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胸腹主动脉瘤修复术后的功能结局。

Functional outcome after thoracoabdominal aneurysm repair.

作者信息

Crawford Robert S, Pedraza Juan D, Chung Thomas K, Corey Michael, Conrad Mark F, Cambria Richard P

机构信息

Division of Vascular and Endovascular Surgery of the General Surgical Services, Massachusetts General Hospital and Harvard Medical School, Boston, Mass, USA.

出版信息

J Vasc Surg. 2008 Oct;48(4):828-35. doi: 10.1016/j.jvs.2008.05.018. Epub 2008 Jul 26.

Abstract

OBJECTIVES

Previous reports have documented perioperative outcomes and major complications (renal failure, spinal cord ischemia, death) after repair of aneurysms of the thoracoabdominal aorta (TAA). This study documented long-term functional outcomes after open TAA repair.

METHODS

The Medical Outcomes Study Short-Form 36-Item Survey (SF-36) was administered to 134 survivors (83 men, 51 women; mean age, 69.5 years) of TAA repair at a mean follow-up from surgery of 60 +/- 38.7 months. Raw scores were compared against cohorts adjusted for age and comorbidity (cardiovascular disease). Assessed was the influence of preoperative and intraoperative factors, as well as postoperative complications on long-term quality of life (QOL).

RESULTS

Raw scores for the eight SF-36 domains and the composite physical and mental component scores were lower (P < .01) in the TAA cohort compared with an age-adjusted reference population. Female gender and age >75 years decreased the physical functioning (P = .02) and role physical (P = .04) domains compared with male gender and patients <65 years old. Previously recognized systemic vascular disease lowered QOL in three SF-36 domains: general health (P = .013), social functioning (P = .003), and role emotional (P = .003); systemic vascular disease also showed a strong trend toward reduction in physical functioning (P = .09) compared with patients without systemic vascular disease. Neither TAA extent (I to IV) nor elective vs urgent/emergency operation influenced long-term QOL in our cohort. Patients with postoperative paraplegia, cerebrovascular accident/cardiac event, and those requiring reoperation showed lower scores in the physical functioning (P = .036), general health (P = .02), and Mental Health (P = .04) domains. Increased length of stay negatively impacted long-term QOL. The TAA cohort and the cardiovascular disease cohort had similar SF-36 scores for four domains (general health, bodily pain, vitality, and social functioning) and physical component scores. The cardiovascular disease group had higher scores in the physical functioning, role physical, role emotional, and mental health domains, and in mental component scores (P < .01).

CONCLUSION

Permanent loss of functional capacity, measured at a mean of 5 years postoperatively, occurs rarely in survivors of TAA repair. Further studies are needed to define the role of hybrid or endovascular strategies, including their impact on long-term functional outcome compared with open TAA repair.

摘要

目的

既往报告记录了胸腹主动脉瘤(TAA)修复术后的围手术期结局和主要并发症(肾衰竭、脊髓缺血、死亡)。本研究记录了开放性TAA修复术后的长期功能结局。

方法

对134例TAA修复术幸存者(83例男性,51例女性;平均年龄69.5岁)进行医学结局研究简明健康调查问卷(SF - 36)评估,手术平均随访时间为60±38.7个月。将原始分数与根据年龄和合并症(心血管疾病)调整的队列进行比较。评估术前和术中因素以及术后并发症对长期生活质量(QOL)的影响。

结果

与年龄调整后的参考人群相比,TAA队列中SF - 36八个领域的原始分数以及综合身体和心理成分分数较低(P <.01)。与男性和年龄<65岁的患者相比,女性和年龄>75岁降低了身体功能(P =.02)和身体角色(P =.04)领域的得分。先前公认的全身性血管疾病在SF - 36的三个领域降低了生活质量:总体健康(P =.013)、社会功能(P =.003)和情感角色(P =.003);与无全身性血管疾病的患者相比,全身性血管疾病在身体功能方面也有强烈的降低趋势(P =.09)。在我们的队列中,TAA范围(I至IV)以及择期手术与急诊/紧急手术均未影响长期生活质量。术后截瘫、脑血管意外/心脏事件的患者以及需要再次手术的患者在身体功能(P =.036)、总体健康(P =.02)和心理健康(P =.04)领域得分较低。住院时间延长对长期生活质量产生负面影响。TAA队列和心血管疾病队列在四个领域(总体健康、身体疼痛、活力和社会功能)以及身体成分分数方面具有相似的SF - 36得分。心血管疾病组在身体功能、身体角色、情感角色和心理健康领域以及心理成分分数方面得分较高(P <.01)。

结论

在TAA修复术幸存者中,术后平均5年测量的功能能力永久性丧失很少见。需要进一步研究来确定杂交或血管内策略的作用,包括与开放性TAA修复相比它们对长期功能结局的影响。

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