复杂解剖条件腹主动脉瘤外科治疗单中心经验  

A single-center experience of surgical treatment of complex abdominal aortic aneurysms

作　　者：汪睿[1] 姚陈[1] 胡作军[1] 王冕[1] 李梓伦[1] 武日东[1] 王斯文[1] 秦原森 宁俊杰 石毅 崔进[1] 吴伟滨 常光其[1] Wang Rui;Yao Chen;Hu Zuojun;Wang Mian;Li Zilun;Wu Ridong;Wang Siwen;Qin Yuansen;Ning Junjie;Shi Yi;Cui Jin;Wu Weibin;Chang Guangqi(Department of Vascular Surgery,National-Guangdong Joint Engineering Laboratory for Diagnosis and Treatment of Vascular Diseases,The First Affiliated Hospital of Sun Yat-sen University,Guangzhou 510080,China)

机构地区：[1]血管疾病诊治技术国家地方(广东)联合工程实验室中山大学附属第一医院血管外科,广州510080

出　　处：《中华血管外科杂志》2022年第2期109-114,共6页Chinese Journal of Vascular Surgery

摘　　要：目的探讨解剖条件复杂的腹主动脉瘤(AAA)的外科治疗效果。方法回顾性分析2002年1月至2021年12月中山大学附属第一医院血管外科手术治疗的211例复杂解剖条件AAA患者的临床资料。根据治疗方式分为开放手术组(82例)和腔内修复术(EVAR)组(129例)。比较分析两组的基线资料、围术期资料及随访资料等,应用Kaplan-Meier曲线分析累积生存率,Logistic回归分析远期结果相关危险因素。结果开放手术组及EVAR组技术成功率分别为100%(82/82)和99.2%(128/129)。围术期内,开放手术组死亡7例,二次干预3例;EVAR组死亡1例,二次干预4例。EVAR组在手术时间、失血量、ICU监护比例、ICU停留时间、围术期并发症发生率及围术期死亡率等方面较开放手术组有优势,差异具有统计学意义[(218.3±125.0)min比(315.0±118.9)min,t=5.57,P<0.001;22(18,48)h比39(20,86)h,U=1275.50,P<0.001;47.3%比87.1%,χ^(2)=24.89,P<0.001;18.6%比36.6%,χ^(2)=8.51,P=0.004;1.8%比8.5%,P=0.006]。开放手术组66例获得随访,中位随访时间为38(9.5,88.5)个月。EVAR组127例获得随访,中位随访时间为24(7.5,47.0)个月。开放手术组全因死亡率高于EVAR组(48.5%比18.9%,χ^(2)=18.46,P<0.001),但在动脉瘤相关死亡率、并发症发生率、二次干预率方面差异无统计学意义。EVAR组1、3、5及10年累积生存率高于开放手术组[(96.4±1.8)%比(93.4±3.2)%,(84.4±4.3)%比(72.6±6.3)%,(72.4±6.2)%比(59.4±7.1)%,(35.1±12.6)%比(35.4±8.1)%],但差异无统计学意义(P=0.324)。多因素Logistic回归分析结果显示,瘤颈血栓是EVAR治疗后远期并发症发生的独立危险因素。结论对于解剖条件复杂的AAA,开放手术和EVAR都是安全有效的治疗方式,但EVAR短期效果更好,开放手术的远期疗效更加确切。Objective To evaluate the clinical effect of surgical treatment of complex abdominal aortic aneurysm(cAAA).Methods Clinical data of 211 patients with cAAA in the Department of Vascular Surgery,the First Affiliated Hospital of Sun Yat-sen University from January 2002 to December 2021 were retrospectively analyzed.Patients were divided into open surgery(OS)group(82 patients)and Endovascular aortic repair(EVAR)group(129 patients).The data of baseline,perioperative,and follow-up were compared between the two groups.Kaplan-Meier method and Logistic regression analysis were performed to investigate cumulative survival rate and risk factors for long-term outcomes.Results The technical success rate was 100%(82/82)and 99.2%(128/129)of OS and EVAR,respectively.The perioperative mortality rate and re-intervention rate of OS group were 8.5%(7/82)and 3.7%(3/82),while EVAR group was 0.8%(1/129)and 3.1%(4/129).In terms of operative duration,blood loss volume,ICU proportion,ICU length of stay,perioperative complication rate,and perioperative mortality rate,EVAR was superior to OS,and the differences were both statistically significant[(218.3±125.0)min vs.(315.0±118.9)min,t=5.57,P<0.001;22(18,48)h vs.39(20,86)h,U=1275.50,P<0.001;47.3%vs.87.1%,χ^(2)=24.89,P<0.001;18.6%vs.36.6%,χ^(2)=8.51,P=0.004;1.8%vs.8.5%,P=0.006].Besides,66 and 127 patients in OS and EVAR group were followed up,and the median follow-up was 38(9.5,88.5)months,and 24(7.5,47.0)months,respectively.The all-cause mortality rate in OS group was higher than that in EVAR group(48.5%vs.18.9%,χ^(2)=18.46,P<0.001),but the difference in the rates of aneurysm-related mortality,complication,and re-intervention was not statistically significant.The 1-,3-,5-,and 10-year cumulative survival rates in EVAR group were higher than those in OS group[(96.4±1.8)%vs.(93.4±3.2)%,(84.4±4.3)%vs.(72.6±6.3)%,(72.4±6.2)%vs.(59.4±7.1)%,(35.1±12.6)%vs.(35.4±8.1)%],but the difference had no statistical significance(P=0.324).Multivariate Logistic regression analysis showed that aneur

关 键 词：腹主动脉瘤 困难瘤颈 开放手术 腔内修复术 治疗 

分 类 号：R654.4[医药卫生—外科学]