Objective To explore the perioperative management of the coexisting diseases for the elderly patients with gastric cancer. Methods The clinical data of perioperative management for coexisting diseases in 528 patients with gastric cancer over 70 years old treated in the First Affiliated Hospital of China Medical University from March 1980 to November 2008 were analyzed retrospectively. Results The main coexisting diseases included cardiovascuclar disease (259 cases, 49.05%), respiratory disease (161 cases, 30.49%), diabetes (72 cases, 13.64%). Adjusting blood pressure and blood glucose, improving cardiopulmonary function, and hepatic and renal function were mainly given. The common postoperative complications included intestinal obstruction (10 cases), pneumonia (10 cases), reflux esophagitis (9 cases), functional evacuation disorder of gastric remnant (7 cases), and anastomotic leakage (5 cases). Ten patients died during perioperative period: 6 died of heart and lung failure, 2 of acute myocardial infarction, 1 of anastomotic leakage, 1 of intestinal obstruction. Conclusions The common coexisting diseases in the elderly patients with gastric cancer are hypertension， bronchitis and diabetes. Complete assessment of the patient’s general health before operation and intensive perioperative management of the coexisting diseases not only can decrease the risk of surgical procedures， but also decrease the incidence of complication and perioperative mortality.
ObjectiveTo assess the accuracy of European System for Cardiac Operative Risk Evaluation (EuroSCORE) model in predicting the in-hospital mortality of Uyghur patients and Han nationality patients undergoing heart valve surgery. MethodsClinical data of 361 consecutive patients who underwent heart valve surgery at our center from September 2012 to December 2013 were collected, including 209 Uyghur patients and 152 Han nationality patients. According to the score for additive and logistic EuroSCORE models, the patients were divided into 3 subgroups including a low risk subgroup, a moderate risk subgroup, and a high risk subgroup. The actual and predicted mortality of each risk subgroup were studied and compared. Calibration of the EuroSCORE model was assessed by the test of goodness of fit, discrimination was tested by calculating the area under the receiver operating characteristic (ROC) curve. ResultsThe actual mortality was 8.03% for overall patients, 6.70% for Uyghur patients,and 9.87% for Han nationality patients. The predicted mortality by additive EuroSCORE and logistic EuroSCORE for Uyghur patients were 4.03% and 3.37%,for Han nationality patients were 4.43% and 3.77%, significantly lower than actual mortality (P<0.01). The area under the ROC curve of additive EuroSCORE and logistic EuroSCORE for overall patients were 0.606 and 0.598, for Han nationality patients were 0.574 and 0.553,and for Uyghur patients were 0.609 and 0.610. ConclusionThe additive and logistic EuroSCORE are unable to predict the in-hospital mortality accurately for Uyghur and Han nationality patients undergoing heart valve surgery. Clinical use of these model should be considered cautiously.
ObjectiveTo compare the outcomes of local anesthesia and general anesthesia in transcatheter aortic valve replacement (TAVR).MethodsA total of 399 severe aortic stenosis patients were included, who underwent TAVR successfully in West China Hospital of Sichuan University between April 2012 and January 2019. The baseline characteristics, procedural details, postprocedural outcomes, and ultrasound data of those patients were collected. All patients were followed up and the end date of follow-up was June 20th 2020. According to anesthetic mode, the patients were divided into local anesthesia group and general anesthesia group. The differences between the two groups in incidence of postprocedural complications, hemodynamics, postprocedural 30-day mortality, and postprocedural 1-year mortality were retrospectively analyzed.ResultsOf the 399 patients, 206 (51.6%) received local anesthesia and 193 (48.4%) received general anesthesia. There was no statistical difference between the two groups in baseline characteristics. The symptoms of both groups were relieved. But the incidences of mild bleeding events (12.4% vs. 1.5%, P<0.001), severe bleeding events (10.4% vs. 0.5%, P<0.001), major vascular complications (0.5% vs. 3.6%, P=0.032), and postprocedural 30-day all causes mortality (1.9% vs. 6.7%, P=0.018) were significantly lower in the local anesthesia group than those in the general anesthesia group.ConclusionIn TAVR, compared with general anesthesia, local anesthesia is safer to use with lower incidence of postprocedural complications and postprocedural 30-day all causes mortality.
ObjectiveTo analyze the variation trend of high low density lipoprotein cholesterol (LDL-C) attribution disease burden in China from 1990 to 2019. MethodsThe burden of disease indicators from Global Burden of Disease 2019 (GBD 2019), such as death attributable to high LDL-C, disability-adjusted life years (DALYs), years of life lost (YLLs), and years lost to disability (YLDs) were extracted. The age was standardized using GBD 2019 global standard population, and the trend of rates with the annual percentage change (APC) was analyzed. ResultsFrom 1990 to 2019, the disease burden of high LDL-C increased with age in China. The mortality rate, DALYs rate and YLLs rate of males were higher than those of females, while the YLDs rate of males was lower than that of females. Joinpoint regression results showed that from 1990 to 2019, the high LDL-C attribution mortality rate (APC=3.4%, P<0.05), DALYs rate (APC=2.4%, P<0.05), YLLs rate (APC=2.4%, P<0.05), YLDs rate (APC = 2.9%, P<0.05), the standardized mortality rate (APC=0.8%, P<0.05) and the standardized YLDs rate (APC=0.7%, P<0.05) all increased in China. Regarding age, the mortality rate, DALYs rate and YLLs rate increased in the age group over 70 years old, while the YLDs rate increased significantly in the age group over 45 years old. ConclusionFrom 1990 to 2019, the burden of disease attributable to high LDL-C in China has become increasingly heavy, and the burden varies according to gender and age.
Objective To understand the epidemiological characteristics of lung cancer death in adults of Zhuhai in order to provide decision-making evidence for lung cancer control and prevention. Methods The data of Mortality Registration System from 2004 to 2005 in Zhuhai were applied to analyze the epidemiological features of lung cancer death in adults. Results From 2004 to 2005, the average mortality from lung cancer and the standardized rate in adults of Zhuhai were 25.3/lakh and 30.3/lakh, respectively. Lung cancer ranked the first on the list of death causes in all cases of cancer death. The standardized rate of the male and female population was 40.1/lakh and 19.2/lakh, respectively. The standardized rate of males was higher than that of females (u=7.23, Plt;0.01). The average mortality from lung cancer increased with age, especially in males over 60 years old. The standardized mortality from lung caner in Xiangzhou, Doumen and Jinwan was 30.5/lakh, 31.1/lakh and 27.3/lakh, respectively. No statistical significance was found in these areas. Conclusion Lung cancer is one of the major malignant tumors among Zhuhai people. Lung cancer mortality is increasing with population aging. Based on the main risk factors of lung cancer, effective preventive measures including tobacco control and environment improvement should be taken.
Heart valve disease is one of the three most common cardiac diseases,and the patients undergoing valve surgery have been increasing every year. Due to the high mortality,increasing number of valve surgeries,and increasing economic burdens on public health, a lot of risk models for valve surgery have been developed by various countries based on their own clinical data all over the world,which aimed to regulate the preoperative risk assessment and decrease the perioperative mortality. Over the last 10 years, a number of excellent risk models for valve surgery have finally been developed including the Society of Thoracic Surgeons(STS), the Society of Thoracic Surgeons’ National Cardiac Database (STS NCD),New York Cardiac Surgery Reporting System(NYCSRS),the European System for Cardiac Operative Risk Evaluation(EuroSCORE),the Northern New England Cardiovascular Disease Study Group(NNECDSG),the Veterans Affairs Continuous Improvement in Cardiac Surgery Study(VACICSP),Database of the Society of Cardiothoracic Surgeons of Great Britain and Ireland(SCTS), and the North West Quality Improvement Programme in Cardiac Interventions(NWQIP). In this article, we reviewed these risk models which had been developed based on the multicenter database from 1999 to 2009, and summarized these risk models in terms of the year of publication, database, valve categories, and significant risk predictors.
Objective To explore the perioperative management of the coexisting diseases for the elderly patients with gastric cancer. Methods The clinical data of perioperative management for coexisting diseases in 528 patients with gastric cancer over 70 years old treated in the First Affiliated Hospital of China Medical University from March 1980 to November 2008 were analyzed retrospectively. Results The main coexisting diseases included cardiovascuclar disease (259 cases, 49.05%), respiratory disease (161 cases, 30.49%), diabetes (72 cases, 13.64%). Adjusting blood pressure and blood glucose, improving cardiopulmonary function, and hepatic and renal function were mainly given. The common postoperative complications included intestinal obstruction (10 cases), pneumonia (10 cases), reflux esophagitis (9 cases), functional evacuation disorder of gastric remnant (7 cases), and anastomotic leakage (5 cases). Ten patients died during perioperative period: 6 died of heart and lung failure, 2 of acute myocardial infarction, 1 of anastomotic leakage, 1 of intestinal obstruction. Conclusions The common coexisting diseases in the elderly patients with gastric cancer are hypertension， bronchitis and diabetes. Complete assessment of the patient’s general health before operation and intensive perioperative management of the coexisting diseases not only can decrease the risk of surgical procedures， but also decrease the incidence of complication and perioperative mortality.
Abstract: Objective To summarize the experience of combined coronary artery bypass grafting(CABG) and valve replacement. Methods From May 1997 to March 2006, the results of 80 consecutive patients undergone valve replacement (MVR) and CABG were analyzed. CABG were performed withtotal grafts in 159 grafts (mean 1.99 grafts), with mitral valve replacement (MVR) in 49 patients, with aortic valve replacement (AVR) in 18 patients, with MVR+AVR in 13 patients(mechanical valve replacement in 68 and biological valve replacement in 12). Results The hospital time after operation was 19.2±13.4d. The hospital mortality rate was 12.5% (10/80). The primary cause of death included low cardiac output yndrome, acute renal failure, nervous system complications ,ventricular fibrillation and cardiac arrest. Multivariate testing of preoperative and operative description identified that preoperative myocardial infarction, worse cardiac function, radiographic cardiac enlargement and low ejection fraction were associated with an increase of hospital mortality (P＜0.05). There were postoperative complications including bleeding, severe ventricular arrhythmia, nervous system complications and incision infection. Followup of 58 patients (82.86%, range 6 to 60 months) showed the symptoms of angina pectoris and heart failure were significantly relieved. There were 2 longterm deaths (cerebral infarction and lung infection). Conclusion Combined CABG and valve replacement is an effective way for treatment of coronary artery and valvular heart disease. Improving the heart function preoperatively, strengthening myocardial protection, shortening operation and myocardial ischemia time, and complete revascularization are the key factors for success operation.
Objective To investigate the epidemiological characteristics of malignant tumor deaths in the registered population of Zhuhai city. Methods A retrospective survey of death from malignant tumor during 2004 and 2005 was performed in the registered population of Zhuhai city. This was based on the retrospective protocol of the third national survey of death cause. The mortality of main malignant tumor and cause of deaths were analyzed. Results During 2004 to 2005, the mean crude mortality and age-specific standardized mortality of malignant tumor were 90.3/100 000 and 97.2/100 000, respectively. Malignant tumor death was the most common cause of death in Zhuhai city, accounting for 21.8% of all deaths. The standardized mortalities in males and females were 119.7/100,000 and 71.6/100,000, respectively. The standardized rate in the male population was significantly higher than that of the female population (u=10.3, Plt;0.01). The mortality of malignant tumor tended to increase with age. The top five causes of malignant tumor deaths were lung cancer, liver cancer, colorectal cancer, nasopharyngeal cancer and gastric cancer. Their standardized mortalities were 20.9, 18.0, 8.7, 8.2, 8.1/100,000, respectively. Conclusion The mortality of mal ignant tumors has showed an increasing trend in Zhuhai city, with the main tumors being lung cancer, liver cancer, colorectal cancer, nasopharyngeal cancer and gastric cancer. Malignant tumor has become a common and frequently-occurring disease with a major impact on the life and health of people in Zhuhai city.
Objective To analyze the influencing factors on postoperative complications and mortality of gastric cancer after total gastrectomy. Methods The clinical data of 622 patients with gastric cancer received total gastrectomy were collected. According to the extent of lymph node dissection, the patients were divided into 2 groups: D0/D1 group (n=35) and D2/D3 group (n=587). The risk factors influencing postoperative morbidity and mortality were determined by logistic multiple regression analysis. Results The total postoperative complication morbidity and mortality for all patients were 9.81% (61/622) and 2.89% (18/622), respectively. The postoperative complication morbidity was 8.57% (3/35) and 9.88% (58/587) in the two groups, the postoperative mortality was 2.86% (1/35) and 2.90% (17/587) in the two groups, there were no significant differences between the two groups (Pgt;0.05). The most common postoperative complication was intestinal obstruction (18.03%, 11/61). Multivariate analysis revealed that risk factors on the postoperative complications and mortality were age ≥ 70 years, TNM stage Ⅳ, preoperative complication, palliative excision, merely manual or mechanical anastomosis, and multivisceral resection (Plt;0.05), however, the extent of lymph node was not influencing factor (Pgt;0.05). Conclusions Patients with advanced gastric cancer have a high risk of postoperative complications and mortality. Multiple organ resection should be avoided for patients with gastric cancer of TNM stage Ⅳ.