食时间、术后卧床时间、住院时间均少于OSR组,分别为(141.15±22.97)min与(242.79±29.41)min、(34.32±16.08)mL与(443.93±109.58)mL、(14.26±3.34)h与(52.25±12.05)h、(4.07±0.63)d与(6.48±0.83)d、(21.88±1.78)d与(24.44±2.44)d,差异均有统计学意义(t=17.919、17.881、14.978、15.532、4.745,P值均<0.05);两组患者围手术期并发症发生率及死亡率比较,差异均无统计学意义(P值均>0.05)。患者均获随访1年,除EVAR组2例出现轻微Ⅱ型内漏外,均无严重并发症发生。结论腹主动脉瘤的OSR和EVAR均能取得良好的近期治疗效果。与OSR相比较,EVAR手术时间更短,术中出血更少,术后禁饮食、卧床及住院时间更短,术后恢复更快。Objective This study aimed to compare the short-term efficacy of open surgery(OSR)and endovascular surgery(EVAR)for abdominal aortic aneurysm.Methods A retrospective analysis was conducted on 118 patients who underwent surgery in the Department of Vascular Surgery of the First Affiliated Hospital of Bengbu Medical College due to abdominal aortic aneurysm from January 2008 to December 2020.The patients comprised 102 males and 16 females aged 70.5±9.6 years.According to different surgical-treatment methods,23 cases were divided into the OSR group,and 95 cases were divided into the EVAR group.The outcome measures were as follows.(1)The baseline data of age,gender,bad living habits,complications,tumor diameter,and complex tumor neck morphology were compared between the two groups.(2)The operation time,intraoperative bleeding,fasting time,postoperative bed time,hospital stay,postoperative complications,and death were compared between the two groups.(3)Computed tomography angiography was rechecked,and the presence of reintervention,stent thrombosis,stent restenosis,graft infection,and various types of internal leakage was noted.Results No significant difference in baseline data was observed between the OSR and EVAR groups(all P values>0.05).The operation was performed in all patients successfully.The operative time,intraoperative blood loss,water fasting time,postoperative bed time,and hospital stay in the EVAR group were all shorter than those in the OSR group:(141.15±22.97)min vs.(242.79±29.41)min,(34.32±16.08)mL vs.(443.93±109.58)mL,(14.26±3.34)h vs.(52.25±12.05)h,(4.07±0.63)d vs.(6.48±0.83)d,(21.88±1.78)d vs.(24.44±2.44)d,respectively.The differences were statistically significant(t=17.919,17.881,14.978,15.532,and 4.745;all P values<0.05).No significant differences were observed in the incidence of perioperative complications and mortality between the two groups(all P values>0.05).All patients were followed up for 1 year.No serious complications were observed,except for two cases of slight type-Ⅱintern

关 键 词：腹主动脉瘤 主动脉腔内修复 人工血管嵌入式移植 

分 类 号：R654.3[医药卫生—外科学]