目的:目前75%的腹主动脉瘤患者接受腹主动脉瘤修复术(EVAR)治疗,这些接受血管内介入手术治疗的患者中,二次介入干预和再次开放手术的发生率正在逐渐增加。本研究回顾性分析在单中心血管外科行EVAR术后再次开放手术的疗效分析评价。方法...目的:目前75%的腹主动脉瘤患者接受腹主动脉瘤修复术(EVAR)治疗,这些接受血管内介入手术治疗的患者中,二次介入干预和再次开放手术的发生率正在逐渐增加。本研究回顾性分析在单中心血管外科行EVAR术后再次开放手术的疗效分析评价。方法:回顾性研究分析2014年1月至2023年1月期间在青岛大学附属医院进行的26例EVAR术后再次开放手术的患者。分析EVAR术后再次开放手术的指征、围手术期并发症、再手术率、生存率。结果:在近10年里,有123例腹主动脉瘤(abdominal aortic aneurysm, AAA)患者因腹主动脉瘤接受开放手术治疗,其中26例为EVAR术后再次开放手术,在这26例患者中,包括3例急诊手术和23例择期手术,从首次EVAR到再次开放手术的时间窗平均为40个月,需要再次手术的情形包括17例(65.4%)内漏,以及4例(15.4%)支架感染,3例(11.5%)破裂,2例(7.7%)血栓形成。其中4例感染患者的支架完整取出,其余22例均为部分保留支架的开放手术,平均手术时间为302 min,平均出血量为1330 ml,术后重症监护时间平均为128 h,平均住院日为35 d。结论:虽然EVAR后再次开放手术在技术上具有挑战性,但在大型的血管外科中心,腹主动脉支架术后再次开放手术是一种比较成熟的术式,本中心腹主动脉支架术后感染的患者具有较高的死亡率(75%),因内漏而进行EVAR术后再次开放手术的患者,5年生存率较非内漏组好,EVAR术后因内漏而再次开放手术的患者占多数(65.38%)。Currently, 75% of patients with abdominal aortic aneurysm are treated with abdominal aortic aneurysm repair (EVAR). Among these patients treated with endovascular intervention, the incidence of secondary intervention and reoperation is increasing. This study retrospectively analyzed the efficacy of reoperation after EVAR in a single center. Methods: A retrospective study was conducted to analyze 26 patients who underwent re-open surgery after EVAR in the Affiliated Hospital of Qingdao University between January 2014 and January 2023. The indications, perioperative complications, reoperation rate and survival rate of re-open surgery after EVAR were analyzed. Result: In the last 10 years, there were 123 patients with abdominal aortic aneurysm (AAA), who had received open surgery for abdominal aortic aneurysm, of which 26 patients had re-open surgery after EVAR, and among these 26 patients, 3 had emergency surgery and 23 had elective surgery. The time window from the first EVAR to re-opening was an average of 40 months, and cases requiring re-surgery included 17 (65.4%) internal leakage, 4 (15.4%) stent infection, 3 (11.5%) rupture, and 2 (7.7%) thrombosis. Stents were removed completely in 4 infected patients, and the remaining 22 patients underwent open surgery with partial stents retained. The average operation time was 302 min, the average blood loss was 1330 ml, the average postoperative intensive care time was 128 h, and the average hospital stay was 35 d. Conclusion: Although re-opening surgery after EVAR is technically challenging, re-opening surgery after abdominal aortic stenting is a relatively mature procedure in large vascular surgery centers. In this center, patients with post-abdominal aortic stenting infection have a higher mortality rate (75%), and patients undergoing re-opening surgery after EVAR due to internal leakage have a higher mortality rate. The 5-year survival rate was better than that of the non-leakage group, and the majority of patients (65.38%) were re-opened for internal leakage after EVAR.展开更多
文摘目的:目前75%的腹主动脉瘤患者接受腹主动脉瘤修复术(EVAR)治疗,这些接受血管内介入手术治疗的患者中,二次介入干预和再次开放手术的发生率正在逐渐增加。本研究回顾性分析在单中心血管外科行EVAR术后再次开放手术的疗效分析评价。方法:回顾性研究分析2014年1月至2023年1月期间在青岛大学附属医院进行的26例EVAR术后再次开放手术的患者。分析EVAR术后再次开放手术的指征、围手术期并发症、再手术率、生存率。结果:在近10年里,有123例腹主动脉瘤(abdominal aortic aneurysm, AAA)患者因腹主动脉瘤接受开放手术治疗,其中26例为EVAR术后再次开放手术,在这26例患者中,包括3例急诊手术和23例择期手术,从首次EVAR到再次开放手术的时间窗平均为40个月,需要再次手术的情形包括17例(65.4%)内漏,以及4例(15.4%)支架感染,3例(11.5%)破裂,2例(7.7%)血栓形成。其中4例感染患者的支架完整取出,其余22例均为部分保留支架的开放手术,平均手术时间为302 min,平均出血量为1330 ml,术后重症监护时间平均为128 h,平均住院日为35 d。结论:虽然EVAR后再次开放手术在技术上具有挑战性,但在大型的血管外科中心,腹主动脉支架术后再次开放手术是一种比较成熟的术式,本中心腹主动脉支架术后感染的患者具有较高的死亡率(75%),因内漏而进行EVAR术后再次开放手术的患者,5年生存率较非内漏组好,EVAR术后因内漏而再次开放手术的患者占多数(65.38%)。Currently, 75% of patients with abdominal aortic aneurysm are treated with abdominal aortic aneurysm repair (EVAR). Among these patients treated with endovascular intervention, the incidence of secondary intervention and reoperation is increasing. This study retrospectively analyzed the efficacy of reoperation after EVAR in a single center. Methods: A retrospective study was conducted to analyze 26 patients who underwent re-open surgery after EVAR in the Affiliated Hospital of Qingdao University between January 2014 and January 2023. The indications, perioperative complications, reoperation rate and survival rate of re-open surgery after EVAR were analyzed. Result: In the last 10 years, there were 123 patients with abdominal aortic aneurysm (AAA), who had received open surgery for abdominal aortic aneurysm, of which 26 patients had re-open surgery after EVAR, and among these 26 patients, 3 had emergency surgery and 23 had elective surgery. The time window from the first EVAR to re-opening was an average of 40 months, and cases requiring re-surgery included 17 (65.4%) internal leakage, 4 (15.4%) stent infection, 3 (11.5%) rupture, and 2 (7.7%) thrombosis. Stents were removed completely in 4 infected patients, and the remaining 22 patients underwent open surgery with partial stents retained. The average operation time was 302 min, the average blood loss was 1330 ml, the average postoperative intensive care time was 128 h, and the average hospital stay was 35 d. Conclusion: Although re-opening surgery after EVAR is technically challenging, re-opening surgery after abdominal aortic stenting is a relatively mature procedure in large vascular surgery centers. In this center, patients with post-abdominal aortic stenting infection have a higher mortality rate (75%), and patients undergoing re-opening surgery after EVAR due to internal leakage have a higher mortality rate. The 5-year survival rate was better than that of the non-leakage group, and the majority of patients (65.38%) were re-opened for internal leakage after EVAR.
