腹主动脉瘤覆膜支架腔内修复术和开放手术患者术后生活质量比较
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摘要
目的比较腹主动脉瘤(abdominal aortic aneurysm,AAA)覆膜支架腔内修复术与开放手术患者术后生活质量,以指导临床医生制订合理的治疗方案。方法选取2010年1月至2015年12月本院收治的156例AAA患者为研究对象,按照治疗方式不同将其分为腔内治疗组(覆膜支架腔内修复治疗,99例)和开放组(开放手术治疗,57例),采用世界卫生组织生存质量测定量表简表(World Health Organization Quality of Life-BREF,WHOQOL-BREF)评价两组患者术后生活质量,并比较手术相关指标及不良事件发生情况。结果开放组患者术中出血量和输血量均明显多于腔内治疗组(P_均<0.05),手术时间明显长于腔内治疗组(P <0.05)。两组患者住院天数、死亡率及主要不良事件发生率比较均无显著差异(P_均> 0.05)。腔内治疗组患者术后WHOQOL-BREF生理领域和社会关系领域评分均显著低于开放组(P_均<0.05),其中,腔内治疗组患者日常生活能力评分和朋友支持评分均显著低于开放组(P_均<0.05)。结论 AAA患者行开放手术治疗后,其在生理领域和社会关系领域的生存质量均优于腔内治疗。
Objective To compare the quality of life of patients with abdominal aortic aneurysm treated by endovascular abdominal aortic aneurysm repair versus traditional open surgery, so as to guide clinicians to formulate reasonable treatment plans. Method A total of 156 patients with AAA treated in our hospital from January 2010 to December 2015 were selected as subjects. According to the different treatment methods, they were divided into endovascular treatment group(endovascular aortic aneurysm repair, 99 cases) and open group(open surgery, 57 cases). The World Health Organization Quality of Life-BREF(WHOQOL-BREF) was used to determine the postoperative quality of life of the two groups. The related indexes of operation and the occurrence of adverse events were compared between the two groups. Result The amount of intraoperative bleeding and blood transfusion in open group were signi?cantly more than those in endovascular treatment group(P_(all)< 0.05), and the operation time in open group was signi?cantly longer than that in endovascular treatment group(P < 0.05). There were no signi?cant differences in the days of hospitalization, mortality and the incidence of major adverse events between the two groups(P_(all)> 0.05). The scores of WHOQOL-BREF physiological domain and social relationship domain in endovascular treatment group after surgery were signi?cantly lower than those in open group(P_(all)< 0.05).The scores of activities of daily living and friend support in the endovascular treatment group were signi?cantly lower than those in open group(P_(all)< 0.05). Conclusion After open surgery, the quality of life of AAA patients in the ?eld of physiology and social relations is better than that of endovascular therapy.
Objective To compare the quality of life of patients with abdominal aortic aneurysm treated by endovascular abdominal aortic aneurysm repair versus traditional open surgery, so as to guide clinicians to formulate reasonable treatment plans. Method A total of 156 patients with AAA treated in our hospital from January 2010 to December 2015 were selected as subjects. According to the different treatment methods, they were divided into endovascular treatment group(endovascular aortic aneurysm repair, 99 cases) and open group(open surgery, 57 cases). The World Health Organization Quality of Life-BREF(WHOQOL-BREF) was used to determine the postoperative quality of life of the two groups. The related indexes of operation and the occurrence of adverse events were compared between the two groups. Result The amount of intraoperative bleeding and blood transfusion in open group were signi?cantly more than those in endovascular treatment group(P_(all)< 0.05), and the operation time in open group was signi?cantly longer than that in endovascular treatment group(P < 0.05). There were no signi?cant differences in the days of hospitalization, mortality and the incidence of major adverse events between the two groups(P_(all)> 0.05). The scores of WHOQOL-BREF physiological domain and social relationship domain in endovascular treatment group after surgery were signi?cantly lower than those in open group(P_(all)< 0.05).The scores of activities of daily living and friend support in the endovascular treatment group were signi?cantly lower than those in open group(P_(all)< 0.05). Conclusion After open surgery, the quality of life of AAA patients in the ?eld of physiology and social relations is better than that of endovascular therapy.
引文
[1]Dangas G,O'Connor D,Firwana B,et al.Open versus endovascular stent graft repair of abdominal aortic aneurysms:a meta-analysis of randomized trials[J].JACC Cardiovasc Interv,2012,5(10):1071-1080.
[2]都元涛,方积乾.世界卫生组织生存质量测定量表中文版介绍及其使用说明[J].中国组织工程研究,2000,4(8):1127-1129.
[3][No authors listed].Development of the World Health Organ ization WHOQOL-BREF quality of life assessment.The WHOQOLGroup[J].Psychol Med,1998,28(3):551-558.
[4]Greenhalgh RM,Brown LC,Powell JT,et al.Endovascular versus open repair of abdominal aortic aneurysm[J].N Engl JMed,2010,362(20):1863-1871.
[5]Stroupe KT,Lederle FA,Matsumura JS,et al.Cost-effectiveness of open versus endovascular repair of abdominal aortic aneurysm in the OVER trial[J].J Vasc Surg,2012,56(4):901-909.e2.
[6]Hinterseher I,Kuffner H,Berth H,et al.Long-term quality of life of abdominal aortic aneurysm patients under surveillance or after operative treatment[J].Ann Vasc Surg,2013,27(5):553-561.
[7]Peach G,Holt P,Loftus I,et al.Questions remain about quality of life after abdominal aortic aneurysm repair[J].J Vasc Surg,2012,56(2):520-527.
[8]Khashram M,Jones GT,Roake JA.Prevalence of abdominal aortic aneurysm(AAA)in a population undergoing computed tomography colonography in Canterbury,New Zealand[J].Eur J Vasc Endovasc Surg,2015,50(2):199-205.
[9]Palombo D,Lucertini G,Pane B,et al.District-based abdominal aortic aneurysm screening in population aged 65 years and older[J].J Cardiovasc Surg(Torino),2010,51(6):777-782.
[10]Ten Bosch JA,Teijink JA,Willigendael EM,et al.Endovascular aneurysm repair is superior to open surgery for ruptured abdominal aortic aneurysms in EVAR-suitable patients[J].JVasc Surg,2010,52(1):13-18.
[11]Lederle FA,Freischlag JA,Kyriakides TC,et al.Long-term comparison of endovascular and open repair of abdominal aortic aneurysm[J].N Engl J Med,2012,367(21):1988-1997.
[12]Soulez G,Therasse E,Monfared AA,et al.Pain and quality of life assessment after endovascular versus open repair of abdominal aortic aneurysms in patients at low risk[J].J Vasc Interv Radiol,2005,16(8):1093-1100.
[13]Aljabri B,Al WK,Abner D,et al.Patient-reported quality of life after abdominal aortic aneurysm surgery:a prospective comparison of endovascular and open repair[J].J Vasc Surg,2006,44(6):1182-1187.
[14]Kolh P.Quality of life after abdominal aortic aneurysm repair:similar long-term results with endovascular and open techniques[J].Eur J Vasc Endovasc Surg,2008,36(3):290-291.
[15]Keisler B,Carter C.Abdominal aortic aneurysm[J].Am Fam Physician,2015,91(8):538-543.
[16]Peach G,Holt P,Loftus I,et al.Questions remain about quality of life after abdominal aortic aneurysm repair[J].J Vasc Surg,2012,56(2):520-527.
[17]Kayssi A,DeBord SA,Roche-Nagle G,et al.Health-related quality-of-life outcomes after open versus endovascular abdominal aortic aneurysm repair[J].J Vasc Surg,2015,62(2):491-498.
[2]都元涛,方积乾.世界卫生组织生存质量测定量表中文版介绍及其使用说明[J].中国组织工程研究,2000,4(8):1127-1129.
[3][No authors listed].Development of the World Health Organ ization WHOQOL-BREF quality of life assessment.The WHOQOLGroup[J].Psychol Med,1998,28(3):551-558.
[4]Greenhalgh RM,Brown LC,Powell JT,et al.Endovascular versus open repair of abdominal aortic aneurysm[J].N Engl JMed,2010,362(20):1863-1871.
[5]Stroupe KT,Lederle FA,Matsumura JS,et al.Cost-effectiveness of open versus endovascular repair of abdominal aortic aneurysm in the OVER trial[J].J Vasc Surg,2012,56(4):901-909.e2.
[6]Hinterseher I,Kuffner H,Berth H,et al.Long-term quality of life of abdominal aortic aneurysm patients under surveillance or after operative treatment[J].Ann Vasc Surg,2013,27(5):553-561.
[7]Peach G,Holt P,Loftus I,et al.Questions remain about quality of life after abdominal aortic aneurysm repair[J].J Vasc Surg,2012,56(2):520-527.
[8]Khashram M,Jones GT,Roake JA.Prevalence of abdominal aortic aneurysm(AAA)in a population undergoing computed tomography colonography in Canterbury,New Zealand[J].Eur J Vasc Endovasc Surg,2015,50(2):199-205.
[9]Palombo D,Lucertini G,Pane B,et al.District-based abdominal aortic aneurysm screening in population aged 65 years and older[J].J Cardiovasc Surg(Torino),2010,51(6):777-782.
[10]Ten Bosch JA,Teijink JA,Willigendael EM,et al.Endovascular aneurysm repair is superior to open surgery for ruptured abdominal aortic aneurysms in EVAR-suitable patients[J].JVasc Surg,2010,52(1):13-18.
[11]Lederle FA,Freischlag JA,Kyriakides TC,et al.Long-term comparison of endovascular and open repair of abdominal aortic aneurysm[J].N Engl J Med,2012,367(21):1988-1997.
[12]Soulez G,Therasse E,Monfared AA,et al.Pain and quality of life assessment after endovascular versus open repair of abdominal aortic aneurysms in patients at low risk[J].J Vasc Interv Radiol,2005,16(8):1093-1100.
[13]Aljabri B,Al WK,Abner D,et al.Patient-reported quality of life after abdominal aortic aneurysm surgery:a prospective comparison of endovascular and open repair[J].J Vasc Surg,2006,44(6):1182-1187.
[14]Kolh P.Quality of life after abdominal aortic aneurysm repair:similar long-term results with endovascular and open techniques[J].Eur J Vasc Endovasc Surg,2008,36(3):290-291.
[15]Keisler B,Carter C.Abdominal aortic aneurysm[J].Am Fam Physician,2015,91(8):538-543.
[16]Peach G,Holt P,Loftus I,et al.Questions remain about quality of life after abdominal aortic aneurysm repair[J].J Vasc Surg,2012,56(2):520-527.
[17]Kayssi A,DeBord SA,Roche-Nagle G,et al.Health-related quality-of-life outcomes after open versus endovascular abdominal aortic aneurysm repair[J].J Vasc Surg,2015,62(2):491-498.