90歳以上の高齢者に対する腹部大動脈瘤手術の手術成績ならびに遠隔成績についての検討
1995年4月から2002年6月に施行した90歳以上の高齢者に対する腹部大動脈瘤(AAA)手術8例を対象とした.男性7例,女性1例.平均年齢90.8±1.4歳(90～94歳).緊急手術は4例でこのうち術前ショックを1例に認めた.術前の併存疾患は高血圧症4例,虚血性心疾患,播種性血管内凝固,胸膜炎をそれぞれ1例に認めた.AAAの最大径は69.5±16.6mm(48～10mm)であり,全例全腹部正中切開を行った.手術成績は全例軽快退院した.術後合併症は,術後譫妄2例,無気肺,イレウスを1例ずつ認めた.遠隔成績は,遠隔死亡5例で,死亡原因は肺炎2例,老衰,心不全,吻合部仮性瘤破裂がそれぞれ1例であっ...
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| Published in | 日本心臓血管外科学会雑誌 Vol. 32; no. 4; pp. 206 - 208 |
|---|---|
| Main Authors | , , , , , , , |
| Format | Journal Article |
| Language | Japanese |
| Published |
特定非営利活動法人 日本心臓血管外科学会
15.07.2003
特定非営利活動法人日本心臓血管外科学会 The Japanese Society for Cardiouascular Surgery |
| Subjects | |
| Online Access | Get full text |
| ISSN | 0285-1474 1883-4108 |
| DOI | 10.4326/jjcvs.32.206 |
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| Abstract | 1995年4月から2002年6月に施行した90歳以上の高齢者に対する腹部大動脈瘤(AAA)手術8例を対象とした.男性7例,女性1例.平均年齢90.8±1.4歳(90～94歳).緊急手術は4例でこのうち術前ショックを1例に認めた.術前の併存疾患は高血圧症4例,虚血性心疾患,播種性血管内凝固,胸膜炎をそれぞれ1例に認めた.AAAの最大径は69.5±16.6mm(48～10mm)であり,全例全腹部正中切開を行った.手術成績は全例軽快退院した.術後合併症は,術後譫妄2例,無気肺,イレウスを1例ずつ認めた.遠隔成績は,遠隔死亡5例で,死亡原因は肺炎2例,老衰,心不全,吻合部仮性瘤破裂がそれぞれ1例であった.遠隔生存率は1年,2年,3年がそれぞれ88±12%,63±17%,20±18%と不良であったが,期待生存率との差は少なかった.手術成績ならびに遠隔成績はほぼ良好であり90歳以上の高齢者であっても,積極的に手術を勧めるべきであると思われる |
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| AbstractList | 1995年4月から2002年6月に施行した90歳以上の高齢者に対する腹部大動脈瘤(AAA)手術8例を対象とした.男性7例,女性1例.平均年齢90.8±1.4歳(90～94歳).緊急手術は4例でこのうち術前ショックを1例に認めた.術前の併存疾患は高血圧症4例,虚血性心疾患,播種性血管内凝固,胸膜炎をそれぞれ1例に認めた.AAAの最大径は69.5±16.6mm(48～10mm)であり,全例全腹部正中切開を行った.手術成績は全例軽快退院した.術後合併症は,術後譫妄2例,無気肺,イレウスを1例ずつ認めた.遠隔成績は,遠隔死亡5例で,死亡原因は肺炎2例,老衰,心不全,吻合部仮性瘤破裂がそれぞれ1例であった.遠隔生存率は1年,2年,3年がそれぞれ88±12%,63±17%,20±18%と不良であったが,期待生存率との差は少なかった.手術成績ならびに遠隔成績はほぼ良好であり90歳以上の高齢者であっても,積極的に手術を勧めるべきであると思われる 1995年4月から2002年6月に施行した90歳以上の高齢者に対する腹部大動脈瘤(AAA)手術8例を対象とした.男性7例,女性1例.平均年齢90.8±1.4歳(90〜94歳).緊急手術は4例でこのうち術前ショックを1例に認めた.術前の併存疾患は高血圧症4例,虚血性心疾患,播種性血管内凝固,胸膜炎をそれぞれ1例に認めた.AAAの最大径は69.5±16.6mm(48〜100mm)であり,全例全腹部正中切開を行った.手術成績は全例軽快退院した.術後合併症は,術後譫妄2例,無気肺,イレウスを1例ずつ認めた.遠隔成績は,遠隔死亡5例で,死亡原因は肺炎2例,老衰,心不全,吻合部仮性瘤破裂がそれぞれ1例であった.遠隔生存率は1年,2年,3年がそれぞれ88±12%,63±17%,20±18%と不良であったが,期待生存率との差は少なかった.手術成績ならびに遠隔成績はほぼ良好であり90歳以上の高齢者であっても,積極的に手術を勧めるべきであると思われる. Of 225 patients who underwent surgery for abdominal aortic aneurysm from April 1995 to June 2002, 8 patients, or 3.6%, aged 90 years or more (mean age 90.8±1.4, range 90 to 94, 7 men and 1 woman) were the subjects of this study. Four of these patients (50%) underwent emergency surgery. Of these 4 patients, preoperative shock was found in 1 patient. Preoperative complications were hypertension in 4 (50%), ischemic heart disease in 1 (13%), disseminated intravascular coagulation syndrome in 1 (13%), and pleuritis in 1 (13%). The maximum diameter of AAA was 69.5±16.6mm (range 48 to 100mm). The surgical procedure was median laparotomy. Long-term follow-up by the attending physician, or questionnaire by phone was completed for all patients and range to 6.3 years (median, 2.4 years). There were no hospital deaths. Postoperative complications were delirium in 2 (25%), atelectasis in 1 (13%), and ileus in 1 (13%). There were 5 (63%) late deaths. The causes of death were pneumonia in 2, senescence in 1, cardiac failure in 1, and rupture of a pseudoaneurysm at the anastmotic site in 1. Long-term survivals at 1 year, 2 years, and 3 years were 88±12%, 63±17%, and 20±18%, respectively, whereas expected survivals at 1, 2, and 3 years were 82%, 65%, and 51%, respectively. Long-term survivals were not good, but no significant difference was found between long-term and expected survivals. Therefore, this surgical and long-term treatment can achieve satisfactory results. This result led us to recommend performing the operation for patients aged 90 years or more, except if they were bedridden, had severe dementia, or were at the end stage of a malignant disease. |
| Author | 中川, 隆司 八百, 英樹 山村, 光弘 宮本, 魏 田中, 宏衞 向井, 資正 良本, 政章 稲井, 理仁 |
| Author_FL | MIYAMOTO Takashi TANAKA Hiroe INAI Yoshihito NAKAGAWA Takashi MUKAI Sukemasa YAMAMURA Mitsuhiro RYOMOT Masaaki YAO Hideki |
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| References | 1) Hu, Y. H., Shimizu, H., Kawakami, N. et al.: Increasing trends in mortality rate of aortic aneurysms in Japan, 1955-90. Tohoku J. Exp. Med. 171: 221-228, 1993. 4) Darling, R. C., Messina, C. R., Brewster, D. C. et al.: Autopsy study of unoperated abdominal aortic aneurysms. The case for early resection. Circulation 56 (Suppl.): II 161-II 164, 1977. 5) Lederle, F. A., Johnson, G. R., Wilson, S. E. et al.: Rupture rate of large abdominal aortic aneurysms in patients refusing or unfit for elective repair. J. A. M. A. 287: 2968-2972, 2002. 7) Heikkinen, M., Salenius, J. P. and Auvinen, O.: Ruptured abdominal aortic aneurysm in a well-defined geographic area. J. Vasc. Surg. 36: 291-296, 2002. 2) Brady, A. R., Brown, L. C., Fowkes, F. G. R. et al.: Long-term outcomes of immediate repair compared with surveillance of small abdominal aortic aneurysms. N. Engl. J. Med. 346: 1445-1452, 2002. 3) Lederle, F. A., Wilson, S. E., Johnson, G. R. et al.: Immediate repair compared with surveillance of small abdominal aortic aneurysms. N. Engl. J. Med. 346: 1437-1444, 2002. 6) Bown, M. J., Sutton, A. J., Bell, P. R. et al.: A metaanalysis of 50 years of ruptured abdominal aortic aneurysm repair. Br. J. Surg. 89: 714-730, 2002. |
| References_xml | – reference: 3) Lederle, F. A., Wilson, S. E., Johnson, G. R. et al.: Immediate repair compared with surveillance of small abdominal aortic aneurysms. N. Engl. J. Med. 346: 1437-1444, 2002. – reference: 6) Bown, M. J., Sutton, A. J., Bell, P. R. et al.: A metaanalysis of 50 years of ruptured abdominal aortic aneurysm repair. Br. J. Surg. 89: 714-730, 2002. – reference: 5) Lederle, F. A., Johnson, G. R., Wilson, S. E. et al.: Rupture rate of large abdominal aortic aneurysms in patients refusing or unfit for elective repair. J. A. M. A. 287: 2968-2972, 2002. – reference: 4) Darling, R. C., Messina, C. R., Brewster, D. C. et al.: Autopsy study of unoperated abdominal aortic aneurysms. The case for early resection. Circulation 56 (Suppl.): II 161-II 164, 1977. – reference: 7) Heikkinen, M., Salenius, J. P. and Auvinen, O.: Ruptured abdominal aortic aneurysm in a well-defined geographic area. J. Vasc. Surg. 36: 291-296, 2002. – reference: 2) Brady, A. R., Brown, L. C., Fowkes, F. G. R. et al.: Long-term outcomes of immediate repair compared with surveillance of small abdominal aortic aneurysms. N. Engl. J. Med. 346: 1445-1452, 2002. – reference: 1) Hu, Y. H., Shimizu, H., Kawakami, N. et al.: Increasing trends in mortality rate of aortic aneurysms in Japan, 1955-90. Tohoku J. Exp. Med. 171: 221-228, 1993. |
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| Snippet | 1995年4月から2002年6月に施行した90歳以上の高齢者に対する腹部大動脈瘤(AAA)手術8例を対象とした.男性7例,女性1例.平均年齢90.8±1.4歳(90～94歳).緊急手術は4... 1995年4月から2002年6月に施行した90歳以上の高齢者に対する腹部大動脈瘤(AAA)手術8例を対象とした.男性7例,女性1例.平均年齢90.8±1.4歳(90〜94歳).緊急手術は4... |
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| Title | 90歳以上の高齢者に対する腹部大動脈瘤手術の手術成績ならびに遠隔成績についての検討 |
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