Huang Mingkui, Tang Yinhe
Department of Vascular Surgery, Taizhou Central Hospital (Taizhou University Hospital) Taizhou 318001, Zhejiang, China.
Department of Hepatobiliary and Pancreatic Surgery, First Affiliated Hospital, Wenzhou Medical College Wenzhou 325000, Zhejiang, China.
Am J Cancer Res. 2025 Mar 15;15(3):1234-1247. doi: 10.62347/NYJT8307. eCollection 2025.
Ruptured abdominal aortic aneurysm (rAAA) is a life-threatening condition with high mortality. This study compared the efficacy and safety of open surgical repair (OSR) and endovascular aortic repair (EVAR) in the treatment of rAAA.
A retrospective analysis of clinical data was conducted for 232 rAAA patients treated at Taizhou Central Hospital and the First Affiliated Hospital of Wenzhou Medical College. Patients were divided into two groups based on surgical methods: OSR group (n=84) and EVAR group (n=148). Perioperative indicators, perioperative complication rates, and 1-year mortality rates were compared. Patients were further divided into a survival group (n=160) and a death group (n=72) based on their 1-year survival status, and the risk factors affecting the prognosis of rAAA patients were analyzed. Postoperative pain was evaluated using the Visual Analog Scale (VAS), Verbal Rating Scale (VRS), and Present Pain Intensity (PPI). Serum levels of C-reactive protein (CRP) and white blood cells (WBC), pro-inflammatory interleukins (IL-1α, IL-6, IL-8), and tumor necrosis factor-α (TNF-α) were measured before and after treatment using enzyme-linked immunosorbent assays (ELISA).
Compared with the OSR group, the EVAR group had significantly shorter surgical time, less intraoperative bleeding (IOB) and intraoperative blood transfusion volume, reduced intraoperative infusion volume, shorter fasting and first walk time, and shorter ICU and hospital days. The incidence of complications in the EVAR group was significantly lower than that in the OSR group (<0.05). Pain scores (VAS, VRS, and PPI) and serum levels of CRP, WBC, IL-1α, IL-6, IL-8, and TNF-α were significantly lower in the EVAR group than those in the OSR group (all <0.05). There was no significant difference in perioperative mortality between the two groups (28.95% vs. 11.80%, >0.05). However, the 1-year mortality rate was significantly lower in the EVAR group (38.1% vs. 27.0%, P<0.05). Multivariate logistic regression analysis identified Alb<40 g/L (=0.004), Cre≥1.5 mg/dL (=0.007), urea nitrogen ≥25 mg/dL (=0.001), ALT≥40 U/L (=0.002), and treatment method (OSR) (=0.024) as independent risk factors for poor postoperative prognosis.
EVAR demonstrates significant advantages over OSR in reducing surgical trauma, decreasing postoperative complications, alleviating pain and inflammatory responses, and improving postoperative survival rates.
腹主动脉瘤破裂（rAAA）是一种危及生命的疾病，死亡率很高。本研究比较了开放手术修复（OSR）和血管腔内主动脉修复（EVAR）治疗rAAA的疗效和安全性。
对在台州中心医院和温州医科大学附属第一医院接受治疗的232例rAAA患者的临床资料进行回顾性分析。根据手术方法将患者分为两组：OSR组（n = 84）和EVAR组（n = 148）。比较围手术期指标、围手术期并发症发生率和1年死亡率。根据患者1年生存状态进一步分为生存组（n = 160）和死亡组（n = 72），并分析影响rAAA患者预后的危险因素。使用视觉模拟评分法（VAS）、语言评定量表（VRS）和目前疼痛强度（PPI）评估术后疼痛。采用酶联免疫吸附测定（ELISA）法测定治疗前后血清C反应蛋白（CRP）、白细胞（WBC）、促炎细胞因子（IL-1α、IL-6、IL-8）和肿瘤坏死因子-α（TNF-α）水平。
与OSR组相比，EVAR组手术时间明显缩短，术中出血量（IOB）和术中输血量减少，术中输液量减少，禁食和首次下床时间缩短，ICU住院时间和住院天数缩短。EVAR组并发症发生率明显低于OSR组（<0.05）。EVAR组疼痛评分（VAS、VRS和PPI）以及血清CRP、WBC、IL-1α、IL-6、IL-8和TNF-α水平均明显低于OSR组（均<0.05）。两组围手术期死亡率无显著差异（28.95%对11.80%，>0.05）。然而，EVAR组1年死亡率明显较低（38.1%对27.0%，P<0.05）。多因素logistic回归分析确定Alb<40 g/L（=0.004）、Cre≥1.5 mg/dL（=0.007）、尿素氮≥25 mg/dL（=0.001）、ALT≥40 U/L（=0.002）和治疗方法（OSR）（=0.024）为术后预后不良的独立危险因素。
在减少手术创伤、降低术后并发症、减轻疼痛和炎症反应以及提高术后生存率方面EVAR显示出比OSR显著优势。
