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目的 比较破裂腹主动脉瘤患者行腔内修复术(endovascular aortic repair,EVAR)与开放手术(open surgical repair,OSR)的疗效及安全性. 方法 回顾性分析1999年4月至2013年12月救治的71例破裂腹主动脉瘤患者的围术期及术后早期(术后30 d)资料,对比OSR和EVAR治疗的术后早期死亡率及并发症率.结果 OSR组有59例患者,EVAR组有12例患者.EVAR组年龄高于OSR组[(68±7)岁与(57±11)岁,t=-3.069,P=0.03];EVAR组COPD比率较OSR组高(58.3％与23.7％,x=5.733,P=0.017).EVAR组手术时间较OSR组短[(138±20) min与(258±66) min,t=-11.527,P＜0.001];术中出血EVAR组低于OSR组[(130±43) ml与(2 295±425) ml,t=-17.529,P＜0.001];EVAR组术中无输血,OSR组术中输血59例,x2=64.058,P＜0.001;ICU驻留时间,呼吸机带机时间,术后禁食时间等EVAR组短于OSR组.EVAR组术后早期期死亡3例,OSR组死亡13例,30 d死亡率无明显差异(25.0％与22.0％,x2=0.000,P=1.000),术后严重并发症率EVAR与OSR组差异无统计学意义(33.3％与32.2％.x2=0.111,P=0.739). 结论 早期诊断、紧急的手术治疗和选择合适的治疗方式是提高破裂腹主动脉瘤救治率的关键.

Objective To compare and analyze the perioperative and early postoperative (30 d) outcomes between endovascular aortic repair (EVAR) and open surgical repair (OSR) for ruptured abdominal aortic aneurysm (RAAA).Methods The clinical data of 71 RAAA patients from April 1999 to December 2013 were collected and analyzed.Patients received EVAR (n =12) or OSR (n =59).Results Patients in EVAR group were older than those in OSR group (68 ± 7 vs 57 ± 11 years old,t =-3.069,P =0.03).The comorbidity rate of chronic obstructive pulmonary disease (COPD) in EVAR group was higher than that in OSR group (58.3％ vs 23.7％,x2 =5.733,P =0.017).As compared with OSR group,the EVAR group had less blood loss (130 ±43 vs 2 295 ±425 ml,t =-17.529,P ＜0.001),a lower rate of blood transfusion (0 vs 100.0％,x2 =64.058,P ＜ 0.001),shorter ICU stay,shorter postoperative fasting time,shorter procedure time,and shorter ventilatory support time.The 30 day mortality rate was similar (25.0％ vs 22.0％,x2 =0.000,P =1.000).Severe perioperative complication rate was similar (33.3％ vs 32.2％,x2 =0.111,P =0.739).Conclusion Early diagnosis,urgent repair using appropriate procedure are the keys to reduce the mortality of RAAA.