破裂性腹主动脉瘤腔内修复术后并发症的相关危险因素研究

摘要

Objective To analyze risk factors of postoperative complications of endovascular aortic repair (EVAR) for ruptured abdominal aortic aneurysm (rAAA).Methods Twenty-five patients with rAAA who had EVAR from November 2012 to October 2016 in Beijing Anzhen Hospital,Capital Medical University were retrospectively enrolled;11 patients had complications after operation (11 cases);14 patients had no complication after operation (14 cases).Age,systolic blood pressure,hemoglobin level,angle and length of proximal aneurysmal neck,occurrences of intraoperative endoleak and postoperative complications were analyzed.Results The angle of proximal aneurysmal neck in complication group was significantly larger than that in non-complication group[(66 ± 19) ° vs (47 ±24) °] (U =99.000,P =0.036).Age,systolic blood pressure,hemoglobin level,length of proximal aneurysmal neck and incidence of intraoperative endoleak had no significant differences between groups [(66 ± 8) years vs (70 ±13)years,(108 ±33)mmHg vs (122 ±30)mmHg,(81 ±23)g/L vs (98 ±32)g/L,(18 ±7)mm vs (26 ± 12)mm,45.5％ (5/11) vs 57.1％ (8/14)] (P ＞0.05).Three patients(12.0％) died of hemorrhagic shock within 30 d after operation.The postoperative complication rate was 44.0％ (11/25),there were 4 cases of interventional complications(2 cases of type Ⅱ endoleak,1 case of femoral artery embolism,1 case of arteriovenous fistula at left brachial artery puncture site) and 7 cases of systemic complications (1 case of cardiac shock,2 cases of pulmonary infection,1 case of gastrointestinal dysfunction,1 case of multiple organ dysfunction syndrome,1 case of abdominal compartment syndrome,1 case of acute pancreatitis complicated with deep venous thrombosis).Conclusions The angle of proximal aneurysmal neck is a related factor of postoperative complications after EVAR for rAAA.%目的 研究影响破裂性腹主动脉瘤腔内修复术后并发症的危险因素.方法 回顾性分析2012年11月至2016年10月在首都医科大学附属北京安贞医院接受腔内修复术治疗的25例破裂性腹主动脉瘤患者的临床资料,根据术后主要并发症情况,将入组病例分为并发症组(11例)和无并发症组(14例).比较2组患者年龄、就诊时收缩压、血红蛋白、近端瘤颈成角、近端瘤颈长度以及术中内漏情况的差异,观察患者术后主要并发症发生情况.结果 并发症组近端瘤颈成角明显大于无并发症组[(66±19)°比(47 ±24)°],差异有统计学意义(U=99.000,P=0.036).并发症组与无并发症组患者年龄、就诊时收缩压、血红蛋白水平、近端瘤颈长度及术中内漏比例差异均无统计学意义[(66±8)岁比(70±13)岁、(108±33) mmHg(1 mmHg=0.133 kPa)比(122±30) mmHg、(81±23) g/L比(98±32) g/L、(18 ±7)mm比(26±12)mm、45.5％(5/11)比57.1％(8/14)](均P＞0.05).25例患者术后30 d内病死3例(12.0％),均死于术后失血性休克;术后并发症发生率为44.0％(11/25).结论 近端瘤颈成角可能与破裂性腹主动脉瘤腔内修复术后主要并发症相关,术前充分评估瘤颈解剖形态可能有助于减少术后并发症.