Pressler V, McNamara J J
J Thorac Cardiovasc Surg. 1985 Jan;89(1):50-4.
In a 1980 review of the natural history and treatment of 176 thoracic aortic aneurysms, we noted the high incidence of rupture (47% overall) in 135 patients not treated surgically. Since that original study we have added another 84 patients to our series and have noted a complete change in management such that most patients are now treated surgically. We now have 260 patients in our series, 126 of whom were treated surgically. Sixty-seven were emergency operations and 59 were elective. Surgical mortality was 8% for elective resection and 33% for emergency operation. Over the past 5 years these figures have improved to 5% surgical mortality for elective resection and 16% surgical mortality for emergency resection. The 5 year survival rates for the entire series were 50% for patients treated with elective operation, 30% for combined emergency and elective operation groups, and 21% for nonsurgically treated patients. Abdominal aortic aneurysm was present in 74 patients (28%) and 23 of these patients had undergone a prior resection of an abdominal aortic aneurysm. This series documents the improved survival of patients with aneurysms of the thoracic aorta who are treated with prompt surgical intervention. It also further substantiates earlier findings of a high incidence of aneurysms of the abdominal aorta in this patient population.
在1980年对176例胸主动脉瘤自然病史及治疗情况的综述中，我们注意到135例未接受手术治疗的患者中破裂发生率很高（总体为47%）。自那项最初的研究以来，我们的病例系列又增加了84例患者，并且注意到治疗方式发生了彻底改变，现在大多数患者接受手术治疗。我们的病例系列现在有260例患者，其中126例接受了手术治疗。67例为急诊手术，59例为择期手术。择期切除的手术死亡率为8%，急诊手术为33%。在过去5年中，这些数字已改善为择期切除的手术死亡率为5%，急诊切除为16%。整个系列中，接受择期手术患者的5年生存率为50%，急诊和择期手术联合组为30%，未接受手术治疗的患者为21%。74例患者（28%）存在腹主动脉瘤，其中23例患者此前已接受腹主动脉瘤切除术。该病例系列证明了接受及时手术干预治疗的胸主动脉瘤患者生存率有所提高。它还进一步证实了此前关于该患者群体腹主动脉瘤高发生率的研究结果。
