Perioperative Risk Factors for Mortality in Non-infected Abdominal Aortic Aneurysm

非感染性腹部主動脈瘤手術治療前後死亡危險因素的探討

吳東和(Tung-Ho Wu) ； 吳介任(Chieh-Ten Wu) ； 林玫娜(Mei-Na Lin) ； 林俊堯(Chun-Yao Lin) ； 趙廷光(Ting-Kuang Chao) ； 林伯彥(Bor-Yan Lin) ； 潘俊彥(Jun-Yan Pan) ； 盧麗芬(Anna Lo) ； 康沛倫(Pei-Luen Kang) ； 鄭國琪(Kwok-Kei Cheng)

《Formosan Journal of Surgery》 38卷5期 (2005/10) Pp. 215-222

https://doi.org/10.29833/FJS.200510.0001

摘要

腹部主動脈瘤為一種常見，且機率日益增多的疾病。由於手術方法、人工血管材料，及病人篩選的進步，大大提高腹部主動脈瘤手術的成功率。本研究目的為探討腹部主動脈瘤手術前後的危險因素與手術結果的相關性。
從1989年到2003年12月間，本院先後有115位病患接受腹部主動脈瘤手術，99位為男性，16位為女性，平均年齡為71.4歲。依據術前所做的電腦斷層診斷，腹部主動脈瘤沒有破裂的有91位，有破裂性腹部主動脈瘤者共24位。
術前腹部主動脈瘤未破裂者，手術死亡率為3.3%；術前腹部主動脈瘤破裂者為66.7%，兩者差異有統計學上的意義。進一步分析，在多項分析中，術前破裂、休克、緊急手術之需要將增加手術的危險性。但年齡、性別兩項在本探討分析中無顯著意義。
所以我們認為早期的診斷與提前手術治療將可有效提昇手術結果。

並列摘要

Background: This study assesses the surgical outcome of non-infected nonruptured abdominal aortic aneurysm (AAA) and ruptured AAA, and defines the risk factors of death.
Methods: We studied 115 consecutive patients who underwent conventional operations for non-infective abdominal aortic aneurysm between July 1989 and December 2003. The 115 patients were divided into two groups according to the preoperative findings of the computed tomography (CT) scan. In group I (n=91), the patients had AAA without CT evidence of preoperative rupture of the abdominal aorta. In group Ⅱ (n=24), the patients had AAA with CT evidence of preoperative rupture of the abdominal aorta. Rupture was defined as free blood in the retroperitoneal or peritoneal space. Data were collected by retrospective chart review. Both univariate and multivariate analyses were used as risk factors for death.
Results: From 1989 to 2003, 115 patients underwent operations for abdominal aortic aneurysm. The average patients age was 71.4±7.1 years (range, 40 to 87 years), and 99(86%) were male. Twenty-four patients were operated upon in ruptured state. The overall hospital mortality was 16.5%(19/115): 66.7%(16/24) in patients with ruptured abdominal aortic aneurysm and 3.3%(3/91) in patients with nonruptured abdominal aortic aneurysm. Risk factors for death were presence of rupture, preoperative shock and necessity for emergency operation.
Conclusions: Mortality rates after AAA repair in our hospital were comparable with those previously reported in other series. Major determinants of surgical mortality in patients with abdominal aortic aneurysm were preoperative complications. Early diagnosis and operation before aneurysm rupture were essential for survival.

並列關鍵字

Abdominal aortic aneurysm ； rupture ； mortality ； complications