腹主动脉瘤血管腔内治疗和开放手术治疗疗效比较

目的比较腹主动脉瘤血管腔内治疗和开放手术治疗的治疗效果。方法总结我科自2001年1月1日至2008年12月31日所有腹主动脉瘤的患者，排除血液动力学不稳定急诊手术2例和未手术死亡或自动出院的8例，总共30例，其中2001年1月1日至2008年12月31日开放手术患者22例，2006年1月1日至2008年12月31日腔内治疗患者8例。通过手术过程中死亡率，30d死亡率、并发症和一年随访中的死亡率、并发症的结果进行总体评价。本项研究经t检验和Χ^2检验统计方法进行检验。结果腔内组30d死亡1例（12．5％）（P=0．440），术中出血量和输血量明显少于手术组（P〈0．001、P〈0．001），术后平均禁食时间均较手术组明显缩短（P〈0．01）。术后并发症发生率低于手术组，一年随访中死亡1例（死亡于非血管原因），无内漏和移位等并发症发生。手术组30天死亡2例，术后并发症发生率高于腔内组，一年随访无死亡，无明显并发症发生。结论在高选择人群研究基础上得出腹主动脉瘤血管腔内治疗具有安全、微创的特点，近期疗效较传统开放手术好的优势。

Endovascular repair versus open surgery in patients with abdominal aortic aneurysms

Aim To compare endovascular repair and open surgery in patients with abdominal aortic aneurysms （AAAs）. Methods All consecutive conscious patien ts with ruptured AAAs who presented to our care teaching hospital between January 1,2001, and December 31,2008, were included in this study （n = 30）. 8 patients underwent endovascular repair between January 1,2006, and December 31, 2008 ,and 22 patients underwent open surgery between January 1,2001 ,and December 31,2008. Patients who were hemodynamically too unstable to undergo a computed tomography angiography scan were excluded. Outcomes eva luated were intraoperative mortality,30 day mortality,systemic complications,mortality and complications during 1-year follow up. The statistical tests we used were the Student t test,Χ^2 test. Results Thirty-day mortality was 1 of 8 patients who underwent endovascular repair, blood loss and blood transfusion in endo-vaseular repair were significantly less than open surgery（ P 〈 0. 001 ,P 〈 0.001 ） ;The median fasting period and postoperative hos- pital stay were shorter in endov ascular repair （P 〈 0.01 ）. During 1-year follow up, one patients initially treated with endovascular repair died as a result of nonaneurysm related causes, no more complications such as endoleak and graft migrations; Thirty day mortality was 2 of 22 patients who underwent open surgery, During 1-year follow up ,0 patients initially treated with open surgery died, post operative complications were more often in endovaseular repair. Conclusion On the basis of our study with a highly selected population, endovaseular repair of AAA is better for early result than conventional open repair and has the advantages of safety and less trauma.