Objective:To analyze and summarize the short and long-term results of open surgical repair (OSR) of abdominal aortic aneurysm (AAA) with hostile neck.Methods:The clinical data of AAA patients with hostile neck who underwent OSR from June 2017 to September 2019 in the Division of Vascular Surgery, West China Hospital of Sichuan University were retrospectively analyzed. A total of 21 patients were included, with a mean age of (64.33±12.46) years, 12 male patients, and 10 impending ruptures. The primary outcome was 30-day mortality, secondary outcomes included 3-year overall survival and reintervention rate.Results:Among 21 patients, 15 were short neck or pararenal aneurysms, 3 were large-neck AAAs, and 9 were AAAs with severe neck angulation. The aneurysm diameter of the patients was (66.54±17.34) mm. Three underwent renal artery reconstruction, and 2 underwent renal artery angioplasty. The median length of stay was 16 (12,19) days. The 30-day postoperative mortality rate was 4.76% (1/21), and the patient died of severe pulmonary infection. During a median follow-up of 40 (40, 67) months, 2 patients died of cardiovascular events. The 3-year overall survival rate was 85.71% (18/21). No aortic-related reintervention or death was observed during follow-up.Conclusion:OSR of AAA with hostile neck is safe and effective. Although there is a short-term risk of postoperative pulmonary complications, the long-term results are stable with a low risk of reintervention and mortalit.
目的 对比破裂腹主动脉瘤腔内修复术与传统开放手术(OSR)治疗破裂腹主动脉瘤的临床疗效.方法 收集2009年1月至2015年12月于四川大学华西医院收治的71例破裂腹主动脉瘤患者的临床资料.根据治疗方式的不同将患者分为腹主动脉瘤腔内修复术(EVAR)组(n=30)和OSR组(n=41).比较两组患者的术前临床特征、手术情况和随访结果.结果 两组患者的年龄、性别、吸烟情况、休克、糖尿病、原发性高血压、冠心病、心力衰竭、心脏瓣膜病、周围血管疾病、慢性阻塞性肺疾病、慢性肾功能不全、昏迷、瘤颈长度、瘤体最大直径、瘤颈角度比较,差异均有统计学意义(P<0.05).EVAR组患者的手术持续时间短于OSR组患者,术中输血量和补液量均明显少于OSR组患者,差异均有统计学意义(P<0.05).术后,两组患者的总体重症监护室(ICU)观察时间比较,差异有统计学意义(P<0.05).EVAR组患者的围手术期病死率明显低于OSR组患者,差异有统计学意义(P<0.01).EVAR组患者的再干预率为16.67％,高于OSR组患者的2.44％,差异有统计学意义(P<0.05).两组患者术后1、3、6、12个月的生存率比较,差异无统计学意义(P>0.05).结论 EVAR治疗破裂腹主动脉瘤的手术时间更短,术后ICU观察时间更短,长期疗效与OSR类似,值得临床推广应用.
为提高川维厂9#燃煤锅炉燃烧的稳定性及降低NOX排放量，对9#炉进行了低氮燃烧器改造。改造后，NOX浓度由改造前的645.1 mg/m3降低到改造后的463mg/m3，低负荷不投天然气能保证稳燃，达到了节能减排效果。
