«上一篇/Previous Article|本期目录/Table of Contents|下一篇/Next Article»

《天津医科大学学报》[ISSN:1006-8147/CN:12-1259/R]

卷:

21卷

期数:

2015年04期

页码:

304-307

栏目:

临床医学

出版日期:

2015-07-15

文章信息/Info

Title:

Comparing the effects of endovascular and open surgery repair of ruptured abdominal aortic aneurysm

文章编号:

1006-8147（2015）04-0304-04

作者:

韩万里; 戴向晨; 罗宇东; 范海伦; 冯 舟; 朱杰昌; 张益伟

（天津医科大学总医院普通外科，天津 300052)

Author(s):

HAN Wan-li;  DAI Xiang-chen;  LUO Yu-dong;  FAN Hai-lun;  FENG Zhou;  ZHU Jie-chang;  ZHANG Yi-wei

（Department of General Surgery, General Hospital, Tianjin Medical University ，Tianjin 300052, China）

关键词:

破裂腹主动脉瘤; 开放手术; 腔内治疗; 腹室综合征

Keywords:

ruptured abdominal aortic aneurysm;  open surgery repair;  endovascular repair ;  abdominal compartment syndrome

分类号:

R654.3

DOI:

-

文献标志码:

A

摘要:

目的：比较破裂腹主动脉瘤（rAAA）腔内治疗（EVAR）与开放手术（OSR）的治疗情况。方法：回顾性分析分别采取开放手术或腔内治疗的rAAA患者临床资料。比较两组术前一般情况、围手术期死亡率及并发症发生率、术后死亡率、术后住院时间等。结果：rAAA患者共35例，其中男28例，女7例，年龄37～84岁，平均(68.37±10.04)岁。 OSR 23例、 EVAR 12例。 两组在年龄、性别、合并症及术前血流动力学稳定性方面无显著性差异（P＞0.05）。OSR组与EVAR组的死亡率依次为：手术期17.4%（4/23）、0（0/12）（P=0.275），术后30 d死亡率30.4%（7/23）、0（0/12）（P=0.070），术后6个月34.8%（8/23）、0.0%（0/12）（P=0.032），术后12个月45.0%（9/20）、0（0/8）（P=0.029）；两组术后住院天数中位数分别是：OSR 17.0 (IQR:14.0～27.0)，EVAR 11.0 (IQR:7.0～16.0) (P=0.024)。结论：腔内治疗可作为rAAA的一线治疗手段，但应根据解剖条件进行手术方式的选择 。单臂支架型血管（AUI）是控制rAAA出血的快速、有效方式。EVAR术后必需加强对腹腔间隔室综合征的观察与处理。

Abstract:

Objective: To compare and analyze effects of endovascular repair (EVAR) and open surgery repair (OSR) in patients with ruptured abdominal aortic aneurysm(rAAA). Methods: Clinical data of patients with rAAA were analyzed retrospectively. Outcome parameters included mortality (intraoperation, 30 day, 6 month and 12 month), complications, reinterventions, and length of hospital stay. Results: Thirty-five consecutive patients with rAAAs were presented, 12 of whom underwent rEVAR, and 23 underwent OSR. Twenty-eight males and 7 females, age from 37 to 84 years with an mean of （68.37 ± 10.04）. At baseline, an equal distribution in age , gender , comorbidities and preoperative hemodynamic (P> 0.05). The intraoperation, 30 day, 6 month and 12 month mortalities were 0.0%(0 of 12), 0.0%(0 of 12), 0.0%(0 of 12),and 0.0%(0 of 8) after rEVAR， compared with 17.4% (4 of 23; P =0.275), 30.4% (7 of 23; P =0.070), 34.8% (8 of 23; P =0.032), and 45.0% (9 of 20; P =0.029) after OSR, respectively. Median length of hospital stay was 11.0 days (interquartile range, 7.0～16.0) after rEVAR and 17.0 days (interquartile range, 14.0～27.0) after OSR (P =0.024). Conclusion: These data suggest that EVAR can be a first-line treatment for rAAA. However, anatomical conditions should be considered with caution. Aortouniiliac is a fast and effective way to control bleeding. Further observation of abdominal compartment syndrome is essential for EVAR.

参考文献/References:

[1]Reimerink J J , van der Laan M J , Koelemay M J , et al. Systematic review and meta-analysis of population-based mortality from ruptured abdominal aortic aneurysm[J]. Br J Surg,2013,100(11):1405

[2]Yusuf S W , Whitaker S C , Chuter T A , et al. Emergency endovascular repair of leaking aortic aneurysm[J]. Lancet,1994,344(8937):1645

[3]Edwards S T , Schermerhorn M L , O’malley A J , et al. Comparative effectiveness of endovascular versus open repair of ruptured abdominal aortic aneurysm in the Medicare population[J].J Vasc Surg, 2014,59(3):575

[4]Mehta M , Byrne J , Darling R C , et al. Endovascular repair of ruptured infrarenal abdominal aortic aneurysm is associated with lower 30-day mortality and better 5-year survival rates than open surgical repair[J]. J Vasc Surg,2013,57(2):368

[5]Reimerink J J , Hoornweg L L , Vahl A C , et al. Endovascular repair versus open repair of ruptured abdominal aortic aneurysms[J]. Ann Surg,2013,258(2):248

[6]Mukherjee D , Kfoury E , Schmidt K , et al. Improved results in the management of ruptured abdominal aortic aneurysm May not be on the basis of endovascular aneurysm repair alone[J]. Vascular, 2014,22(1):51

[7]Sarac T P , Bannazadeh M , Rowan A F , et al. Comparative predictors of mortality for endovascular and open repair of ruptured infrarenal abdominal aortic aneurysms[J]. Ann Vasc Surg,2011,25(4):461

[8]Azhar B , Patel S R , Holt P J , et al. Misdiagnosis of ruptured abdominal aortic aneurysm: systematic review and Meta-Analysis[J]. J Endovasc Ther,2014,21(4):568

[9]Philipsen T E , Hendriks J M , Lauwers P , et al. The use of rapid endovascular balloon occlusion in unstable patients with ruptured abdominal aortic aneurysm[J]. Innovations (Phila),2009,4(2):74

[10]Ten B J , Willigendael E M , van Sambeek M R , et al. EVAR suitability is not a predictor for early and midterm mortality after open ruptured AAA repair[J]. Eur J Vasc Endovasc Surg,2011,41(5):647

相似文献/References:

[1]杨芳 综述,詹江华 审校.胆道闭锁肝门肠吻合术式研究进展[J].天津医科大学学报,2020,26(06):587.
[2]孙 昊,戴向晨,罗宇东,等.破裂腹主动脉瘤腔内修复与开放手术效果的比较[J].天津医科大学学报,2018,24(04):328.
　SUN Hao,DAI Xiang-chen,LUO Yu-dong,et al.Comparison of effect between open surgical and endovascular repair on ruptured abdominal aortic aneurysm[J].Journal of Tianjin Medical University,2018,24(04):328.

备注/Memo

备注/Memo:

作者简介 韩万里（1987-），男，硕士在读，研究方向：普外血管外科；通信作者：戴向晨，E-mail: 13302165917@163.com。

常用功能

更新日期/Last Update: 2015-07-16