Chiesa Roberto, Melissano Germano, Civilini Efrem, de Moura Marcelo Liberato Ruettimann, Carozzo Andrea, Zangrillo Alberto
Division of Vascular Surgery, Vita-Salute University, Scientific Institute H. San Raffaele, Milano, Italy.
Ann Vasc Surg. 2004 Sep;18(5):514-20. doi: 10.1007/s10016-004-0072-z. Epub 2004 Jul 29.
In the last few years, advances in surgical techniques and in organ protection adjuncts have improved outcomes in thoracic (TAA) and thoracoabdominal aortic aneurysm (TAAA) surgical repair, although mortality and morbidity are still noteworthy. The aim of the current retrospective study is to determine whether the use of adjuncts influenced mortality and morbidity rates. From 1993 to 2003 we performed 353 procedures for TAA (175 cases) and TAAA (178 cases). This series has been divided into two consecutive groups: in group I (from 1993 to 1997), distal aortic perfusion with left atriofemoral bypass and cerebrospinal fluid drainage were used selectively, and in group II (from 1998 to 2003), the adjuncts were used routinely (together with surgical techniques of less invasive approach in selected cases). Total in-hospital mortality rates were significantly different ( p < 0.05): 15.9% in group I and 8.6% in group II. The overall incidence of paraplegia or paraparesis in group I was 8.3% and in Group II it was 5.1%. Renal failure occurred in 9.6% of group I and in 4.1% of group II. The incidence of respiratory failure in group I was 28%, and was 17.9% in group II. Respiratory failure was significantly lower ( p < 0.05) in group II. The reduction in the incidence of renal failure and paraplegia in the two groups was nonsignificant. In conclusion, the use of adjuncts and our improved experience allowed us to achieve a significant improvement in mortality and major morbidity rates in the group of patients operated on after 1998.
在过去几年中，手术技术和器官保护辅助手段的进步改善了胸主动脉瘤（TAA）和胸腹主动脉瘤（TAAA）手术修复的效果，尽管死亡率和发病率仍然值得关注。本回顾性研究的目的是确定辅助手段的使用是否会影响死亡率和发病率。1993年至2003年，我们对TAA（175例）和TAAA（178例）进行了353例手术。该系列被分为两个连续的组：第一组（1993年至1997年），选择性地使用左心房股动脉旁路进行远端主动脉灌注和脑脊液引流；第二组（1998年至2003年），常规使用辅助手段（在部分病例中结合采用侵入性较小的手术技术）。两组的院内总死亡率存在显著差异（p<0.05）：第一组为15.9%，第二组为8.6%。第一组截瘫或轻截瘫的总体发生率为8.3%，第二组为5.1%。第一组肾衰竭发生率为9.6%，第二组为4.1%。第一组呼吸衰竭发生率为28%，第二组为17.9%。第二组呼吸衰竭发生率显著较低（p<0.05）。两组肾衰竭和截瘫发生率的降低不显著。总之，辅助手段的使用以及我们经验的改进使我们在1998年后接受手术的患者组中，死亡率和主要发病率得到了显著改善。
