Perko M J, Nørgaard M, Herzog T M, Olsen P S, Schroeder T V, Pettersson G
Department of Cardiothoracic Surgery, Rigshospitalet, Copenhagen, Denmark.
Ann Thorac Surg. 1995 May;59(5):1204-9. doi: 10.1016/0003-4975(95)00132-5.
From 1984 to 1993, 1,053 patients were admitted with aortic aneurysm (AA) and 170 (15%) were not operated on. The most frequent reason for nonoperative management was presumed technical inoperability. Survivals for patients with thoracic, thoracoabdominal, and abdominal AA were comparable. No significant differences in survival for patients with dissecting and nondissecting AA were detected. In all, 132 patients (78%) died and 78 (59%) of them died of rupture. Mean time to rupture was 1,300 +/- 8 days. Cumulative 5-year hazard of rupture for the dissecting AA was twice that of the nondissecting (p < 0.001). Hazards of rupture for type A and B dissections were comparable. Diameter of 6 cm or greater was associated with a fivefold increase in cumulative hazard of rupture (p < 0.001). Diameter of AA, incidence of renal failure, and arterial hypertension were predictive of mortality, whereas the first two variables were predictive of rupture. In conclusion, because the majority of patients in all subgroups died of rupture, all patients should be recognized as candidates for surgical treatment. Present data justify aggressive approach to the patient with AA 6 cm or more in diameter and type A dissections. The results suggest that type B dissections may have a more favorable course if operated on, but a prospective, randomized study is necessary to confirm this observation. We believe that older patients and those with a small aneurysm may benefit from early, elective operation.
1984年至1993年期间，1053例患者因主动脉瘤（AA）入院，其中170例（15%）未接受手术治疗。非手术治疗最常见的原因是推测技术上无法手术。胸主动脉瘤、胸腹主动脉瘤和腹主动脉瘤患者的生存率相当。未发现夹层主动脉瘤和非夹层主动脉瘤患者在生存率上有显著差异。总共有132例患者（78%）死亡，其中78例（59%）死于破裂。破裂的平均时间为1300±8天。夹层主动脉瘤的5年累积破裂风险是非夹层主动脉瘤的两倍（p<0.001）。A型和B型夹层的破裂风险相当。直径6cm或更大与累积破裂风险增加五倍相关（p<0.001）。主动脉瘤直径、肾衰竭发生率和动脉高血压可预测死亡率，而前两个变量可预测破裂。总之，由于所有亚组中的大多数患者死于破裂，所有患者都应被视为手术治疗的候选者。目前的数据证明对直径6cm或更大的主动脉瘤患者和A型夹层患者采取积极的治疗方法是合理的。结果表明，B型夹层如果接受手术治疗可能有更有利的病程，但需要进行前瞻性随机研究来证实这一观察结果。我们认为老年患者和小动脉瘤患者可能从早期择期手术中获益。
