目的:探讨高龄胆囊炎的外科手术治疗。方法:回顾分析1999年1月至2008年10月100例高龄胆囊炎患者的临床资料。结果:手术治疗治愈99例,平均住院12天。结论:高龄胆囊炎患者合并症多,病情进展快,治疗难度大,风险高,要重视围手术期处理和手术时机、方法的选择,才能保证外科手术的成功。
目的 探讨高龄初产妇临产前的心理状态，了解其负性心理原因，及时给予护理干预，使其顺利渡过围生期。 方法 2010年6月－2011年9月，将在待产且年龄≥35岁的60例初产妇归为高龄组，随机选取同期住院的适龄初产妇60例作为对照组，应用焦虑自评量表（SAS）、抑郁自评量表（SDS）及症状自评量表（SCL-90），对高龄初产妇进行产前心理评估及检测血中肾上腺素（E）和去甲肾上腺素（NE）水平。 结果 高龄初产妇产前的SAS和SDS评分及E和NE水平，SCL-90量表中总分及躯体化、强迫、焦虑、抑郁因子分与适龄组比较，差异有统计学意义（P＜0.01）；SAS评分与E、NE水平，SDS评分与E、NE水平均呈正相关，相关系数分别为：0.378、0.402、0.384、0.369（P＜0.01）。 结论 高龄初产妇分娩前多数存在不同程度的负性心理，应根据其不同情况给予相应的心理干预以促进产妇顺利渡过围生期。
ObjectiveTo summarize the experience in treating the elderly patients (≥75 years old) with carotid artery stenosis, and to evaluate the efficacy and safety of the carotid endarterectomy (CEA). MethodsThe datum of 312 cases with carotid artery stenosis and underwent the CEA in the vascular surgery department of Peking Union Medical College Hospital from October 2009 to October 2012 were retrospectively analized.The risk factors of the CEA in treating the elderly patients were analized, and the measures to prevent perioperative complications were discussed. ResultsThirty-nine cases were brought into the research.The mean follow-up was (22.18±8.71) months.Thirty-three cases (84.6%) were male and 6 cases (15.4%) were female.The median age was 77 years old (75-82 years old).Eleven cases (28.2%) were with bilateral lesions, and 7 cases (17.9%) were asymptomatic.A total of 39 CEA procedures were successfully performed, 22 artificial vascular patches (56.4%) and 16 shunts (41.0%) were used.The mean average hospital stay was (17.38±5.39) days.One case showed cerebral hyperperfusion syndrome in 2th day after operation, another 1 case was found ipsilateral restenosis in 15th month after operation. ConclusionCEA is a safe and effective measure in treating the elderly patients with carotid artery stenosis, if the the indications of surgery is performed strictly.
Objective To explore the effects of recombinant human growth hormone （rhGH） on senile patients after pancreaticoduodenectomy. MethodsFortysix patients were divided into the therapeutic group (rhGH, n=17) and control group (n=29). Both were treated with parenteral nutrition. In the therapeutic group, rhGH (8 u/d) was given hypodermically for 7 days. After operation the levels of albumin, prealbumin, transferrin, and immunoglobulin were measured. Postoperative fatigue syndrome and the average length of stay in hospital were observed too. ResultsAfter operation the levels of albumin, prealbumin, transferrin, and immunoglobulin in the therapeutic group were significantly higher than those of control group. The degree of postoperative fatigue syndrome in the therapeutic group was less than that of control group. The average length of stay in hospital was significantly shortened. Conclusion The early application of rhGH in senile patients after pancreaticoduodenectomy can enhance immune function, reduce the incidence of infection, promote the postoperative recovery, shorten the average length of stay in hospital,decrease the mortality, increase the safety of operation and improve the postoperative life quality of senile patients.
Objective To observe the short-term efficacy and the incidence of adverse cardiovascular events in patients aged over 80 years with multivessel coronary artery disease following two-stage Hybrid surgery. Methods We retrospectively analysed the clinical data of 67 patients aged over 80 years with multivessel coronary artery disease undergoing surgery in our hospital. The were 44 males and 23 females with an anverage age of 82.4±2.1 years. According to the operation pattern, the patients were divided into two groups: a two-stage Hybrid surgery group (n=29, 19 males, 10 females, aged 83.2±3.1 years) and a traditional thoracotomy group (n=38, 25 males, 13 females, aged 83.3±3.4 years). We compared the clinical results of perioperation between the two groups. Results Conpared with the traditional thoracotomy group, the two-stage Hybrid surgery group had shorter postoperative duration of mechanical ventilation (6.7±2.2 hvs. 18.2±3.4 h) and hospitalization stay (15.7±3.0 dvs. 20.7±5.6 d) and had less volume of chest drainage during the first 24 h after surgery (176.5±32.3 mlvs. 443.8±51.5 ml). The incidence of adverse cardiovascular events in the two-stage Hybrid surgery group was significantly lower than that in the traditional thoracotomy group (6.9%vs. 23.1%, P<0.05). Conclusion The two-stage Hybrid surgery in patients aged over 80 years with multivessel coronary artery disease can significantly decrease the postoperative incidence of adverse cardiovascular events, shorten the postoperative duration of mechanical ventilation and hospitalization stay, reduce the volume of chest drainage during the first 24 h after surgery and improve prognosis of surgery for the elderly patients.
Objective To discuss whether age has an influence on short-term effect of intersphincteric resection (ISR) for elderly (≥75 years old) patients with ultra-low rectal or canal cancer or not. Methods From February 2016 to February 2017, 196 patients with ultra-low rectal or canal cancer received ISR in the Gastrointestinal Surgery Center of West China Hospital were eligible to include in this study, then they were divided into ≥75 years old group and <75 years old group according to the patients’ age. The intraoperative index, postoperative index, and complications rate were compared between these two groups. Results There were 113 cases in the ≥75 years old group, 83 cases in the <75 years old group, the baselines such as the gender composition, body mass index, tumor histology type, differentiation degree, tumor size, and distance from the anal margin had no significant differences ( P>0.05), but the preoperative anaesthetized ASA grade, proportions of pulmonary insufficiency, hypoproteinemia, anemia, hypertension, diabetes, and cardiac insufficiency of the ≥75 years old group were significantly higher than those of the <75 years old group (P<0.05). The operative time, intraoperative bleeding, and total complications rate had no differences between these two groups (P>0.05), the first exhaust time, the first eating time, the first defecation time, the first ambulation time, and hospitalization time of the ≥75 years old group were significantly longer than those of the <75 years old group (P=0.023, 0.037, 0.019, 0.020, and 0.012, respectively). There were no significant differences in the incidences of the anastomotic leakage, perianal infection, intestinal obstruction, and wound infection between these two groups (P>0.05). All the 196 patients were followed-up with an average follow-up of 7 months, there were 4 cases of recurrent patients, of which 3 were in the ≥75 years old group and 1 in the <75 years old group; there were 3 cases of death, of which 2 were in the ≥75 years old group and 1 in the <75 years old group. Conclusions Short-term recovery of elderly patients with ultra-low rectal or canal cancer is slower than younger patients because of poor preoperative conditions. ISR surgery is still safe and effective for elderly patients with ultra-low rectal or canal cancer and postoperative complications rate has no obvious increase, but it needs a surgeon’s skilled operation technology and multi-disciplinary team cooperation.
目的总结75岁以上高龄冠心病患者行冠状动脉旁路移植术（CABG）的围手术期临床经验，以提高手术疗效。 方法2014年2～6月沈阳军区总医院心外科为20例75～84岁冠状动脉粥样硬化患者行非体外循环冠状动脉旁路移植术，其中男11例、女9例，主要病变均为三支冠状动脉严重狭窄或伴左主干狭窄，其中5例患者伴急性心肌梗死，所有患者均为限期手术。分析全组手术时间、住院时间、围手术期并发症、术后结果等。 结果全组均采用左乳内动脉吻合前降支，大隐静脉吻合其他分支，平均桥血管数量为3.2支；平均手术时间3.3 h；术后平均呼吸机辅助时间9.6 h；术后平均重症监护时间26.4 h；术后平均住院时间为12.3 d。术后出现阵发性心房颤动3例；术后呼吸机辅助期间低氧血症2例，术后因咳痰无力及误吸并发严重肺炎1例；术后明显腹胀、纳差6例，其中1例因腹胀行短期胃肠减压及完全胃肠道外营养，1例因纳差再次入院治疗；术后伤口愈合不良清创缝合1例。所有患者均痊愈出院，心功能改善，心绞痛症状消失。 结论对于高龄患者，非体外循环冠状动脉旁路移植术疗效满意；胃肠功能、呼吸功能及手术耐受力为影响高龄患者围手术期恢复较为突出的因素，应采取更为积极的治疗和应对策略。