腹主动脉瘤开放手术与腔内修复术中期结果比较的单中心前瞻性研究

目的 比较腹主动脉瘤开放手术与腔内修复的治疗效果.方法 2009年1月到2011年1月随机入组既符合开放手术又符合腔内修复指征的腹主动脉瘤患者84例,分别行开放手术及腔内修复.其中腔内修复组48例,男性42例(87.5％),女性6例(12.5％);年龄50～83岁,平均70.8岁.开放手术组36例,其中男性31例(86.1％),女性5例(13.9％);年龄50～80岁,平均67.4岁.对围手术期及随访结果进行对比分析.结果 两组手术时间(t=9.863,P=0.000)、术中出血量(t=4.647,P=0.000)、术中输血量(t=3.334,P=0.002)和住院时间(t=2.327,P=0.022)、住院费用(t =2.314,P=0.023)差异有统计学意义.随访3～6个月,两组围手术期并发症发生率(x2=0.480,P=0.488)、术后3个月并发症发生率(x2=0.664,P=0.415)及病死率(P=0.429)、术后6个月并发症发生率(x2 =0.128,P=0.720)差异无统计学意义.结论 腹主动脉瘤腔内修复在手术时间、出血量、输血量、住院时间等方面优于开放手术,但有较高的住院费用.围手术期及术后随访两组的并发症发生率无差异,生存率及远期并发症发生率比较尚需更长时间随访及更大的样本量.

Comparison of open and endovascular repair for abdominal aortic aneurysmmid-term outcomes: a single center randomized controlled trial

Objective To compare the effects of open and endovascular repair for abdominal aortic aneurysm. Methods Between January 2009 and January 2011, 84 patients were randomized to endovascular aneurysm repair (EVAR) or open repair.There were 48 patients in EVAR group,42 cases were male (87.5％ ),6 cases were female ( 12.5％ ),aged from 50 to 83 years with a mean of 70.8 years.There were 36 patients in open repair group,31 cases were male (86.1％ ),5 cases were female ( 13.9％ ),aged from 50 to 80 years with a meal of 67.4 years.The results of perioperative period and follow-up were analyzed.Results Between the two groups,there was significant difference on operative time (t =9.863,P =0.000),blood loss ( t =4.647,P =0.000 ),blood transfusion ( t =3.334,P =0.002),hospital stay (t =2.327,P=0.022),and medical expense (t =2.314,P =0.023).There was no significant difference for perioperative complications (x2 =0.480,P =0.488 ).There was no significant difference for complications ( x2 =0.664,P =0.415 ) and mortality ( P =0.429) during 3 months follow-up.There was no significant difference for complications during 6 months follow-up ( x2 =0.128,P =0.720).Conclusions Operative time,blood loss and transfusion,hospital stay in EVAR group are less than which in open repair group,the medical expense of EVAR was higher than open repair.There is no significant difference for complications during 6 months follow-up between 2 groups.Long-term follow-up and more patents are needed to analyze survival rate and long-term complications.