破裂腹主动脉瘤腔内治疗与手术治疗效果比较

目的:比较破裂腹主动脉瘤（rAAA）腔内治疗（EVAR）与开放手术（OSR）的治疗情况。方法:回顾性分析分别采取开放手术或腔内治疗的rAAA患者临床资料。比较两组术前一般情况、围手术期死亡率及并发症发生率、术后死亡率、术后住院时间等。结果:rAAA患者共35例，其中男28例，女7例，年龄37～84岁，平均(68.37±10.04)岁。 OSR 23例、 EVAR 12例。 两组在年龄、性别、合并症及术前血流动力学稳定性方面无显著性差异（P＞0.05）。OSR组与EVAR组的死亡率依次为:手术期17.4%（4/23）、0（0/12）（P=0.275），术后30 d死亡率30.4%（7/23）、0（0/12）（P=0.070），术后6个月34.8%（8/23）、0.0%（0/12）（P=0.032），术后12个月45.0%（9/20）、0（0/8）（P=0.029）；两组术后住院天数中位数分别是:OSR 17.0 (IQR:14.0～27.0)，EVAR 11.0 (IQR:7.0～16.0) (P=0.024)。结论:腔内治疗可作为rAAA的一线治疗手段，但应根据解剖条件进行手术方式的选择 。单臂支架型血管（AUI）是控制rAAA出血的快速、有效方式。EVAR术后必需加强对腹腔间隔室综合征的观察与处理。

Comparing the effects of endovascular and open surgery repair of ruptured abdominal aortic aneurysm

Objective: To compare and analyze effects of endovascular repair (EVAR) and open surgery repair (OSR) in patients with ruptured abdominal aortic aneurysm(rAAA). Methods: Clinical data of patients with rAAA were analyzed retrospectively. Outcome parameters included mortality (intraoperation, 30 day, 6 month and 12 month), complications, reinterventions, and length of hospital stay. Results: Thirty-five consecutive patients with rAAAs were presented, 12 of whom underwent rEVAR, and 23 underwent OSR. Twenty-eight males and 7 females, age from 37 to 84 years with an mean of （68.37 ± 10.04）. At baseline, an equal distribution in age , gender , comorbidities and preoperative hemodynamic (P> 0.05). The intraoperation, 30 day, 6 month and 12 month mortalities were 0.0%(0 of 12), 0.0%(0 of 12), 0.0%(0 of 12),and 0.0%(0 of 8) after rEVAR， compared with 17.4% (4 of 23; P =0.275), 30.4% (7 of 23; P =0.070), 34.8% (8 of 23; P =0.032), and 45.0% (9 of 20; P =0.029) after OSR, respectively. Median length of hospital stay was 11.0 days (interquartile range, 7.0～16.0) after rEVAR and 17.0 days (interquartile range, 14.0～27.0) after OSR (P =0.024). Conclusion: These data suggest that EVAR can be a first-line treatment for rAAA. However, anatomical conditions should be considered with caution. Aortouniiliac is a fast and effective way to control bleeding. Further observation of abdominal compartment syndrome is essential for EVAR.