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一医院收治的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30 d、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(x)±s表示,采用t检验.计数资料比较采用x2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、(179 018 ±65 796)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、(77 853±21 164)元,两组比较,差异有统计学意义(t=-32.464,-51.719,-294.350,-11.833,-10.957,2 778.748,P＜0.05).腔内修复组患者术后30 d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、腹膜后血肿、手术切口不愈合、MODS死亡、严重心功能不足死亡分别为0、0、2、5、0、0、2、2、11、0、2、0、2例,开腹手术组患者分别为2、2、3、10、1、2、0、3、11、2、0、1、1例,两组比较,差异无统计学意义(P＞0.05).腔内修复组患者术后心衰和Ⅰ型内漏分别为0例和8例,开腹手术组分别为4例和0例,两组比较,差异有统计学意义(P＜0.05).229例患者术后获得了随访,失访42例(腔内修复组29例,开腹手术组13例),随访时间为1～132个月.术后近期随访结果显示:腔内修复组患者发生肺炎、肠梗阻、脑血栓、下肢血栓形成、活动后下肢疼痛、下肢感觉异常、会阴感觉异常、感染、Ⅰ型内漏、支架弯曲脱落、吻合口动脉瘤形成、MODS死亡、间断腹泻例数腔内修复组分别为0、0、0、2、8、11、1、2、2、1、0、2、0例,开腹手术组分别为2、1、2、4、2、7、1、2、0、0、2、1、3例,两组比较,差异无统计学意义(P＞0.05).腔内修复组患者术后无胸痛、腹胀发生,开腹手术组各为4例,两组比较,差异有统计学意义(P＜0.05).术后中远期随访结果显示:腔内修复组患者发生感染、支架脱落、MODS死亡、下肢活动后疼痛、感染性休克死亡、动脉瘤破裂死亡、心脏病死亡例数分别为0、1、1、3、2、1、2例;开腹手术组分别为2、0、0、1、2、0、0例,两组比较,差异无统计学意义(P＞0.05).腔内修复组患者术后3、5、10年的生存率分别为94.35％、89.52％、60.48％,开腹手术组分别为93.33％、91.42％、69.52％,两组比较,差异均无统计学意义(x2=0.103,0.239,2.033,P＞0.05).结论 腔内修复治疗腹主动脉瘤在围术期疗效中有微创优势;腔内修复与开腹手术术后并发症发生率和远期生存率相当;两种手术方式均是治疗腹主动脉瘤的有效方法.
目的 分析腹主動脈瘤腔內脩複與開腹手術治療的臨床療效.方法 迴顧性分析2004年1月至2014年12月中國醫科大學附屬第一醫院收治的271例行手術治療的腹主動脈瘤患者的臨床資料.153例患者行腔內脩複治療設為腔內脩複組,118例患者行開腹手術治療設為開腹手術組.患者術前先行超聲檢查初篩;三維計算機斷層攝影血管造影檢查明確診斷;病情急重者行腹部增彊CT檢查明確診斷.腔內脩複治療方法:經股動脈切口進入腹主動脈,選擇分支覆膜支架行腔內脩複治療.開腹手術治療方法:取腹正中切口,切開腹主動脈瘤,清理內側附壁血栓及硬化斑塊,取Y型人工血管行腹主動脈耑耑吻閤及髂動脈耑側吻閤.採用電話方式隨訪,隨訪時間截至2014年12月31日.觀察患者手術情況、術後30 d、術後近期(術後3箇月至術後3年)併髮癥、中遠期(術後＞3年)併髮癥、患者死亡情況、生存率.符閤正態分佈的計量資料以(x)±s錶示,採用t檢驗.計數資料比較採用x2和Fisher確切概率法檢驗.採用Kaplan-Meier法繪製生存麯線,Log-rank檢驗進行生存分析.結果 271例患者術前均行三維計算機斷層攝影血管造影檢查明確診斷.腔內脩複組患者手術時間、術中齣血量、術中輸血量、術後離床活動時間、術後住院時間和治療費用分彆為(179 ±64) min、(79 ±36) mL、0、(5.7 ±3.1)d、(12 ±6)d、(179 018 ±65 796)元,開腹手術組患者分彆為(205 ±40) min、(402±297) mL、(410±367) mL、(8.3±2.1)d、(18±11)d、(77 853±21 164)元,兩組比較,差異有統計學意義(t=-32.464,-51.719,-294.350,-11.833,-10.957,2 778.748,P＜0.05).腔內脩複組患者術後30 d併髮癥:低氧血癥、心肌缺血、心律失常、腹瀉、陰莖陰囊壓迫性水腫、輸尿管結石、急性尿潴留、血栓形成、感染、腹膜後血腫、手術切口不愈閤、MODS死亡、嚴重心功能不足死亡分彆為0、0、2、5、0、0、2、2、11、0、2、0、2例,開腹手術組患者分彆為2、2、3、10、1、2、0、3、11、2、0、1、1例,兩組比較,差異無統計學意義(P＞0.05).腔內脩複組患者術後心衰和Ⅰ型內漏分彆為0例和8例,開腹手術組分彆為4例和0例,兩組比較,差異有統計學意義(P＜0.05).229例患者術後穫得瞭隨訪,失訪42例(腔內脩複組29例,開腹手術組13例),隨訪時間為1～132箇月.術後近期隨訪結果顯示:腔內脩複組患者髮生肺炎、腸梗阻、腦血栓、下肢血栓形成、活動後下肢疼痛、下肢感覺異常、會陰感覺異常、感染、Ⅰ型內漏、支架彎麯脫落、吻閤口動脈瘤形成、MODS死亡、間斷腹瀉例數腔內脩複組分彆為0、0、0、2、8、11、1、2、2、1、0、2、0例,開腹手術組分彆為2、1、2、4、2、7、1、2、0、0、2、1、3例,兩組比較,差異無統計學意義(P＞0.05).腔內脩複組患者術後無胸痛、腹脹髮生,開腹手術組各為4例,兩組比較,差異有統計學意義(P＜0.05).術後中遠期隨訪結果顯示:腔內脩複組患者髮生感染、支架脫落、MODS死亡、下肢活動後疼痛、感染性休剋死亡、動脈瘤破裂死亡、心髒病死亡例數分彆為0、1、1、3、2、1、2例;開腹手術組分彆為2、0、0、1、2、0、0例,兩組比較,差異無統計學意義(P＞0.05).腔內脩複組患者術後3、5、10年的生存率分彆為94.35％、89.52％、60.48％,開腹手術組分彆為93.33％、91.42％、69.52％,兩組比較,差異均無統計學意義(x2=0.103,0.239,2.033,P＞0.05).結論 腔內脩複治療腹主動脈瘤在圍術期療效中有微創優勢;腔內脩複與開腹手術術後併髮癥髮生率和遠期生存率相噹;兩種手術方式均是治療腹主動脈瘤的有效方法.
목적 분석복주동맥류강내수복여개복수술치료적림상료효.방법 회고성분석2004년1월지2014년12월중국의과대학부속제일의원수치적271례행수술치료적복주동맥류환자적림상자료.153례환자행강내수복치료설위강내수복조,118례환자행개복수술치료설위개복수술조.환자술전선행초성검사초사;삼유계산궤단층섭영혈관조영검사명학진단;병정급중자행복부증강CT검사명학진단.강내수복치료방법:경고동맥절구진입복주동맥,선택분지복막지가행강내수복치료.개복수술치료방법:취복정중절구,절개복주동맥류,청리내측부벽혈전급경화반괴,취Y형인공혈관행복주동맥단단문합급가동맥단측문합.채용전화방식수방,수방시간절지2014년12월31일.관찰환자수술정황、술후30 d、술후근기(술후3개월지술후3년)병발증、중원기(술후＞3년)병발증、환자사망정황、생존솔.부합정태분포적계량자료이(x)±s표시,채용t검험.계수자료비교채용x2화Fisher학절개솔법검험.채용Kaplan-Meier법회제생존곡선,Log-rank검험진행생존분석.결과 271례환자술전균행삼유계산궤단층섭영혈관조영검사명학진단.강내수복조환자수술시간、술중출혈량、술중수혈량、술후리상활동시간、술후주원시간화치료비용분별위(179 ±64) min、(79 ±36) mL、0、(5.7 ±3.1)d、(12 ±6)d、(179 018 ±65 796)원,개복수술조환자분별위(205 ±40) min、(402±297) mL、(410±367) mL、(8.3±2.1)d、(18±11)d、(77 853±21 164)원,량조비교,차이유통계학의의(t=-32.464,-51.719,-294.350,-11.833,-10.957,2 778.748,P＜0.05).강내수복조환자술후30 d병발증:저양혈증、심기결혈、심률실상、복사、음경음낭압박성수종、수뇨관결석、급성뇨저류、혈전형성、감염、복막후혈종、수술절구불유합、MODS사망、엄중심공능불족사망분별위0、0、2、5、0、0、2、2、11、0、2、0、2례,개복수술조환자분별위2、2、3、10、1、2、0、3、11、2、0、1、1례,량조비교,차이무통계학의의(P＞0.05).강내수복조환자술후심쇠화Ⅰ형내루분별위0례화8례,개복수술조분별위4례화0례,량조비교,차이유통계학의의(P＜0.05).229례환자술후획득료수방,실방42례(강내수복조29례,개복수술조13례),수방시간위1～132개월.술후근기수방결과현시:강내수복조환자발생폐염、장경조、뇌혈전、하지혈전형성、활동후하지동통、하지감각이상、회음감각이상、감염、Ⅰ형내루、지가만곡탈락、문합구동맥류형성、MODS사망、간단복사례수강내수복조분별위0、0、0、2、8、11、1、2、2、1、0、2、0례,개복수술조분별위2、1、2、4、2、7、1、2、0、0、2、1、3례,량조비교,차이무통계학의의(P＞0.05).강내수복조환자술후무흉통、복창발생,개복수술조각위4례,량조비교,차이유통계학의의(P＜0.05).술후중원기수방결과현시:강내수복조환자발생감염、지가탈락、MODS사망、하지활동후동통、감염성휴극사망、동맥류파렬사망、심장병사망례수분별위0、1、1、3、2、1、2례;개복수술조분별위2、0、0、1、2、0、0례,량조비교,차이무통계학의의(P＞0.05).강내수복조환자술후3、5、10년적생존솔분별위94.35％、89.52％、60.48％,개복수술조분별위93.33％、91.42％、69.52％,량조비교,차이균무통계학의의(x2=0.103,0.239,2.033,P＞0.05).결론 강내수복치료복주동맥류재위술기료효중유미창우세;강내수복여개복수술술후병발증발생솔화원기생존솔상당;량충수술방식균시치료복주동맥류적유효방법.
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 ultrasonography 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 abdoninal 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 of hospital stay and hospital expenses were (179 ± 64) minutes,(79 ± 36) mL,0,(5.7 ± 3.1) days,(12 ± 6) days,(179 018 ± 65 796) yuan in the EVAR group and (205 ± 40) minutes,(402 ± 297) mL,(410 ± 367) mL,(8.3 ± 2.1) days,(18 ± 11) days,(77 853 ±21 164) yuan in the OSR group,with significant differences between the 2 groups (t =-32.464,-51.719,-294.350,-11.833,-10.957,2 778.748,P ＜ 0.05).The number of patients complicated with postoperative hypoxemia,myocardial ischemia,arrhythmia,diarrhea,penial and scrotal oppressive edema,ureteral calculus,acute urinary retention,thrombosis,infection,retroperitoneal hematoma,unhealed incision,death from multiple organ dysfunction syndrome (MODS) and death from severe cardiac insufficiency were 0,0,2,5,0,0,2,2,11,0,2,0 and 2 in the EVAR group and 2,2,3,10,1,2,0,3,11,2,0,1 and 1 in the OSR group,with no significant difference between the 2 groups (P ＞ 0.05).The number of patients complicated with postoperative heart failure and Ⅰ-shaped inner leakage were 0 and 8 in the EVAR group and 4 and 0 in the OSR group,with a significant difference between the 2 groups (P ＜ 0.05).Of the 271 patients,229 were followed up for 1-132 months and 42 lost to follow-up (29 in the EVAR group and 13 in the OSR group).The results of postoperative short-term follow-up:the number of patients complicated with pneumonia,intestinal obstruction,cerebral thrombus,thrombosis of lower extremities,post-activity lower extremities pain,lower extremities paresthesia,perineal paresthesia,infection,Ⅰ-shaped inner leakage,bending and stripped stents,anastomotic aneurism,death from MODS and intermittent diarrhea were 0,0,0,2,8,11,1,2,2,1,0,2 and 0 in the EVAR group and 2,1,2,4,2,7,1,2,0,0,2,1 and 3 in the OSR group,with no significant difference between the 2 groups (P ＞ 0.05).The number of patients complicated with chest pain and abdominal distension were 0 and 0 in the EVAR group and 4 and 4 in the OSR group,with a significant difference between the 2 groups (P ＜ 0.05).The results of postoperative medium-and long-term follow-up:the number of patients complicated with infection,stripped stents,death from MODS,post-activity lower extremities pain,death from infectious shock,death from ruptured aneurysm and death from heart disease were 0,1,1,3,2,1 and 2 in the EVAR group and 2,0,0,1,2,0 and 0 in the OSR group,with no significant difference between the 2 groups (P＞0.05).The 3-,5-,10-year survival rates in the EVAR group and in the OSR group were 94.35％,89.52％,60.48％ and 93.33％,91.42％,69.52％,respectively,showing no significant difference between the 2 groups (x2 =0.103,0.239,2.033,P ＞ 0.05).Conclusion EVAR has an advantage of micro-invasion in perioperative management,and both of EVAR and OSR are effective for the treatment of AAA with equivalent incidence of complications and long-term survival rate.
