摘要目的 评估腔内修复术(EVAR)治疗腹主动脉瘤(AAA)的疗效及安全性,并比较不同年龄阶段患者的预后情况.方法 回顾性分析2005年5月到2011年5月接受EVAR的81例AAA 患者的住院和随访资料,将所有患者划分为高龄组(年龄≥75岁)和相对低龄组(年龄＜75岁),分别为24例和57例.对两组患者的一般状况、合并症、手术情况、院内并发症和随访等资料进行对比.结果 所有覆膜支架均顺利植入,技术成功率91.4％ (74/81).术中无死亡病例,住院病死率1.2％( 1/81).74例获得随访,随访率91.4％,平均随访47.5个月.随访期间死亡12例,1、2、3、4和5年生存率分别为98.6％、92.2％、80.8％、58.7％和44.1％.与相对低龄组比较,高龄组出现腹部疼痛症状比例较低,而合并肾脏疾病和冠状动脉粥样硬化性心脏病比例较高,术后重症监护时间较长,内漏发生率明显增加,而肺部感染和穿刺点血肿发生率也有增高趋势,其余住院及随访情况则无明显差异.结论 EVAR治疗AAA创伤小,安全,短中期疗效满意.高龄患者接受EVAR治疗后部分并发症发生率更高,围手术期应充分准备和密切观察,更好地防治可能的并发症,进一步改善预后.

abstractsObjective To evaluate the efficacy and safety of endovascular aneurysm repair (EVAR) for abdominal aortic aneurysm (AAA),and to compare the prognosis between patients of different ages.Methods The hospitalization and follow-up data of 81 AAA patients treated by EVAR from May 2005 to May 2011 were retrospectively analyzed.All the patients were divided into advanced age group (age≥75 years,24 cases) and relatively young group (age＜75 years,57 cases).General conditions,comorbidity,procedure,in-hospital complications,and follow-up were compared between these two groups.Results All covered stents were successfully deployed,a technical success rate of 91.4％ (74/81) was achieved.There was no intraoperative death.In-hospital mortality was 1.2％ (1/81).The follow-up rate was 91.4％ (74/81 ),with a mean follow-up of 47.5 months.Twelve deaths were recorded during follow-up,1,2,3,4,and 5-year survival rates were 98.6％,92.2％,80.8％,58.7％,and 44.1％,respectively. When compared with relatively young group,the advanced age group had a lower rate of abdominal pain as the major symptom,but a higher rates of renal diseases and coronary artery diseases.Furthermore,the advanced age group had a longer stay in intensive care unit and higher morbidity of endoleaks,and also tended to have increased rates of pulmonary infection and access site hematoma,while the other parameters were similar between the two groups.Conclusions EVAR of AAA is less invasive,safe,and effective during short to mid-tern follow-up.The patients of advanced age suffer from higher rates of some complications,thus careful perioperative preparation and intensive monitor are mandatory for preventing or treating potential complications and improving prognosis for these patients.