老年主动脉瘤的临床病理分析

Clinicopathological characteristics of aortic aneurysm in elderly patients

目的 总结老年住院死亡病例尸体解剖中主动脉瘤的检出率及其临床病理特点.方法 人选北京医院病理科资料库中1969年4月1日至2013年10月31日间60 ～100岁的老年患者的系统病理解剖资料,共909例.回顾性分析其中经尸检病理证实存在主动脉瘤的病例,总结其病变性质、合并疾病特点和死亡原因.结果 909例尸体解剖资料中,主动脉瘤59例,检出率为6.5％,生前未诊断35例（59.3％）.与60 ～ 79岁的患者相比,80岁及以上的患者主动脉瘤检出率更高（10.2％比2.9％,x2=19.97,P＜0.01）.腹主动脉为最常见的发生部位（54例,91.5％）,多部位主动脉瘤检出率为20.3％（12例）.主动脉瘤合并冠心病44例（74.6％）,严重冠状动脉狭窄和三支病变分别达到21例（35.6％）和7例（11.9％）.死亡原因中居首位的是心脑血管疾病,达31例（52.5％）,其中包括主动脉瘤破裂致死亡7例（11.9％）.结论 80岁及以上老年住院死亡患者中主动脉瘤的比例较高,临床上易漏诊.老年主动脉瘤患者合并冠心病者多见,心脑血管疾病死亡的比例高.应加强老年人群中,特别是高龄老年人中主动脉瘤的早期筛查和综合评估.

Objective To explore the prevalence and clinicopathological features of aortic aneurysm （AA） in elderly inpatients at autopsy.Methods All the AA cases were retrospectively analyzed in 909 autopsy cases aged 60-100 years in our hospital.The pathological changes,comorbidities and death reasons were evaluated.Results AA was diagnosed pathologically in 59 patients （6.5%）,clinical diagnosis was not made in 37（62.7%） cases.The AA prevalence in patients aged ≥ 80 years was significantly higher than patients 〈 80 years （10.2% vs.2.9%,x2 =19.97,P 〈 0.01）.Abdominal AA was more common （91.5%） and the prevalence of multiple AA was 20.3%.Coronary artery disease （CAD） was diagnosed in 44 AA patients （74.6%） including 21 （35.6%） with severe coronary artery stenosis and 7（11.9%） with three-vessel disease,31 patients （52.5%） died of cardiac-cerebral diseases,including 7 （11.9%） with ruptured AA.Conclusions The prevalence of AA was high in elderly inpatients aged ≥ 80 years with a relatively high missed diagnosis rate.AA was often complicated with CAD.The main cause of death of AA patients was cardiac-cerebral diseases.The screening,evaluation and treatment of AA should be enhanced in elderly patients,especially in patients aged 80 years and over.