腹主动脉瘤腔内修复技术在90岁以上老年患者中应用的评价  

Evaluation of endovascular abdominal aortic aneurysm repair in nonagenarians

作　　者：张宏鹏[1] 郭伟[1] 刘小平[1] 尹太[1] 贾鑫[1] 熊江[1] 马晓辉[1] 

机构地区：[1]解放军总医院血管外科,北京100853

出　　处：《中华老年多器官疾病杂志》2011年第6期504-507,共4页Chinese Journal of Multiple Organ Diseases in the Elderly

摘　　要：目的探讨年龄逾90岁的腹主动脉瘤(AAA)患者行腔内修复术治疗的安全性和有效性。方法 2003年5月至2011年3月,12例年龄逾90岁的AAA患者接受主动脉腔内修复技术(EVAR)治疗,其中急诊手术2例。平均年龄(91.7±1.5)岁,其中11例为男性(91.7%)。统计技术成功率、围手术期并发症、死亡率;术后3,6,9,12个月及每年进行随访,进行CT或超声检查。结果 7例行全身麻醉,5例行局部麻醉,技术成功率为100%,无中转开刀手术患者;2例采用Endurant支架,4例采用Talent支架,6例采用Zenith支架;手术时间(3.4±1.3)h,出血量(220.5±60.5)ml,术后住院时间(8.4±2.3)d;30d死亡率为8.3%,1年死亡率为16.7%,3年死亡率为41.7%,5年死亡率为75%;11例术后30d仍存活的患者,平均术后生存时间为28.5个月(9～73个月)。结论对于年龄逾90岁的AAA患者,EVAR手术成功率高,围手术期死亡率和并发症发生率低,但从中远期结果来看部分患者的手术获益是有限的,因此术前个体化评估十分重要。Objective To investigate the safety and efficacy of endovascular abdominal aortic aneurysm repair（EVAR）in nonagenarians.Methods From May 2003 to March 2011,12 nonagenarian abdominal aortic aneurysm（AAA） patients,including 2 emergency cases,were treated with endovascular repair.Mean age was（91.7±1.5） years,ranging 90—95 years,and there including 2 emergency cases,were 11 males（91.7%）.Technical success rate,perioperative complications and mortality were evaluated. Follow-up protocol consisted of computed tomography（CT） or ultrasound examinations performed at 3,6,9,12 months,and annually thereafter.Results Seven patients were operated under general anesthesia and five under local anesthesia.The technical success rate was 100%,with no need for open conversion.Two Endurant endogafts,four Talent endografts and six Zenith endografts were used.Mean operatiion time was（3.4±1.3）h,mean procedural blood loss was（220.5±60.5）ml,and mean postoperative hospital stay length was（8.4±2.3）d.Mortality rates were 8.3%at 30 days,16.7%at 1 year,41.7%at 3 years and 75%at 5 year.Mean survival of the eleven patients who expired beyond the first 30 days was 28.5 months,ranging 9～73 months.Conclusion EVAR in nonagenarians is associated with acceptable procedural success and perioperative morbidity and mortality.The medium and long-term results suggest that EVAR may be of limited benefit in some patients who are aged over 90 years.So the individual patient selection is very important.

关 键 词：主动脉瘤 腹 支架 血管修复术 老年人 90岁以上 

分 类 号：R543.1[医药卫生—心血管疾病]