Flanigan D P, Quinn T, Kraft R O
Surg Gynecol Obstet. 1980 Feb;150(2):171-6.
One hundred and eighty-seven patients with abdominal aortic aneurysm seen during a 15 year period were denied operation at the time of initial evaluation because of the small size of the aneurysm or serious medical contraindications, or both. Seven patients were operated upon because of rupture, 16 because of symptomatic expansion, 13 because of increase in size to greater than 6 centimeters and six because of improvement in medical status. Operative related deaths occurred in five of the seven patients operated upon for rupture, four of the 16 patients operated upon because of symptomatic expansion and one of the 19 patients operated upon electively. Of the 153 patients selectively observed, 74 died during the follow-up period; 20 deaths were aneurysm related. while 54 deaths were due to associated disease. Sixteen of 18 patients with a rupture of the aneurysm died as a result. In the entire group of 187 patients, the cumulative survival rate was 44 per cent at five years and 27 per cent at ten years. Results of this study support the current management of high risk patients with abdominal aortic aneurysms but suggest that there is a need for an even more aggressive approach to patient selection.
在15年期间就诊的187例腹主动脉瘤患者，在初次评估时因动脉瘤尺寸小、存在严重医学禁忌证或两者皆有而未接受手术。7例患者因动脉瘤破裂接受手术，16例因有症状的动脉瘤扩张接受手术，13例因动脉瘤尺寸增大至超过6厘米接受手术，6例因医学状况改善接受手术。在因动脉瘤破裂接受手术的7例患者中，有5例发生手术相关死亡；在因有症状的动脉瘤扩张接受手术的16例患者中，有4例发生手术相关死亡；在择期接受手术的19例患者中，有1例发生手术相关死亡。在153例接受选择性观察的患者中，74例在随访期间死亡；20例死亡与动脉瘤相关，54例死亡归因于相关疾病。18例动脉瘤破裂患者中有16例因此死亡。在这187例患者的整个队列中，5年累积生存率为44%，10年累积生存率为27%。本研究结果支持目前对腹主动脉瘤高危患者的管理方式，但表明在患者选择方面需要采取更积极的方法。
