Bowers D, Cave W S
J R Soc Med. 1985 Oct;78(10):812-20. doi: 10.1177/014107688507801005.
One hundred and eighty-eight patients in whom the diagnosis of aneurysm of the abdominal aorta (AAA) was established after 1 January 1960 were followed until their deaths or to 31 December 1979. By the actuarial method, the cumulative 5-year risk of an intact aneurysm progressing to rupture was 35%; the observed 5-year survival rate for patients who had medical management for intact AAA was 30%, for patients who had elective surgery for AAA 74%, for patients who had emergency surgery for ruptured AAA 35%, and for those who did not have surgery for ruptured AAA 0%. Comparison of the non-operated and electively-operated groups of patients showed that the former was disproportionately weighted with older higher-risk patients, suggesting that the difference in survival rates for the two groups might be a reflection of patient selection rather than of surgical intervention. Comparison of the cumulative 5-year risk of rupture of an intact AAA with the cumulative 5-year mortality rate associated with elective surgery for intact AAA showed that elective surgery for intact AAA might be expected to result in a reduction in the cumulative 5-year mortality rates of patients with intact AAA.
1960年1月1日后确诊为腹主动脉瘤（AAA）的188例患者，随访至其死亡或1979年12月31日。采用精算方法，完整动脉瘤进展至破裂的累积5年风险为35%；对于完整AAA接受保守治疗的患者，观察到的5年生存率为30%，AAA接受择期手术的患者为74%，破裂AAA接受急诊手术的患者为35%，破裂AAA未接受手术的患者为0%。对未手术和择期手术患者组进行比较发现，前者中高风险老年患者比例过高，这表明两组生存率的差异可能反映的是患者选择而非手术干预。将完整AAA破裂的累积5年风险与完整AAA择期手术相关的累积5年死亡率进行比较表明，完整AAA择期手术可能会降低完整AAA患者的累积5年死亡率。
