腹主动脉瘤破裂的血管内修复与开放修复对比
Endovascular vs. Open Repair for Ruptured Abdominal Aortic Aneurysm.
作者信息
Patelis Nikolaos, Moris Demetrios, Karaolanis Georgios, Georgopoulos Sotiris
机构信息
Vascular Unit, First Department of Surgery, Laiko General Hospital, Medical School, National & Kapodistrian University of Athens, Athens, Greece.
Lerner Research Institute, Cleveland Clinic Foundation, Cleveland, OH, USA.
出版信息
Med Sci Monit Basic Res. 2016 Apr 19;22:34-44. doi: 10.12659/MSMBR.897601.
BACKGROUND
Patients presenting with ruptured abdominal aortic aneurysms are most often treated with open repair despite the fact that endovascular aneurysm repair is a less invasive and widely accepted method with clear benefits for elective aortic aneurysm patients. A debate exists regarding the definitive benefit in endovascular repair for patients with a ruptured abdominal aortic aneurysm. The aim of this literature review was to determine if any trends exist in favor of either open or endovascular repair.
MATERIAL AND METHODS
A literature search was performed using PUBMED, OVID, and Google Scholar databases. The search yielded 64 publications.
RESULTS
Out of 64 publications, 25 were retrospective studies, 12 were population-based, 21 were prospective, 5 were the results of RCTs, and 1 was a case-series. Sixty-one studies reported on early mortality and provided data comparing endovascular repair (rEVAR) and open repair (rOR) for ruptured abdominal aneurysm groups. Twenty-nine of these studies reported that rEVAR has a lower early mortality rate. Late mortality after rEVAR compared to that of rOR was reported in 21 studies for a period of 3 to 60 months. Results of 61.9% of the studies found no difference in late mortality rates between these 2 groups. Thirty-nine publications reported on the incidence of complications. Approximately half of these publications support that the rEVAR group has a lower complication rate and the other half found no difference between the groups. Length of hospital stay has been reported to be shorter for rEVAR in most studies. Blood loss and need for transfusion of either red cells or fresh frozen plasma was consistently lower in the rEVAR group.
CONCLUSIONS
Differences between the included publications affect the outcomes. Randomized control trials have not been able to provide clear conclusions. rEVAR can now be considered a safe method of treating rAAA, and is at least equal to the well-established rOR method.
背景
尽管血管腔内动脉瘤修复术是一种侵入性较小且被广泛接受的方法，对择期主动脉瘤患者有明确益处，但出现腹主动脉瘤破裂的患者大多接受开放修复治疗。对于腹主动脉瘤破裂患者，血管腔内修复术的最终益处存在争议。本综述的目的是确定是否存在支持开放修复或血管腔内修复的任何趋势。
材料与方法
使用PUBMED、OVID和谷歌学术数据库进行文献检索。检索结果为64篇出版物。
结果
在64篇出版物中，25篇为回顾性研究，12篇为基于人群的研究，21篇为前瞻性研究，5篇为随机对照试验结果，1篇为病例系列研究。61项研究报告了早期死亡率，并提供了腹主动脉瘤破裂组血管腔内修复术（rEVAR）和开放修复术（rOR）的数据比较。其中29项研究报告rEVAR的早期死亡率较低。21项研究报告了rEVAR与rOR术后3至60个月的晚期死亡率。61.9%的研究结果发现这两组的晚期死亡率没有差异。39篇出版物报告了并发症的发生率。这些出版物中约一半支持rEVAR组并发症发生率较低，另一半则发现两组之间没有差异。大多数研究报告rEVAR的住院时间较短。rEVAR组的失血量和红细胞或新鲜冰冻血浆的输血需求一直较低。
结论
纳入出版物之间的差异影响结果。随机对照试验未能提供明确结论。rEVAR现在可被视为治疗rAAA的一种安全方法，至少与成熟的rOR方法相当。
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