Is 80 years too old for aneurysmectomy?
Is 80 years too old for aneurysmectomy?
复制标题
80岁适合做动脉瘤切除术吗？
作者：
T. O'Donnell;R. Darling;R. R. Linton
对111例初诊为腹主动脉瘤(AAA)的80岁以上高龄患者的临床资料显示，86例患者行主动脉瘤切除和移植。腹主动脉破裂(n=30)手术死亡率为74%。相比之下，扩大动脉瘤组(n=19)和择期手术组(n=44)的AAA切除分别与10%和2%的死亡率相关。因此，63名80多岁的老年人接受了未破裂的腹主动脉切除，总死亡率为4.7%。虽然近一半的患者在手术前检测到了心脏病，但选择性组既往心肌梗死(7%)和充血性心力衰竭(8%)的发生率较低。同时，AAA切除后心肌梗死(6%)和充血性心力衰竭的发生率相对较低。仅有5%的未破裂患者术后出现明显的少尿性氮质血症。长期存活率与80岁以上人群的长期存活率相当。这些患者的生活质量并未因AAA切除而受到不利影响。相比之下，接受保守治疗的患者中有50%死于腹主动脉破裂。生理年龄而不是实际年龄决定了80岁以上老年人进行AAA切除的选择。
The records of 111 patients, 80 years of age or older, with a primary diagnosis of abdominal aortic aneurysm(AAA) showed that 86 patients underwent aneurysm resection and grafting. Ruptured AAAs (n=30) were associated with an operative mortality of 74%. By contrast, AAA resection in the expanding aneurysm group (n=19) and in the elective surgery group (n=44) was associated with a 10% and 2% mortality, respectively. Thus, resection of a nonruptured AAA in 63 octogenarians was carried out with an overall mortality of 4.7%. While nearly half of the patients had cardiac disease detected preoperatively, the elective group demonstrated a low incidence of previous myocardial infarction (7%) and congestive heart failure (8%). Concomitantly, the incidence of myocardial infarction (6%) and congestive heart failure was relatively low after AAA resection. Significant postoperative oliguric azotemia was observed in only 5% of the nonruptured patients. Long-term survival was comparable to that of the general population over the age of 80 years. The quality of life enjoyed by these patients was not adversely affected by AAA resection. By contrast, 50% of patients treated conservatively died of ruptured AAA. Physiologic rather than chronologic age should determine selection for AAA resection in the octogenarian.