低风险肾下腹主动脉瘤腔内治疗与开腹手术临床分析

摘要

目的:比较低风险肾下腹主动脉瘤腔内治疗与开腹手术的治疗效果.方法:回顾性分析42例低风险肾下腹主动脉瘤手术的临床资料.比较腔内治疗组(17例)与开腹手术组(25例)患者手术情况、并发症及治疗费用.结果:腔内治疗组患者在手术时间、ICU时间、术后住院时间、术中出血量上均优于开腹手术组患者(P＞0.05),差异具有统计学意义.腔内治疗组患者在30 d围手术期死亡率及手术相关并发症上均少于开腹手术组患者,但差异无统计学意义(P＞0.05).住院费用、1年内门诊随诊费用腔内治疗组明显高于开腹手术组(P＜0.05),差异具有统计学意义.结论:对低风险肾下腹主动脉瘤患者,腔内治疗具备微创和术后恢复快的优势,但在降低围手术期的死亡率和并发症发生率上没有明显优势且治疗费用昂贵.结合中国国情,建议对于低风险肾下腹主动脉瘤患者采用传统开腹手术方式进行治疗.%Objective: To investigate the therapeutic effect of endovascular repair (EVAR) and open surgical repair (OSR) in patients with low risk infrarenal abdominal aortic aneurysm (AAA). Methods: Retrospective case analysis was made on 42 cases of low risk infrarenal AAA patients underwent wither EVAR or OSR. Therapeutic effect, complication, and cost of treatment were compared between EVAR (n=17) and OSR(n=25). Results: Compared to OSR group, operation time, length of stay in ICU, postoperation hospital stay and intraoperative blood loss significantly decreased(P＜0.05) in EVAR group. EVAR had lower perioperative mortality rate and less complications compared to OSR, but there were no significant difference (P＞0.05). Cost from hospitalizaiion up to 1 year follow up after EVAR were significantly higher than OSR(P＞0.05). Conclusion: EVAR is a safe and minimally invasive operation that gave rise to faster postoperative recovery in low risk infrarenal AAA patients. However, EVAR shows no advantage in lowering the perioperative mortality rate and complications. Therefore in combination with economy situation in China, OSR should be suggested as the first choice of treatment in low risk infrarenal AAA patients.