Powell J T, Brown L C, Forbes J F, Fowkes F G R, Greenhalgh R M, Ruckley C V, Thompson S G
Vascular Surgery Research Group, Imperial College, Charing Cross Hospital, London, UK.
Br J Surg. 2007 Jun;94(6):702-8. doi: 10.1002/bjs.5778.
The aim was to determine whether early open surgical repair would benefit patients with small abdominal aortic aneurysm compared with surveillance on long-term follow-up.
The 1090 patients who were enrolled into the UK Small Aneurysm Trial between 1991 and 1995 were followed up for aneurysm repair and mortality until November 2005.
By November 2005, 714 patients (65.5 per cent) had died, 929 (85.2 per cent) had undergone aneurysm repair, 150 (13.8 per cent) had died without aneurysm repair and 11 (1.0 per cent) remained alive without aneurysm repair. After 12 years, mortality in the surgery and surveillance groups was 63.9 and 67.3 per cent respectively, unadjusted hazard ratio 0.90 (P = 0.139). Three-quarters of the surveillance group eventually had aneurysm repair, with a 30-day elective mortality of 6.3 per cent (versus 5.0 per cent in the early surgery group, P = 0.366). Estimates suggested that the cost of treatment was 17 per cent higher in the early surgery group, with a mean difference of 1326 pounds. The death rate in these patients was about twice that in the population matched for age and sex.
There was no long-term survival benefit of early elective open repair of small abdominal aortic aneurysms. Even after successful aneurysm repair, the mortality among these patients was higher than in the general population.
目的是确定与长期随访监测相比，早期开放性手术修复对小腹主动脉瘤患者是否有益。
对1991年至1995年纳入英国小动脉瘤试验的1090例患者进行随访，观察动脉瘤修复情况及死亡率，直至2005年11月。
至2005年11月，714例患者（65.5%）死亡，929例（85.2%）接受了动脉瘤修复，150例（13.8%）未行动脉瘤修复死亡，11例（1.0%）未行动脉瘤修复仍存活。12年后，手术组和监测组的死亡率分别为63.9%和67.3%，未调整的风险比为0.90（P = 0.139）。监测组四分之三的患者最终接受了动脉瘤修复，择期手术30天死亡率为6.3%（早期手术组为5.0%，P = 0.366）。估计表明，早期手术组的治疗费用高出17%，平均差值为1326英镑。这些患者的死亡率约为年龄和性别匹配人群的两倍。
早期选择性开放性修复小腹主动脉瘤无长期生存益处。即使动脉瘤修复成功，这些患者的死亡率仍高于一般人群。
