高龄腹主动脉瘤患者的治疗与预后分析

Evaluation of treatment and prognosis of abdominal aortic aneurysm in octogenarians

目的探讨80岁以上高龄腹主动脉瘤患者的治疗选择及其预后。方法回顾性分析中山大学附属第一医院2015年1月至2019年12月70例80岁以上腹主动脉瘤患者资料,其中腔内治疗45例,开放手术5例,保守治疗20例。结果腔内治疗组围术期死亡率6.7%(3/45),开放手术组死亡率20.0%(1/5)。随访2~65个月(中位随访时间21.75个月),腔内治疗组随访期间死亡10例,失访1例,动脉瘤相关死亡率2.4%(1/41),累计生存率75.6%(31/41);开放手术组死亡2例,动脉瘤相关死亡率0%,累计生存率50.0%(2/4);保守治疗组死亡7例,失访3例,动脉瘤相关死亡率41.2%(7/17),累计生存率58.8%(10/17)。Kaplan-Meier生存分析提示腔内手术组优于保守治疗组,差异有统计学意义(P=0.029)。结论高龄腹主动脉瘤患者经充分评估后可积极手术治疗,首选手术方式为腔内治疗。开放手术和保守治疗可用于不满足腔内手术条件的患者。

Objective To explore the option of therapy and prognosis of elderly(>80 years,octogenarians)abdominal aortic aneurysms(AAA)patients.Methods The data of 70 octogenarians with AAA from January 2015 to December 2019 in the First Affiliated Hospital of Sun Yat-sen University were analyzed retrospectively.Among them,45 received endovascular treatment,5 received open surgery and 20 received conservative treatment.Results The perioperative mortality rate was 6.7%(3/45)in the endovascular treatment group,and 20.0%(1/5)in the open surgery group.The Follow-up time was 2 to 65 months(median follow-up time of 21.75 months).In the endovascular treatment group,10 patients died and one patient was lost to follow-up.The aneurysm-related mortality rate was 2.4%(1/41),and the cumulative survival rate was 75.6%(31/41).Two patients died in the open surgery group.The aneurysm-related mortality was 0%,and the cumulative survival rate was 50.0%(2/4).Seven patients in the conservative treatment group died,and three patients was lost to follow-up.The aneurysm-related mortality was 41.2%(7/17),and the cumulative survival rate was 58.8%(10/17).Kaplan-Meier survival analysis indicated that the endovascular treatment group was better than the conservative treatment group,and the difference was statistically significant(P=0.029).Conclusion Surgical treatment would be a reasonable option of treatment for octogenarian AAA patient with full assessment,and the first choice is endovascular treatment.Open surgery and conservative treatment can be used for patients who do not meet the conditions endovascular treatment.