Kawachi Yoshito, Nakashima Atsuhiro, Toshima Yoshihiro, Kosuga Tomokazu, Imasaka Kenichi, Tomoeda Hiroshi
Department of Cardiovascular Surgery, Clinical Research Institute, National Kyushu Medical Center Hospital, Fukuoka, Japan.
Jpn J Thorac Cardiovasc Surg. 2003 Sep;51(9):438-41. doi: 10.1007/BF02719598.
This report describes 3 aged patients undergoing emergent surgery who refused elective operation for a thoracic aortic aneurysm because of freedom from symptoms attributable to the aneurysm at the time of presentation. A 77-year-old woman with a thoracoabdominal aneurysm 57 mm in diameter at presentation had recurrent hemoptysis 12 months later. A 78-year-old man with a saccular type distal arch aneurysm 64 mm in diameter at presentation was transported with shock and hemothorax 27 months later. Another 82-year-old man with a saccular type distal arch aneurysm 60 mm in diameter at presentation was admitted with severe chest and back pain 36 months later. All of them underwent tube graft replacements of the aneurysm urgently and were discharged on foot. Aged patients with life-threatening events should not be denied surgical intervention because of excessive operative mortality and morbidity, even if they had previously refused elective surgery.
本报告描述了3例接受急诊手术的老年患者，他们因就诊时动脉瘤无症状而拒绝接受胸主动脉瘤的择期手术。一名77岁女性，就诊时胸腹部动脉瘤直径为57 mm，12个月后出现反复咯血。一名78岁男性，就诊时囊状型远端弓部动脉瘤直径为64 mm，27个月后因休克和血胸而被转运。另一名82岁男性，就诊时囊状型远端弓部动脉瘤直径为60 mm，36个月后因严重的胸痛和背痛入院。他们均紧急接受了动脉瘤的人工血管置换术，并步行出院。即使老年患者之前拒绝接受择期手术，对于有生命危险事件的患者，也不应因手术死亡率和发病率过高而拒绝手术干预。
