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开放胸腔腹腔大动脉瘤修复:来自国家服务的结果
Allison C Winarski1, Rachael O Forsythe1, Ian J Young1
1Scottish National Service for Thoracoabdominal Aneurysms, Royal Infirmary of Edinburgh, Edinburgh, UK.
The British journal of surgery
|January 27, 2026
概括
胸腔腹腔大动脉动脉瘤 (TAAA) 的开放性手术是持久的,但存在风险. 结果根据TAAA修复的程度有很大差异,某些手术的死亡率和脊髓缺血率更高.
科学领域:
- 心血管外科心血管外科
- 血管外科 血管外科
- 大动脉动脉瘤修复修复
背景情况:
- 开放式手术仍然是胸腔腹腔大动脉动脉瘤 (TAAA) 修复的持久方法.
- 然而,它与重大外科手术后并发症的相当大的风险有关,包括死亡率.
- 本研究评估了25年来TAAA开放维修的结果.
研究的目的:
- 描述开放胸腔腹腔大动脉动脉瘤 (TAAA) 修复的结果.
- 分析患者的生存率和并发症率.
- 评估修复程度对结果的影响.
主要方法:
- 对所有开放的TAAA修复 (1999-2023) 的程序细节和临床结果的回顾性审查.
- 主要结局:住院死亡率. 二级结局:生存率,永久脊髓缺血 (SCI),脏替代疗法和手术并发症.
- 卡普兰-梅尔分析比较了胸腔切除术 (克劳福德程度I-III,V) 与腹腔切除术 (克劳福德程度IV) 修复的生存率.
主要成果:
- 424名患者接受了开放的TAAA修复 (148名胸腔切除术,276名腹腔切除术).
- 住院死亡率总体为13.4%. 与腹腔切除术相比,胸腔切除术修复的30天死亡率 (23.6%) 和永久性SCI率 (8.8%) 较高.
- 第二级修复显示了最高的死亡率 (30.2%) 和SCI率 (14.3%). 估计的5年生存率总体为68.3%.
结论:
- 开放的TAAA维修与重大运营风险有关.
- 动脉瘤修复的程度是影响患者结果的关键因素.
- 基于修复程度的风险分层对于管理TAAA患者至关重要.
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