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Clinical Analysis of 156 Old Patients with Severe Acute Cholangitis Treated by PTCD under Ultrasonic Guidance

目的 总结超声引导下经皮经肝穿刺胆管引流术(PTCD)的优、缺点,为临床治疗重症急性胆管炎（SAC）提供参考。方法 回顾性分析我院1994年8月至2008年7月期间对156例老年SAC患者行在超声引导下的PTCD治疗的临床资料。结果 156例行PTCD均获成功,1次穿刺成功140例，其成功率达89.7%（140/156）; 16例首次穿刺失败后再次穿刺均成功。无一例发生腹腔出血、胆汁性腹膜炎等并发症。本组引流效果较好,中毒危象缓解，黄疸减退，肝功能改善。结论 PTCD较外科手术创伤小、操作简单、快速,具有微创的特点,对老年、有严重合并症及复杂疾病不能耐受手术及麻醉的SAC患者，其作为紧急抢救措施切实可行,并为后期施行根治性手术争取了时间。

老年患者原发性视网膜脱离60例分析

人工股骨头置换术在高龄股骨粗隆间骨折中的应用

目的 总结人工股骨头置换术治疗高龄患者股骨粗隆间骨折的方法和疗效。方法 2002年2月～2005年12月，采用骨水泥型双极人工股骨头置换治疗高龄股骨粗隆间新鲜骨折19例。其中男7例，女12例；年龄78～102岁，中位年龄83.3岁。摔伤13例，车撞伤6例。损伤至手术时间2～10 d。合并糖尿病9例，高血压病9例，慢性支气管炎1例（缓解期），脑梗塞后遗症2例（骨折侧肌力在Ⅳ级以上）。术前患髋Harris评分均为差；骨折按Evan’s分型：Ⅱ型2例，Ⅲ型9例，Ⅳ型8例。结果 19例获6～41个月随访，患髋均无明显疼痛。12例恢复术前行走功能，5例行走能力下降需要扶助，2例不能独立行走。术后并发下肢深静脉血栓1例，泌尿道感染1例，一过性精神障碍2例，7例术后8~37个月分别死于心肌梗死，心衰、脑出血、肺内感染等。结论 人工股骨头置换术治疗高龄患者股骨粗隆间骨折短期疗效满意，可以显著提高患者的生活质量，但应严格掌握适应证。

人工双极股骨头置换术治疗老年股骨颈骨折

【摘要】目的观察人工双极股骨头置换术治疗老年股骨颈骨折的临床疗效。方法2004年4月2007年10月,采用人工双极股骨头置换术治疗21例老年股骨颈骨折。男8例,女13例;年龄68～80岁,平均年龄726岁。致伤原因:摔伤16例,车祸伤5例。骨折类型:头下型11例,经颈型8例,基底型2例。合并骨质疏松17例,内科疾病31例。伤后至入院时间2～22 h,平均16 h。结果平均手术时间70 min,平均输血量300 mL,手术后引流量平均40 mL。手术后切口均I期愈合。并发尿路感染3例,肺部感染1例,均经抗生素治疗后痊愈。21例均获随访,随访时间6个月～4年,平均28年。X线片检查示髋关节间隙正常。末次随访时按Harris评分标准评定髋关节功能:优14例,良5例,可1例,差1例,优良率90%。结论人工双极股骨头置换术治疗老年股骨颈骨折具有能及时解除患者疼痛、恢复关节功能、防止并发症等优点。

老年重症急性胆管炎59例报告

老年胆囊炎胆囊结石88例外科治疗体会

德国治疗渗出型老年性黄斑变性的现状

Evidence-Based Treatment for an Elderly Patient with Intertrochanteric Fractures

Objective To identify an evidence-based treatment for an elderly patient with intertrochanteric fractures. Methods Clinical problems were presented on the basis of the patient’s conditions, and evidence was collected from the NGC (2000 to 2009), The Cochrane Library (Issue 4, 2009), TRIP Database, PubMed (1966 to 2009) and CBM (1978 to 2009). Treating strategies were formulated in terms of the three-combination principle (best evidence, the doctor’s professional knowledge and the patient’s desire). Results Three guidelines and sixteen studies were included. The current evidence indicated that surgery was the preferred solution to intertrochanteric fractures of the elderly patient. The sliding hip screw (SHS) appeared superior to others. There was insufficient evidence to support the routine use of closed suction drainage in orthopedic surgeries. Early surgery was associated with shorter hospital stay and improved mortality. Antibiotic prophylaxis significantly reduced infections. In order to lower the risk of venous thromboembolism, pharmacological prophylaxis should be carried out when the patient was admitted to hospital and be assisted with mechanical prophylaxis after surgery. Nutritional supplementation was conducive to the recovery of the patient. Rehabilitation ought to be performed as soon as possible. Considering the patient’s condition, the treatment option was established according to the available evidence and guidelines. Short-term follow-up showed a good outcome. Conclusion Through the evidence-based method, an individual treatment plan could obviously improve the treatment effect and prognosis.

Investigation and Analyses of Complication among the Bedridden Elderly

本研究通过对151例卧床大于1月的老年患者半年的并发症的描述及分析，说明不同卧床时间的患者的并发症发生不同，随着卧床时间的延长，并发症发生增加。并发症与卧床时间、日常生活能力障碍、认知功能障碍呈正相关关系，相关系数分别为0.684，0.409，0.496。应该减少患者卧床时间，注重对卧床老年患者认知、日常生活能力的评估、护理，鼓励患者活动，以减少并发症。

Etiological Analysis and Clinical Characteristics of Liver Cirrhosis in Elderly Patients

ObjectiveTo discuss the clinical characteristics of liver cirrhosis in elderly patients. MethodsWe retrospectively analyzed the clinical data of 67 patients (elderly group) with liver cirrhosis aged ≥60 treated between January 1998 and December 2010. Then, we compared these cases with another 72 liver cirrhosis patients (non-elderly group) aged<60. ResultsThe incidence of jaundice, ascites and albumin deficiency in the elderly patients was significantly higher than that in the non-elderly patients (P<0.05). Complications in the elderly group were relatively more, including electrolyte imbalance, infections, gastrointestinal bleeding, hepatic encephalopathy, liver cancer, liver and kidney syndrome and liver and lung syndrome, and the incidence of these complications was all significantly higher than the non-elderly group (P<0.05) except the liver and kidney syndrome (P>0.05). The causes of liver cirrhosis in both groups were similar. The most common cause was hepatitis B virus infection, followed by chronic alcoholism, but in the elderly group, chronic alcoholism, cholestasis, poisoning from medicines and poisons and liver blood circulation disorders were more common than the non-elderly group (P<0.05); hepatitis B and non-alcoholic fatty hepatitis were more common in the non-elderly group than in the elderly group (P<0.05). The elderly group had more Child-Pugh class C cases (P<0.05), while there were more class A cases in the non-elderly group (P<0.05). Twenty-six patients died in the elderly group with a mortality rate of 38.8%; while only 13 died in the non-elderly group with a mortality rate of 18.1%. The difference of mortality rate was significant between the two groups (P<0.05). Common causes of death in the elderly group were infection, hepatic encephalopathy, and electrolyte disorders and gastrointestinal bleeding, while the common causes of death in the non-elderly group were gastrointestinal bleeding and electrolyte disorders. ConclusionThe etiology, clinical manifestations and prognosis of liver cirrhosis in elderly patients differ from those in younger patients. We must pay more attention on treating complications of liver cirrhosis in elderly patients.