多中心近10年(2013—2022年)161例破裂腹主动脉瘤临床分析  

Clinical analysis of 161 multicenter cases of ruptured abdominal aortic aneurysms over the past

作　　者：陈可 查斌山[2] 曾家琪 赵文鹏 杨志浩 刘昭[1] 周敏[1] 乔彤[1] 赵鑫[5] 周为民[4] 陈智勇[2] 李文东 李晓强 CHEN Ke;ZHA Binshan;ZENG Jiaqi;ZHAO Wenpeng;YANG Zhihao;LIU Zhao;ZHOU Min;QIAO Tong;ZHAO Xin;ZHOU Weimin;CHEN Zhiyong;LI Wendong;LI Xiaoqiang(Department of Vascular Surgery,Drum Tower Hospital Affiliated to the Medical School,Nanjing University,Nanjing 210008,China;Department of Vascular Surgery,the First Affiliated Hospital of Anhui Medical University,Hefei 230001,China;Department of Vascular Surgery,Kunshan Hospital of Traditional Chinese Medicine,Kunshan,Jiangsu 215300,China;Department of Vascular Surgery,the Second Affiliated Hospital of Nanchang University,Nanchang 330000,China;Department of Cardiovascular Surgery,Qilu Hospital,Shandong University,Ji'nan 250012,China)

机构地区：[1]南京大学医学院附属鼓楼医院血管外科,江苏南京210008 [2]安徽医科大学第一附属医院血管外科,安徽合肥230001 [3]江苏省昆山市中医医院血管外科,江苏昆山215300 [4]南昌大学第二附属医院血管外科,江西南昌330000 [5]山东大学齐鲁医院心血管外科,山东济南250012

出　　处：《中国普通外科杂志》2024年第12期1967-1974,共8页China Journal of General Surgery

摘　　要：背景与目的:破裂是腹主动脉瘤最严重的并发症,由于需要快速诊断、紧急手术,且手术难度极大,病死率一直居高不下。目前,国内针对破裂腹主动脉瘤(rAAA)的报道极少,给rAAA的防治带来了诸多困难。本研究收集了多中心、大样本量rAAA患者的流行病学特征、治疗效果及预后资料,分析近10年国内rAAA手术的现状与趋势,以期为临床提供参考。方法:回顾性分析2013年1月—2022年12月五家大型血管外科中心收治的161例rAAA病例(南京大学医学院附属鼓楼医院50例、安徽医科大学第一附属医院19例、南昌大学第二附属医院33例、山东大学齐鲁医院31例、中国科学技术大学附属第一医院28例)的临床与随访资料。结果:161例患者中,男性124例(77.02%),女性37例(22.98%);平均年龄68.27岁;男性与女性的中位发病年龄分别为70岁与71岁。全组平均动脉瘤直径为7.11 cm,其中男性为7.72 cm、女性为6.82 cm,差异有统计学意义(P<0.05)。患者的主要合并症为高血压、冠心病。超过80%的患者首发症状为腹痛,以腰背部疼痛为首发症状的患者占比为15%,有8例患者因头晕、视物模糊等症状就诊。161例患者中,行传统开放手术(OSR组)86例,行主动脉瘤腔内修复术(EVAR组)75例,EVAR占比在逐年增加,近5年接近70%,且70岁以上患者中高达90%。所有OSR组均采用全身麻醉,而EVAR组20例采用局部麻醉,55例采用全身麻醉。此外,OSR组与EVAR组患者在手术时间(231.77 min vs.162.49 min)、术中输血量(1578.56 mL vs.843.87 mL)、住院时间(21.21 d vs.15.34 d)、ICU住院时间(8.28 d vs.5.49 d)、住院费用(10.85万元vs.13.28万元)方面差异均有统计学意义(均P<0.05)。EVAR组与OSR组在总并发症及围术期死亡发生率方面差异无统计学意义(均P>0.05),患者围术期死亡原因主要包括呼吸循环衰竭、急性心肌梗死、严重感染等。92例患者术后获得有效随访,随访时间10~142个月,生存Background and Aims:Rupture is the most serious complication of abdominal aortic aneurysm,requiring rapid diagnosis,emergency surgery,and posing significant surgical challenges,with high mortality rates.Currently,there is very limited reporting on ruptured abdominal aortic aneurysm(rAAA)in our country,which presents numerous difficulties for the prevention and treatment of rAAA.This study collected the data of epidemiological characteristics,treatment outcomes,and prognosis of rAAA patients from multiple centers with a large sample size,analyzing the current status and trends of rAAA surgery in China over the past decade,aiming to provide reference for clinical practice.Methods:The clinical and follow-up data of 161 rAAA patients treated at five major vascular surgery centers(50 from Drum Tower Hospital Affiliated to the Medical School,Nanjing University;19 from the First Affiliated Hospital of Anhui Medical University;33 from the Second Affiliated Hospital of Nanchang University;31 from Qilu Hospital,Shandong University;and 28 from the First Affiliated Hospital of the University of Science and Technology of China)were retrospectively analyzed.Results:Among the 161 patients,124(77.02%)were male and 37(22.98%)were female,with an average age of 68.27 years.The median age at diagnosis was 70 years for males and 71 years for females.The overall mean aneurysm diameter was 7.11 cm,with males at 7.72 cm and females at 6.82 cm,showing a statistically significant difference(P<0.05).The main comorbidities were hypertension and coronary artery disease.Over 80%of patients presented with abdominal pain as the initial symptom,while 15%presented with low back pain,and 8 patients sought medical attention for dizziness or visual disturbances.Among the 161 patients,86 underwent open surgical repair(OSR),and 75 received endovascular aneurysm repair(EVAR).The proportion of EVAR has increased annually,reaching nearly 70%in the past five years,and up to 90%in patients aged over 70 years:All OSR procedures were performed under general

关 键 词：主动脉瘤 腹 动脉瘤 破裂 多中心研究 

分 类 号：R654.3[医药卫生—外科学]