腹主动脉瘤术后死亡与严重并发症分析

目的:分析腹主动脉瘤(AAA)围手术期死亡与严重并发症的发生情况与防治策略。方法:回顾分析2009年1月—2014年12月中南大学湘雅医院143例接受手术治疗的AAA患者临床资料。结果:全组围手术期(术后30 d内)死亡6例(4.2%),发生严重并发症20例(14.0%)。腔内修复术患者术后病死率低于开腹手术患者,但差异未达统计学意义(1.3%vs.7.5%,P0.05);腔内修复术患者严重并发症发生率明显低于开腹手术患者(6.6%vs.22.4%,P0.05),术前合并冠心病的患者术后心血管并发症的发生率明显高于非冠心病患者(9.1%vs.0.9%,P0.05),而术前合并高血压术后心血管并发症的发生率无明显增加(4.8%vs.2.5%,P0.05);术前合并其他系统基础疾病的患者例数较少,未作相关统计分析。结论:腔内修复术在降低AAA围手术期病死率与严重并发症发生率方面较开放手术有明显优势;对于术前合并冠心病的患者应积极采取预防措施预防与防止术后心血管并发症的发生。

Analysis of perioperative death and severe complications of abdominal aortic aneurysm

Objective: To analyze the occurrence of perioperative death and severe complications of abdominal aortic aneurysm (AAA) and the preventive strategy. Methods: The clinical data of 143 AAA patients undergoing surgical treatment from January 2009 to December 2014 in Xiangya Hospital of Central South University were retrospectively analyzed. Results: In the whole group of patients, there was perioperative (within 30 d after operation) death in 6 cases (4.2%) and severe complications occurred in 20 cases (14.0%). In patients undergoing endovascular repair, the incidence of postoperative death was lower than that in patients undergoing open surgery, but the difference did not reach a statistical significance (1.3% vs. 7.5%, P>0.05), while the incidence of severe complications was significantly lower than that in the latter (6.6% vs. 22.4%, P<0.05). The incidence of postoperative cardiovascular complications in patients with preoperative concomitant coronary artery disease was significantly higher than that in patients with non-coronary artery disease (9.1% vs. 0.9%, P<0.05), but showed no significant increase in patients with hypertension (4.8% vs. 2.5%, P>0.05). Patients with other underlying diseases were not included in statistical analysis due to small number of cases. Conclusion: Endovascular repair has evident superiority to open surgery in respects of reducing perioperative death and severe complications of AAA, and in those patients with preoperative concomitant coronary artery disease, aggressive preventive measures should be taken to avoid the occurrence of cardiovascular complications.