Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas.
Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas; Office of Surgical Research, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas.
Ann Thorac Surg. 2021 Sep;112(3):717-724. doi: 10.1016/j.athoracsur.2020.09.032. Epub 2020 Nov 18.
The present study was done to examine the incidence, predictors, and impact of early gastrointestinal (GI) complications after open thoracoabdominal aortic aneurysm repair.
We retrospectively analyzed data from 3587 open thoracoabdominal aortic aneurysm repairs performed at our center from 1986 to 2019. We used univariate analyses and multivariable logistic regression to identify risk factors associated with GI complications, including bleeding, ischemia, obstruction, and acute pancreatitis. Adverse event was defined as operative death or persistent stroke, paraplegia, paraparesis, or renal failure necessitating dialysis.
Gastrointestinal complications developed after 213 repairs (5.9%). Gastrointestinal complications less often developed after extent I repair than after repairs that involved infrarenal abdominal aortic segments (ie, extent II to IV repairs; P = .003). Patients who had GI complications more often underwent endarterectomy, stenting, or bypass of visceral arteries (51.2% vs 42.2%; P = .01). Use of selective visceral perfusion did not differ between groups. Patients who had GI complications had higher rates of operative mortality (34.3% vs 6.6%) and adverse events (44.1% vs 13.2%) and had longer hospitalization (29 vs 11 days; P < .001 for all). Independent predictors of GI complications included incidental splenectomy, rupture, non-extent I repair, older age, and longer aortic cross-clamp time. Short-term, midterm, and long-term survival were poorer for patients who had GI complications (P < .001).
Although uncommon, early GI complications after open thoracoabdominal aortic aneurysm repair are associated with significant early and late morbidity and mortality. Development of perioperative strategies to mitigate these complications is warranted.
本研究旨在探讨开放胸腹主动脉瘤修复术后早期胃肠道（GI）并发症的发生率、预测因素和影响。
我们回顾性分析了 1986 年至 2019 年在我们中心进行的 3587 例开放胸腹主动脉瘤修复的数据。我们使用单因素分析和多变量逻辑回归来确定与 GI 并发症相关的风险因素，包括出血、缺血、梗阻和急性胰腺炎。不良事件定义为手术死亡或持续性中风、截瘫、不全截瘫或需要透析的肾衰竭。
213 例（5.9%）术后发生胃肠道并发症。与累及肾下腹主动脉段（即 I 型至 IV 型修复）的修复相比，I 型修复后胃肠道并发症发生率较低（P=0.003）。发生 GI 并发症的患者更常接受内膜切除术、支架置入或内脏动脉旁路（51.2%比 42.2%；P=0.01）。两组选择性内脏灌注的使用没有差异。发生 GI 并发症的患者手术死亡率（34.3%比 6.6%）和不良事件发生率（44.1%比 13.2%）更高，住院时间更长（29 天比 11 天；P<0.001）。GI 并发症的独立预测因素包括偶然脾切除术、破裂、非 I 型修复、年龄较大和主动脉阻断时间较长。发生 GI 并发症的患者短期、中期和长期生存率较差（P<0.001）。
尽管不常见，但开放胸腹主动脉瘤修复术后早期胃肠道并发症与显著的早期和晚期发病率和死亡率相关。制定围手术期策略以减轻这些并发症是有必要的。
