香港地区动脉瘤的治疗现状

目的 阐述香港动脉扩张性疾病的流行病学模式及主动脉瘤传统手术与腔内治疗术的发展现状。方法 分析香港医院管理局1999－2000年主动脉瘤统计数值,香港血管外科工作小组在公立医院主动脉瘤调查报告及香港大学外科学系血管外科833例患者经验。结果 主动脉瘤是香港地区目前第10大致命疾病,每年大概发现800例新病例,而主动脉瘤破裂率为10％,破裂病死率为80％。目前一半手术适应证为主动脉瘤破裂,有大比例患者未获手术治疗。在有经验的血管外科中心腹主动脉瘤择期手术病死率已下降至2％,而破裂手术病死率也降低为38％。结论 香港地区主动脉瘤发病率与世界发病率同步增加。近年腔内治疗术迅速发展,有一定的成效,但患者选择与随访至为重要。

Current status of aortic aneurysm surgery in Hong Kong

Objective To determine the epidemiology and the status of open and endovascular aortic surgery for aortic aneurysm in Hong Kong. Methods Three separate data sources were obtained: (1) the Hong Kong Hospital Authority discharge statistics for 1999 and 2000; (2) a survey on aortic aneurysms in public hospitals conducted by the working group of vascular surgery; and (3) the department of surgery, University of Hong Kong Medical Center aortic aneurysm database. The disease pattern, distribution as well as audit of operative mortality was determined. Results Aortic aneurysm ranked tenth as the leading causes of death in Hong Kong, and the incidence is increasing. Almost 800 new cases were diagnosed each year, with 10% presenting as rupture, but the death rate for ruptured aneurysms was 80%. About half of all operationson aortic aneurysms was performed for rupture, and a significant number of newly diagnosed patients were not receiving surgery. In experienced centers, the operative mortality for elective and ruptured aneurysm have improved to 2% and 38% in recent years. A growing interest and number of endovascular repair operations were performed which has led to some concerns on patient selection and follow up. Conclusions Similar to a worldwide trend, aortic aneurysm in Hong Kong is diagnosed more frequently. With the relatively high mortality for ruptured aneurysms, effective diagnosis and elective surgery on patients with aortic aneurysms in experienced vascular centers remained the best treatment. Since a majority of aneurysms remained untreated, patient and physician education is of paramount importance.