超高龄腹主动脉瘤患者治疗的单中心经验  

Single-center experience in treatment of super-elderly patients with abdominal aortic aneurysm

作　　者：陈可 杨金启 韩康 张洪悦 李文东 李晓强 Chen Ke;Yang Jinqi;Han Kang;Zhang Hongyue;Li Wendong;Li Xiaoqiang(Department of Vascular Surgery,Nanjing Drum Tower Hospital,the Affiliated Hospital of Nanjing University Medicine School,Nanjing 210008,Jiangsu,China)

机构地区：[1]南京大学医学院附属鼓楼医院血管外科,江苏南京210008

出　　处：《中国血管外科杂志(电子版)》2025年第1期29-32,共4页Chinese Journal of Vascular Surgery(Electronic Version)

基　　金：国家自然科学基金面上项目(82470517);南京市医技发展一般项目(YKK23105);南京鼓楼医院临床研究专项资金项目(2021-LCYJ-PY-09)。

摘　　要：目的探讨超高龄腹主动脉瘤(abdominal aortic aneurysm,AAA)患者的治疗选择及预后。方法回顾性收集南京大学医学院附属鼓楼医院2018年2月至2022年8月收治的25例90岁以上AAA患者临床资料,记录和分析腔内治疗和保守治疗的结果及随访情况。结果5例患者行保守治疗,20例腔内治疗患者均行腹主动脉腔内修复术。围手术期无患者死亡,7例患者出现手术相关并发症,包括穿刺点血肿、肺部感染、心功能不全,所有患者均无输血。患者随访时间为6~69个月,中位随访时间24个月。腔内治疗组15例患者死亡,动脉瘤相关死亡率为0;保守治疗组5例均死亡,其中动脉瘤破裂死亡2例。Kaplan-Meier分析提示腔内治疗组中位生存时间27个月,优于保守治疗组的15个月,差异有统计学意义(P=0.001)。结论超高龄AAA患者经充分评估后可积极手术治疗,手术风险可控,短期效果及预后相对满意。Objective To explore the treatment options and prognosis of super-elderly patients with abdominal aortic aneurysm(AAA).Methods The clinical data of 25 AAA patients aged over 90 years treated at Nanjing Drum Tower Hospital,the Affiliated Hospital of Nanjing University Medicine School from February 2018 to August 2022 were collected retrospectively.The outcomes and follow-up of endovascular aortic repair(EVAR)and conservative treatment were recorded and analyzed.Results Five patients underwent conservative treatment,while 20 patients underwent EVAR.No perioperative deaths occurred.Seven patients experienced procedure-related complications,including puncture site hematoma,pulmonary infection and cardiac insufficiency,with no blood transfusion required in any patient.The follow-up period ranged from 6 to 69 months,with a median follow-up of 24 months.In the endovascular group,15 patients died,but aneurysm-related mortality was 0.All five patients in the conservative treatment group died,including two deaths due to aneurysm rupture.Kaplan-Meier analysis revealed a median survival time of 27 months in the endovascular group,significantly longer than the 15 months in the conservative group(P=0.001).Conclusion Super-elderly patients with AAA can benefit from surgical intervention following comprehensive evaluation.The surgical risks are manageable,and the short-term outcomes and prognosis are relatively satisfactory.

关 键 词：超高龄 腹主动脉瘤 腔内治疗 预后 

分 类 号：R654.3[医药卫生—外科学]