Immediate repair compared with surveillance of small abdominal aortic aneurysms.
Immediate repair compared with surveillance of small abdominal aortic aneurysms.
复制标题
DOI：
10.1056/nejmoa012573
复制
发表时间：
2002-05-09
影响因子：
158.5
通讯作者：
Bandyk, D
中科院分区：
文献类型：
--
作者：
Lederle, FA;Wilson, SE;Bandyk, D
背景：选择性腹小动脉瘤手术修复是否能提高生存率仍有争议。方法：我们随机选取50 ~ 79岁、直径4.0 ~ 5.4 cm且手术风险不高的腹主动脉瘤患者，进行立即开腹手术修复，或每6个月进行超声或计算机断层扫描监测，修复预留给出现症状或扩大到5.5 cm的动脉瘤。随访时间为3.5 ~ 8.0年（平均4.9年）。结果：569例患者随机分为即刻修复组和567例观察组。到研究结束时，立即修复组中92.6%的患者和监测组中61.6%的患者进行了动脉瘤修复。两组的主要结局——任何原因的死亡率无显著差异（与监测组相比，即刻修复组的相对危险度为1.21；95%可信区间为0.95 - 1.54）。根据年龄或动脉瘤直径确定的任何预先指定亚组的生存趋势都不支持立即修复。尽管即刻修复组的总手术死亡率较低，为2.7%，但仍获得了这些发现。与监测组（2.6%）相比，立即修复组（3.0%）与腹主动脉瘤相关的死亡率也没有降低。观察组中有11名患者发生腹主动脉瘤破裂（每年0.6%），导致7人死亡。与腹主动脉瘤相关的住院率在监测组降低了39%。结论：即使手术死亡率较低，选择性修复小于5.5 cm的腹主动脉瘤也不能提高生存率。
Background: Whether elective surgical repair of small abdominal aortic aneurysms improves survival remains controversial.Methods: We randomly assigned patients 50 to 79 years old with abdominal aortic aneurysms of 4.0 to 5.4 cm in diameter who did not have high surgical risk to undergo immediate open surgical repair of the aneurysm or to undergo surveillance by means of ultrasonography or computed tomography every six months with repair reserved for aneurysms that became symptomatic or enlarged to 5.5 cm. Follow-up ranged from 3.5 to 8.0 years (mean, 4.9).Results: A total of 569 patients were randomly assigned to immediate repair and 567 to surveillance. By the end of the study, aneurysm repair had been performed in 92.6 percent of the patients in the immediate-repair group and 61.6 percent of those in the surveillance group. The rate of death from any cause, the primary outcome, was not significantly different in the two groups (relative risk in the immediate-repair group as compared with the surveillance group, 1.21; 95 percent confidence interval, 0.95 to 1.54). Trends in survival did not favor immediate repair in any of the prespecified subgroups defined by age or diameter of aneurysm at entry. These findings were obtained despite a low total operative mortality of 2.7 percent in the immediate-repair group. There was also no reduction in the rate of death related to abdominal aortic aneurysm in the immediate-repair group (3.0 percent) as compared with the surveillance group (2.6 percent). Eleven patients in the surveillance group had rupture of abdominal aortic aneurysms (0.6 percent per year), resulting in seven deaths. The rate of hospitalization related to abdominal aortic aneurysm was 39 percent lower in the surveillance group.Conclusions: Survival is not improved by elective repair of abdominal aortic aneurysms smaller than 5.5 cm, even when operative mortality is low.