Humphreys W V, Evans F, Watkin G, Williams T
Department of Vascular Surgery, Gwynedd Hospital, Bangor, UK.
Br J Surg. 1995 Oct;82(10):1361-3. doi: 10.1002/bjs.1800821022.
A total of 114 reconstructions were performed in 82 octogenarian patients and the results compared with those of 33 patients who had primary amputation. The operative mortality rate was higher after amputation (45 versus 11 per cent) and the mean survival less (25 versus 34 months). Quality of life assessment using a Rosser scale suggested that, although there was no improvement in the 38 per cent with a failed reconstruction, there was a significant improvement in the 62 per cent whose reconstruction remained patent. There was minimal improvement in quality of life after primary amputation and this was due to relief of pain. Costs (including the costs of revisions and community costs) were assessed in detail. Although the mean total operative costs of reconstruction were higher than those of amputation (10,222 pounds versus 6475 pounds) this was more than offset by the high community costs of amputation. The total cost of reconstruction was 13,546 pounds, compared with 33,095 pounds for amputation. Following reconstruction 66 per cent of those patients independent before critical limb ischaemia occurred were able to return to their own home; only 33 per cent of amputees were able to do so.
对82名老年患者共进行了114次重建手术，并将结果与33名接受初次截肢手术的患者进行了比较。截肢后的手术死亡率更高（45%对11%），平均生存期更短（25个月对34个月）。使用罗瑟量表进行的生活质量评估表明，虽然重建失败的38%患者生活质量没有改善，但重建保持通畅的62%患者生活质量有显著改善。初次截肢后生活质量改善极小，这是由于疼痛缓解。详细评估了费用（包括翻修费用和社区费用）。虽然重建手术的平均总手术费用高于截肢手术（10222英镑对6475英镑），但截肢手术高昂的社区费用大大抵消了这一差异。重建的总成本为13546英镑，而截肢的总成本为33095英镑。在发生严重肢体缺血之前能够独立生活的患者中，66%在重建后能够回家；只有33%的截肢患者能够做到这一点。
