Kazmi Syed Sh, Krog Anne H, Berge Simen T, Sundhagen Jon O, Sahba Mehdi, Falk Ragnhild S
Department of Vascular Surgery, Division of Cardiovascular and Pulmonary Diseases, Oslo University Hospital.
Institute of Clinical Medicine, University of Oslo, Oslo.
Vasc Health Risk Manag. 2017 May 12;13:169-176. doi: 10.2147/VHRM.S134669. eCollection 2017.
In patients operated with laparoscopic aortobifemoral bypass (LABFB) for atherosclerotic obstruction in aortoiliac segment, the main focus of the reports published during the last two decades has been morbidity and mortality. The primary objective of this study was to examine the health-related quality of life (HRQL) in these patients before and after LABFB.
Fifty consecutive patients (27 females) with Trans-Atlantic Inter-Society Consensus II, type D lesions were prospectively included. Short-Form 36 (SF-36) questionnaire was used to get information about the HRQL before LABFB and at 1, 3 and 6 months after the operation. Main indication for LABFB was intermittent claudication. Linear mixed-effect models were used to assess changes in HRQL over time. Age, gender, smoking, blood loss, operation time, concomitant operation, the American Society of Anesthesiologists category, length of hospital stay, previous vascular procedures and aorta cross-clamping were used as fixed factors and their impact on the physical components of the SF-36, as well as the summary scores were determined with univariate analysis. Variables with <0.2 were included in the multivariate regression analysis. <0.05 was considered statistically significant.
Statistically significant improvement was found in all SF-36 domains as well as in the summary scores after LABFB compared to the preoperative scores. The improvement in scores was substantial already at 1 month and the effect was maintained at 3 and 6 months survey time points. Concomitant operations had a statistically significant negative impact on the physical components of SF-36. Data completeness of item questionnaires was 93% in the whole material. Reliability scale and homogeneity estimates for the eight domains had high internal consistency.
Patients operated with LABFB for Trans-Atlantic Inter-Society Consensus II, type D lesions have reduced HRQL. LABFB leads to substantial and statistically significant improvement in the patients' HRQL, when examined with SF-36. These results need to be replicated by a randomized clinical trial.
在因主-髂动脉段动脉粥样硬化性梗阻而接受腹腔镜主动脉双股动脉搭桥术（LABFB）的患者中，过去二十年发表的报告主要关注发病率和死亡率。本研究的主要目的是检查这些患者在LABFB术前和术后的健康相关生活质量（HRQL）。
前瞻性纳入50例连续的患有跨大西洋跨学会共识II型D病变的患者（27例女性）。使用简短健康调查问卷36项版（SF-36）来获取LABFB术前以及术后1个月、3个月和6个月时有关HRQL的信息。LABFB的主要指征是间歇性跛行。采用线性混合效应模型评估HRQL随时间的变化。将年龄、性别、吸烟、失血量、手术时间、同期手术、美国麻醉医师协会分级、住院时间、既往血管手术史和主动脉阻断作为固定因素，并通过单因素分析确定它们对SF-36身体成分以及汇总得分的影响。将系数<0.2的变量纳入多因素回归分析。P<0.05被认为具有统计学意义。
与术前评分相比，LABFB术后所有SF-36领域以及汇总得分均有统计学意义的改善。术后1个月时得分就有显著提高，并且在3个月和6个月的调查时间点效果得以维持。同期手术对SF-36的身体成分有统计学意义的负面影响。整个材料中项目问卷的数据完整性为93%。八个领域的信度量表和同质性估计具有较高的内部一致性。
因跨大西洋跨学会共识II型D病变接受LABFB手术的患者HRQL降低。当采用SF-36进行评估时，LABFB可使患者的HRQL得到显著且具有统计学意义的改善。这些结果需要通过随机临床试验进行验证。
