Objective: To investigate the etiology, treatment method and prevention of gastrointestinal complications(GCs) after endovascular and open repair of abdominal aortic aneurysm (AAA). Methods: The clinical data of 716 cases who were diagnosed as AAA and underwent endovascular(EVAR) or open repair (OR) from Department of Vascular Surgery, Beijing Anzhen Hospital, Capital Medical University April 2009 to March 2017 were collected and analyzed retrospectively. There were 608 males (84.9%)and 108 females(15.1%), aging of 69.4 years (range: 52-86 years). There were 539 cases(75.3%) underwent EVAR and 177 cases(24.7%) underwent OR. The morbidity of GCs and mortality of GCs, such as acute pancreatitis, cholecystitis, ischemic colitis, intestinal obstruction and peptic ulcer, between EVAR and OR group were compared. The treatment of the GCs and the prognosis of the patients were reported. Results: The morbidity of GCs in EVAR and OR group were 4.6%(25/539)and 35.0%(62/177), respectively. There were 10 cases and 28 cases suffering from acute pancreatitis in EVAR and OR group, respectively; 4 cases and 6 cases suffering from cholecystitis in the two groups; 6 cases and 13 cases suffering from ischemic colitis in the two groups; 5 cases suffering from intestinal obstruction in OR group; 5 cases and 10 cases suffering from peptic ulcer in the two groups. Two patients died in EVAR group, and the peri-operative mortality was 0.37%, one died of ischemic colitis with acute myocardial infarction, the other died of ischemic colitis with septic shock. Six patients died in OR group, and the peri-operative mortality was 3.39%, two patients died of acute pancreatitis with intestinal necrosis, one patient died of cholangitis with peritonitis and septic shock, three patients died of ischemic colitis with acute renal failure or septicemia. Conclusions: The etiology of peri-operative GCs after AAA repair may include inferior mesenteric artery occlusion or ligation, pancreas injury, organ hypoperfusion and so on.
目的： 探讨腹主动脉瘤（AAA）腔内修复（EVAR）及开放修复（OR）术后消化系统并发症的发生原因、处理方法和预防措施。 方法： 对首都医科大学附属北京安贞医院血管外科2009年4月至2017年3月诊治的716例AAA患者的临床资料进行回顾性分析。716例AAA患者中，男性608例（84.9%），女性108例（15.1%），年龄69.4岁（范围：52~86岁）；行EVAR术539例（75.3%），行OR术177例（24.7%）。统计分析EVAR组和OR组患者消化系统并发症（急性胰腺炎、胆囊炎、缺血性结肠炎、肠梗阻、消化道溃疡）的发生及治疗转归情况。 结果： EVAR组和OR组患者术后消化系统并发症总体发生率分别为4.6%（25/539）和35.0%（62/177），其中急性胰腺炎分别为10例和28例，胆囊炎分别为4例和6例，缺血性结肠炎分别为6例和13例，肠梗阻分别为0例和5例，消化道溃疡分别为5例和10例。围手术期有8例患者死亡，其中EVAR组死亡2例（0.37%），死因分别为术后缺血性结肠炎合并急性心肌梗死1例、缺血性结肠炎合并感染中毒性休克1例；OR组死亡6例（3.39%），死因分别为术后急性胰腺炎合并肠坏死2例、胆管炎继发腹膜炎并发感染中毒性休克1例、缺血性结肠炎合并急性肾功能衰竭或败血症3例。 结论： AAA术后消化系统并发症的发生多与术中封盖或结扎肠系膜下动脉、胰腺损伤、器官低灌注等因素有关。.
Keywords: Aortic aneurysm, abdominal; Complications; Gastrointestinal system; Treatment.