St. George's Vascular Institute, St. George's Healthcare NHS Trust, London, United Kingdom.
J Vasc Surg. 2012 Aug;56(2):520-7. doi: 10.1016/j.jvs.2012.02.062.
Morbidity and mortality have traditionally been used as key markers of surgical outcome. However, as complication rates associated with abdominal aortic aneurysm (AAA) repair decrease, subjective measures, such as quality of life (QOL), are increasingly recognized as important indicators of treatment efficacy and quality of care. This review presents the existing evidence relating to QOL changes in patients undergoing AAA repair by open repair (OR) and endovascular techniques (EVAR) and challenges current misconceptions about the relative effect of these two procedures.
A comprehensive literature search was performed to identify studies relating to QOL or health status in AAA repair. Quality of included studies was assessed according to Scottish Intercollegiate Guidelines Network methodology.
Twenty-three studies satisfied the inclusion criteria. Preoperative QOL in AAA patients has been previously suggested as being worse than that of the general population, that OR patients have a worse QOL in the early postoperative period, and that EVAR patients have a worse QOL in the longer term. None of these assertions is uniformly supported in the literature. From the existing evidence, no clear conclusions can be drawn about the relative QOL benefits of OR vs EVAR.
There are a paucity of good-quality data relating to health status and QOL in patients undergoing AAA repair. Little is known about the prevalence of preoperative or postoperative symptoms and the degree to which these influence patient well-being. Further investigation is needed to clarify health status and QOL changes in these patients and allow clinicians to make targeted improvements in practice.
发病率和死亡率一直被用作手术结果的关键指标。然而，随着腹主动脉瘤（AAA）修复相关并发症发生率的降低，生活质量（QOL）等主观指标越来越被认为是治疗效果和护理质量的重要指标。本文综述了经开放修复（OR）和血管内技术（EVAR）治疗的 AAA 患者 QOL 变化的现有证据，并挑战了目前对这两种手术相对效果的误解。
进行了全面的文献检索，以确定与 AAA 修复相关的 QOL 或健康状况的研究。根据苏格兰校际指南网络方法评估纳入研究的质量。
23 项研究符合纳入标准。先前有研究表明，AAA 患者的术前 QOL 比一般人群差，OR 患者在术后早期 QOL 更差，EVAR 患者在长期随访中 QOL 更差。这些说法在文献中并没有得到一致的支持。根据现有证据，无法明确得出 OR 与 EVAR 相对 QOL 获益的结论。
关于接受 AAA 修复的患者的健康状况和 QOL 的高质量数据很少。对于术前或术后症状的发生率以及这些症状对患者幸福感的影响程度知之甚少。需要进一步调查，以阐明这些患者的健康状况和 QOL 变化，并使临床医生能够在实践中进行有针对性的改进。
