开放手术和血管腔内修复术治疗肾下型腹主动脉瘤的临床对照研究
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摘要
目的：总结传统开放手术(open surgery, OS)和血管腔内修复术(endovascular aneurysm repair, EVAR)治疗肾下型腹主动脉瘤(abdominal aortic aneurysm, AAA)的临床经验,进一步了解两种手术方法的手术适应症、手术指征及围手术期处理原则,为临床个体化治疗提供理论依据。
方法：回顾分析2003年1月至2012年1月期间47例行腹主动脉瘤切除并人工血管置换术和21例行血管腔内修复术的肾下型AAA患者病案资料和随访资料,统计手术时间、腹主动脉阻断时间、术中出血量、输血量、术后引流量、ICU停留时间、术后住院时间、住院总费用、围手术期及随访期间并发症和死亡情况等,总结不同手术方法围手术期合并症、术后并发症和手术中的处理方法。并使用统计学软件将上述结果进行对比分析。
结果：OS组与EVAR组术前首发症状以胃肠道不适的比例分别为44.7%(21例)和14.3%(3例),具有统计学差异,其他一般情况基本类似；两组手术时间、腹主动脉阻断时间、术中出血量、输血量、术后引流量、ICU停留时间、术后住院时间、住院总费用分别为(3.5+1.2)h和(2.1±0.75) h、(56.0±11.1) min和Omin、(270±60) ml和(60±30) ml、(100±40) ml和Oml、(125±60) ml和0ml、(55±12)h和(18±9) h、(14.8±3.5) d和(7.5±2.5) d、(5.4±1.5)万元和(14.4土1.6)万元,均具有统计学差异。两组围手术期重要脏器并发症发生率、死亡率分别为29.8%(14例)和28.6%(6例)、4.3%(2例)和4.8%(1例),无统计学差异；EVAR组远期并发症发生率较OS组明显升高,差异具有显著统计学意义(P<0.01),而两组随访生存率结果并无差异。
结论：传统OS治疗肾下型AAA短期并发症多,以胃肠道不适和肺炎为主,远期并发症少,无复发,疗效确切。而EVAR时间短,术中出血、输血少,术后恢复快,短期疗效好,但术后近、远期并发症发生率和术后生存率与OS无明显差异,费效比较OS低,目前尚无法取代传统OS。
Objective To summarize our clinical experience of traditional open surgery (OS) and endovascular aneurysm repair (EVAR) for infrarenal abdominal aortic aneurysm (AAA). Further understanding of the operative indications and perioperative period principles of the two surgery methods, and provide a theoretical basis for individual therapy.
Methods Retrospective analysis the clinical data and follow-up data of47cases underwent abdominal aortic aneurysm resection and artificial vascular replacement (OS group) and21cases received endovascular aneurysm repair (EVAR group) during January2003and January2012. Collect the information of operation time, aortic cross-clamp time, bleeding and blood transfusion volume, postoperative drainage volume, ICU residence time, postoperative hospital stay, the total cost of hospitalization and complications and death during perioperative and follow-up period. Summarize the treatment details during perioperative period of the different operation methods. The results were analyzed by statistical software.
Results The ratio of onset symptom as gastrointestinal discomfort were44.7%(OS group, n=21) and14.3%(EVAR group, n=3), with statistical difference. The two groups of operation time, aortic cross-clamp time, bleeding and blood transfusion volume, postoperative drainage volume, ICU residence time, postoperative hospital stay and the total cost of hospitalization were (3.5±1.2)h vs (2.1±0.75)h,(56.0±11.1) min vs Omin,(270±60)ml vs (60±30) ml,(100±40)ml vs0ml,(125±60)ml vs0ml,(55±12) h vs (18±9)h,(14.8±3.5)d vs (7.5±2.5)d and (54±15)thousand RMB vs (144±16) thousand RMB, respectively, with statistically differences. Two groups of perioperation period main complication rate and mortality rate were29.8%(OS group, n=14) and28.6%(EVAR group, n=6),4.3%(OS group, n=2) and4.8%(EVAR group, n=1), with no significant difference. There was significant difference of long-term complication rate between the two groups (P<0.01), while the two groups of follow-up survival results were similar.
Conclusion Traditional OS for infrarenal AAA has short-term complications mainly as gastrointestinal discomfort and pneumonia, few long-term complications and no recurrence. EVAR has the advantages as short operation time, low bleeding and blood transfusion volume, fast postoperative recovery, however, the postoperative heart failure risk EVER is higher than OS, with a lower cost-efficiency. EVAR may not be used as a general option in place of traditional OS.
方法：回顾分析2003年1月至2012年1月期间47例行腹主动脉瘤切除并人工血管置换术和21例行血管腔内修复术的肾下型AAA患者病案资料和随访资料,统计手术时间、腹主动脉阻断时间、术中出血量、输血量、术后引流量、ICU停留时间、术后住院时间、住院总费用、围手术期及随访期间并发症和死亡情况等,总结不同手术方法围手术期合并症、术后并发症和手术中的处理方法。并使用统计学软件将上述结果进行对比分析。
结果：OS组与EVAR组术前首发症状以胃肠道不适的比例分别为44.7%(21例)和14.3%(3例),具有统计学差异,其他一般情况基本类似；两组手术时间、腹主动脉阻断时间、术中出血量、输血量、术后引流量、ICU停留时间、术后住院时间、住院总费用分别为(3.5+1.2)h和(2.1±0.75) h、(56.0±11.1) min和Omin、(270±60) ml和(60±30) ml、(100±40) ml和Oml、(125±60) ml和0ml、(55±12)h和(18±9) h、(14.8±3.5) d和(7.5±2.5) d、(5.4±1.5)万元和(14.4土1.6)万元,均具有统计学差异。两组围手术期重要脏器并发症发生率、死亡率分别为29.8%(14例)和28.6%(6例)、4.3%(2例)和4.8%(1例),无统计学差异；EVAR组远期并发症发生率较OS组明显升高,差异具有显著统计学意义(P<0.01),而两组随访生存率结果并无差异。
结论：传统OS治疗肾下型AAA短期并发症多,以胃肠道不适和肺炎为主,远期并发症少,无复发,疗效确切。而EVAR时间短,术中出血、输血少,术后恢复快,短期疗效好,但术后近、远期并发症发生率和术后生存率与OS无明显差异,费效比较OS低,目前尚无法取代传统OS。
Objective To summarize our clinical experience of traditional open surgery (OS) and endovascular aneurysm repair (EVAR) for infrarenal abdominal aortic aneurysm (AAA). Further understanding of the operative indications and perioperative period principles of the two surgery methods, and provide a theoretical basis for individual therapy.
Methods Retrospective analysis the clinical data and follow-up data of47cases underwent abdominal aortic aneurysm resection and artificial vascular replacement (OS group) and21cases received endovascular aneurysm repair (EVAR group) during January2003and January2012. Collect the information of operation time, aortic cross-clamp time, bleeding and blood transfusion volume, postoperative drainage volume, ICU residence time, postoperative hospital stay, the total cost of hospitalization and complications and death during perioperative and follow-up period. Summarize the treatment details during perioperative period of the different operation methods. The results were analyzed by statistical software.
Results The ratio of onset symptom as gastrointestinal discomfort were44.7%(OS group, n=21) and14.3%(EVAR group, n=3), with statistical difference. The two groups of operation time, aortic cross-clamp time, bleeding and blood transfusion volume, postoperative drainage volume, ICU residence time, postoperative hospital stay and the total cost of hospitalization were (3.5±1.2)h vs (2.1±0.75)h,(56.0±11.1) min vs Omin,(270±60)ml vs (60±30) ml,(100±40)ml vs0ml,(125±60)ml vs0ml,(55±12) h vs (18±9)h,(14.8±3.5)d vs (7.5±2.5)d and (54±15)thousand RMB vs (144±16) thousand RMB, respectively, with statistically differences. Two groups of perioperation period main complication rate and mortality rate were29.8%(OS group, n=14) and28.6%(EVAR group, n=6),4.3%(OS group, n=2) and4.8%(EVAR group, n=1), with no significant difference. There was significant difference of long-term complication rate between the two groups (P<0.01), while the two groups of follow-up survival results were similar.
Conclusion Traditional OS for infrarenal AAA has short-term complications mainly as gastrointestinal discomfort and pneumonia, few long-term complications and no recurrence. EVAR has the advantages as short operation time, low bleeding and blood transfusion volume, fast postoperative recovery, however, the postoperative heart failure risk EVER is higher than OS, with a lower cost-efficiency. EVAR may not be used as a general option in place of traditional OS.
引文
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