Journal of Chest Surgery

The Korean Society for Thoracic and Cardiovascular Surgery (대한심장혈관흉부외과학회)
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The Risk Factors Influencing the Postoperative Mortality of the Patients with an Abdominal Aortic Aneurysm

복부대동맥류 환자에서의 수술 후 사망의 위험인자 분석

  • Lee, Seong-Kwang (Department of Thoracic and Cardiovascular Surgery, Pusan Paik Hospital, College of Medicine, Inje University) ;
  • Jun, Hee-Jae (Department of Thoracic and Cardiovascular Surgery, Pusan Paik Hospital, College of Medicine, Inje University) ;
  • Park, Kyung-Taek (Department of Thoracic and Cardiovascular Surgery, Pusan Paik Hospital, College of Medicine, Inje University) ;
  • Yoon, Young-Chul (Department of Thoracic and Cardiovascular Surgery, Pusan Paik Hospital, College of Medicine, Inje University) ;
  • Han, IL-Yong (Department of Thoracic and Cardiovascular Surgery, Pusan Paik Hospital, College of Medicine, Inje University) ;
  • Lee, Yang-Haeng (Department of Thoracic and Cardiovascular Surgery, Pusan Paik Hospital, College of Medicine, Inje University) ;
  • Cho, Kwang-Hyun (Department of Thoracic and Cardiovascular Surgery, Pusan Paik Hospital, College of Medicine, Inje University)
  • 이성광 (인제대학교 의과대학 부산백병원 흉부외과학교실) ;
  • 전희재 (인제대학교 의과대학 부산백병원 흉부외과학교실) ;
  • 박경택 (인제대학교 의과대학 부산백병원 흉부외과학교실) ;
  • 윤영철 (인제대학교 의과대학 부산백병원 흉부외과학교실) ;
  • 한일용 (인제대학교 의과대학 부산백병원 흉부외과학교실) ;
  • 이양행 (인제대학교 의과대학 부산백병원 흉부외과학교실) ;
  • 조광현 (인제대학교 의과대학 부산백병원 흉부외과학교실)
  • Received : 2010.07.05
  • Accepted : 2010.09.26
  • Published : 2010.12.05
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Abstract

Background: Despite the rapid expansion of percutaneous endovascular repair, open surgical repair is still recognized as an option to achieve a cure. We retrospectively analyzed over a 6 year period the surgical outcomes, the complications and the mortality-related factors for patients with abdominal aortic aneurysms. Material and Method: We analyzed 36 patients who underwent surgery for abdominal aortic aneurysms between May 2001 and June 2005, and between April 2007 and November 2009. The indications for surgery were rupture, a maximal aortic diameter > 50 mm, and medically intractable hypertension or pain. Result: The mean patient age was $69.67{\pm}6.97$ years (range: 57 to 84 years). Thirty two patients (88.9%) were males and 4 patients (11.1%) were females. Extension to the iliac artery existed in 28 patients (77.8%). Thirteen patients (36.1%) had ruptured aortic aneurysms. The mean maximal diameter of the aorta was $73.7{\pm}13.3$ mm (60 to 100 mm). Surgery was performed by a midline laparotomy and 10 patients (27.8%) underwent emergency surgery. The mortality rate was 8.3%; the mortality rate for the patients with ruptured aneurysms was 23.1 % and the mortality rate for patients with unruptured aneurysms was 0%. The postoperative complications included wound infection (3 cases), sepsis (2 cases), renal failure (2 cases) and pneumonia (1 case). Unstable vital signs, pre-operative transfusion, ruptured aneurysm, emergency surgery, comorbidity (DM and syncope) and complications (sepsis and renal failure) were the statistically significant mortality-related factors (p < 0.05). Conclusion: Emergency surgery for ruptured aortic aneurysms continues to have high mortality, but the unruptured cases are repaired with relative safety. Even though endovascular aortic repair is the trend for abdominal aortic aneurysms, an elective operation of the unruptured aneurysms could decrease the procedure's morbidity and the inconvenient for repeat evaluation with good surgical results.

배경: 최근에 경피적 대동맥 스텐트 삽입술의 비약적인 발전으로 외과적 수술이 감소하고는 있으나, 여전히 근치를 위한 치료로 인정되고 있다. 저자들은 지난 6년 8개월간 시행한 복부 대동맥류의 수술성적 및 그 예후에 미치는 영향인자에 대해 분석하여 보았다. 대상 및 방법: 2001년 5월부터 2005년 6월까지, 2007년 4월부터 2009년 11월까지 복부 대동맥류로 수술 받은 환자 36명을 대상으로 하였다. 수술의 적응은 파열, 60 mm 이상의 최대직경, 내과적으로 조절 안되는 고혈압이나 통증이 있는 경우 등이었다. 결과: 환자들의 평균 나이는 $69.67{\pm}6.97$세 (57~84세)였고, 남자가 32명(89.2%), 여자가 4명 (10.8%)이었다 신동맥 하부부터 장골동맥 위까지 진행된 경우는 8명(22.2%), 장골동맥까지 진행된 경우는 28명(77.8%)이었다. 진단 당시 대동맥이 파열되어 있었던 환자들은 13명(36.l%)이었다. 대동맥의 평균 최대직경은 $73.7{\pm}13.3 mm$ (60~100 mm)였다. 수술은 대부분 정중 복부절개를 통한 복강 내 접근으로 시행하였고, 응급수술은 10명의 환자(27.8%)에서 시행하였다. 전체 환자 중 3명이 사망하여 전체 사망률은 8.3%였고, 파열된 환자의 사망률은 23.1%, 파열되지 않은 환자의 사망률은 0%였다. 수술 후 합병증으로는 창상감염 3예, 패혈증 2예, 신부전 2예, 폐렴 1예씩 있었다. 사망에 영향을 주는 인자로는 수술 전 불안정한 활력징후 수혈, 또는 실신이 있었던 경우, 과거력 상 당뇨병이 있는 경우, 동맥류가 파열된 경우와 응급수술 등이 있으며, 합병증 중 패혈증, 신부전이 발생한 경우와 술중 심폐소생술을 시행한 경우가 통계적으로 의미 있었다(p<0.05). 결론: 파열된 복부대동맥류에 대한 응급수술은 여전히 높은 사망률을 보이나, 파열되지 않은 복부대동맥류의 수술은 비교적 안전하게 진행할 수 있다. 비록 경피적 대동맥 스탠트 삽입술이 최근의 치료 경향이나 파열되지 않은 동맥류의 계획된 수술은 시술과 관련된 부작용이나 반복된 검사의 불편함을 줄이고 좋은 결과를 얻을 수 있을 것으로 생각한다.

Keywords

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