腘动脉瘤开放手术与腔内修复术的对比研究
| 作者: |
1洪诗钗,
2周旻,
1卢伟锋,
1洪翔,
1陈刚,
1黄玉龙,
1陈艺辉,
2周修适,
1,2王利新,
2郭大乔,
1,2符伟国,
2王玉琦
1 复旦大学附属中山医院厦门医院 血管外科，福建 厦门 361015 2 复旦大学附属中山医院 血管外科 / 复旦大学血管外科研究所，上海 200032 |
| 通讯: |
王利新
Email: wang.lixin@zs-hospital.sh.cn |
| DOI: | 10.3978/.2018.06.008 |
| 基金: | 国家自然科学基金资助项目（81570438）；上海科学技术委员会资助项目（18441902400）。 |
摘要
目的：比较腘动脉瘤（PAA）开放手术与腔内修复术的治疗效果。
方法：回顾性分析 2008 年 1 月—2017 年 12 月收治的 33 例 PAA 患者的临床资料，其中 22 例（23 条肢体）行开放手术（开放手术组），11 例（13 条肢体）行腔内修复术（腔内修复组），分析、比较两组患者的一般资料、围手术期情况、随访结果。
结果：腔内修复组患者年龄与高血压病合并症比例明显大于开放手术组（χ2=8.250，P=0.008；2=6.203，P=0.024），而两组在其他合并症、术前瘤体直径、术后伤口并发症方面均无统计学差异（均P>0.05）。开放手术组均在全麻下完成手术，腔内修复组 6 例（54.5%）全麻下完成腔内手术（2=12.257， P=0.002）。腔内修复组术后住院时间与总住院时间明显少于开放手术组（t=-4.221，P=0.000；t= -3.090，P=0.002）。中位随访时间 36 个月（1~120 个月），开放手术组有 5 例再次干预，其中 2 例行截肢术；腔内修复组有 2 例再次干预。Kaplan-Meier 分析显示两组患者免于再次干预率的差异无统计学意义（P>0.05）。
结论：对于高龄、外科手术风险高、解剖学条件合适、流出道情况良好的 PAA 患者，腔内修复术短中期疗效确切、住院时间短、围手术期恢复快，可替代外科手术成为首选治疗方案。
关键词：
动脉瘤；腘动脉；血管内操作；疗效比较研究
方法：回顾性分析 2008 年 1 月—2017 年 12 月收治的 33 例 PAA 患者的临床资料，其中 22 例（23 条肢体）行开放手术（开放手术组），11 例（13 条肢体）行腔内修复术（腔内修复组），分析、比较两组患者的一般资料、围手术期情况、随访结果。
结果：腔内修复组患者年龄与高血压病合并症比例明显大于开放手术组（χ2=8.250，P=0.008；2=6.203，P=0.024），而两组在其他合并症、术前瘤体直径、术后伤口并发症方面均无统计学差异（均P>0.05）。开放手术组均在全麻下完成手术，腔内修复组 6 例（54.5%）全麻下完成腔内手术（2=12.257， P=0.002）。腔内修复组术后住院时间与总住院时间明显少于开放手术组（t=-4.221，P=0.000；t= -3.090，P=0.002）。中位随访时间 36 个月（1~120 个月），开放手术组有 5 例再次干预，其中 2 例行截肢术；腔内修复组有 2 例再次干预。Kaplan-Meier 分析显示两组患者免于再次干预率的差异无统计学意义（P>0.05）。
结论：对于高龄、外科手术风险高、解剖学条件合适、流出道情况良好的 PAA 患者，腔内修复术短中期疗效确切、住院时间短、围手术期恢复快，可替代外科手术成为首选治疗方案。
Open surgery versus endovascular repair for popliteal artery aneurysm: a comparative study
CorrespondingAuthor:WANG Lixin Email: wang.lixin@zs-hospital.sh.cn
Abstract
Objective: To compare the clinical effi cacy of open surgery and endovascular repair for popliteal artery aneurysm.
Methods: Th e clinical data of 33 patients with popliteal artery aneurysm treated from January 2008 to December 2017 were retrospectively analyzed. Of the patients, 22 cases (23 limbs) underwent open surgery (open surgery group) and 11 cases (13 limbs) received endovascular repair (endovascular repair group). The general data, perioperative variables and follow-up results of the two groups of patients were analyzed and compared. Results: The age and proportion of cases with concomitant hypertension were significantly greater in endovascular repair group than those in open surgery group (2=8.250, P=0.008; 2=6.203, P=0.024), while no significant differences were noted in terms of other concomitant diseases, preoperative diameter of aneurysm and wound complications between these two groups (all P>0.05). All patients in open surgery group and 6 patients (54.5%) in endovascular repair group underwent operation under general anesthesia (2=12.257, P=0.002). The length of postoperative hospital stay and total hospital stay in endovascular repair group were significantly reduced compared with open surgery group (t=–4.221, P=0.000; t=–3.090, P=0.002). Mean follow-up time was 36 months (1 month to 120 months), during which time, 5 patients in open surgery group received reintervention, of whom, 2 cases underwent major amputations; 2 patients received reintervention in endovascular repair group. Kaplan-Meier curve showed that there was no significant difference in freedom from reintervention between these two groups (P>0.05).
Conclusion: For PAA patients with advanced age, high risk from open surgery, appropriate anatomic conditions and favorable outflow vessels, endovascular repair may be a safe alternative to open surgery, which has demonstrable efficacy with a short length of hospital stay and rapid perioperative recovery.
Keywords：
Aneurysm; Popliteal Artery; Endovascular Procedures; Comparative Effectiveness Research
Methods: Th e clinical data of 33 patients with popliteal artery aneurysm treated from January 2008 to December 2017 were retrospectively analyzed. Of the patients, 22 cases (23 limbs) underwent open surgery (open surgery group) and 11 cases (13 limbs) received endovascular repair (endovascular repair group). The general data, perioperative variables and follow-up results of the two groups of patients were analyzed and compared. Results: The age and proportion of cases with concomitant hypertension were significantly greater in endovascular repair group than those in open surgery group (2=8.250, P=0.008; 2=6.203, P=0.024), while no significant differences were noted in terms of other concomitant diseases, preoperative diameter of aneurysm and wound complications between these two groups (all P>0.05). All patients in open surgery group and 6 patients (54.5%) in endovascular repair group underwent operation under general anesthesia (2=12.257, P=0.002). The length of postoperative hospital stay and total hospital stay in endovascular repair group were significantly reduced compared with open surgery group (t=–4.221, P=0.000; t=–3.090, P=0.002). Mean follow-up time was 36 months (1 month to 120 months), during which time, 5 patients in open surgery group received reintervention, of whom, 2 cases underwent major amputations; 2 patients received reintervention in endovascular repair group. Kaplan-Meier curve showed that there was no significant difference in freedom from reintervention between these two groups (P>0.05).
Conclusion: For PAA patients with advanced age, high risk from open surgery, appropriate anatomic conditions and favorable outflow vessels, endovascular repair may be a safe alternative to open surgery, which has demonstrable efficacy with a short length of hospital stay and rapid perioperative recovery.