Objective To observe the clinical effect of enhanced recovery after surgery (ERAS) in elderly patients with right colon cancer. MethodsA total of 90 elderly patients who were diagnosed as right colon cancer and underwent radical resection of right colon cancer in the Department of Gastrointestinal Surgery of the Affiliated Hospital of Qingdao University from April 2018 to October 2018 were enrolled prospectively. These patients were randomly divided into two groups: ERAS group (n=44) receiving ERAS during perioperative period and control group (n=46) undergoing conventional surgical treatment. To compare the occurrence of postoperative complications, the recovery of gastrointestinal function, and the changes of serum inflammatory factors between the two groups before and after operation. Results① There was no significant difference in the incidence of total postoperative complications and the incidence of complications (including anastomotic leakage, incision infection, postoperative bleeding, intestinal obstruction, cardiovascular complications, pulmonary infection, and urethral infection） between the ERAS group and the control group (P>0.05). ② The first anal exhaust time, postoperative fever time, postoperative hospitalization time, quality of life score, and hospitalization cost of the ERAS group were better than those of the control group (P<0.05). ③ There were no significant difference in serum IL-6, TNF-α, and CRP levels between the two groups before operation (P>0.05), but on the 1st and 3rd day after operation, the three indexes of the control group were higher than those of the ERAS group (P<0.05). ConclusionThe application of the idea of ERAS in the elderly patients with right colon cancer can promote the recovery of gastrointestinal function, shorten the hospitalization time, and improve the clinical outcome.
ObjectiveTo investigate the surgical complications and its influence factors of radical surgery in the treatment of elderly patients with colorectal cancer. MethodsTwo hundreds and sixteen patients with colorectal cancer who were treated in the Second People's Hospital of Lianyungang City from January 2010 to September 2014 as the research object, the clinical data were collected by the self-made general data questionnaire, and they were analyzed by descriptive statistics and logistic regression analysis using SPSS 19.0. ResultsFor elderly patients with colorectal cancer radical operation, pulmonary infection and wound infection were the common complications.Single factor and logistic regression analysis showed that medical comorbidity, hypoproteinemia, operation time, Dukes staging, and smoking were risk factors of postoperative complications in the colorectal cancer patients. ConclusionFor elderly patients with colorectal cancer underwent radical operation, pulmonary infection and wound infection are the common complications.It's occurrence by various factors.
目的:比较人工股骨头置换与骨折内固定治疗高龄股骨转子间骨折的临床疗效。方法:筛选1997年6月至2008年6月间收治的60例高龄新鲜不稳定性股骨转子间骨折患者分为A、B两组。A组为行人工股骨头置换者,B组为行骨折内固定者。A组30例,平均年龄83.6岁;B组30例,平均年龄81.7岁。随访时间8个月～9年(平均2.3年)。结果:两种术式在住院时间和术后引流量的差异无统计学意义(Pgt;0.05);而在手术时间、术中出血量、下地开始行走时间、术后早期并发症、术后内科合并症和髋关节功能恢复、术后1年内死亡率等方面,两组比较差异均有统计学意义(Plt;0.05)。结论:人工股骨头置换术可以作为治疗高龄股骨转子间骨折的一种选择,术后能早期离床负重活动、较快恢复伤前活动能力、降低术后短期并发症和内科合并症的发生率、减低术后一年内死亡率。
ObjectiveTo investigate the short-term effectiveness of unicompartmental knee arthroplasty (UKA) in the treatment of knee osteoarthritis of super-age patients over 85 years old.MethodsSenile patients with unilateral compartment osteoarthritis of the knee who received UKA between November 2013 and May 2017 and met the inclusion criteria were enrolled as the research objects. Among them, 40 patients (50 knees) were more than 85 years old (super-age group) and 44 patients (50 knees) were 52-81 years old (control group). There was significant difference in age between the two groups (t=17.33, P=0.00). There was no significant difference in body mass index, degenerative classification of medial and lateral compartments, varus deformity of knee, disease duration, complicating diseases, and preoperative hemoglobin, hematocrit (HCT), American Hospital for Special Surgery (HSS) score, range of motion (ROM) of knee, visual analogue scale (VAS) score, and femoral-tibial angle (FTA) between the two groups (P>0.05). Hospital stay, hemoglobin, and HCT of the two groups were recorded before operation and on the first day after operation. The changes of hemoglobin and HCT after operation were calculated. During follow-up period, the ROM of the knee, HSS score, and VAS score were measured; the position of the prosthesis and FTA were observed by X-ray films.ResultsThere was no significant difference in hospital stay between the two groups (t=1.05, P=0.29). Hemoglobin and HCT of the two groups on the first day after operation were significantly lower than those before operation (P<0.05). There was no significant difference in the postoperative changes of hemoglobin and HCT between the two groups (P>0.05). All the patients were followed up completely except 4 cases (5 knees) in the super-age group. The follow-up time ranged from 14 to 44 months of super-age group (mean, 29 months) and 21 to 33 months of control group (mean, 24 months). There were significant differences in HSS score, VAS score, ROM of the knee, and FTA between pre-operation and last follow-up in the two groups (P<0.05). There was significant difference in HSS score between the two groups (P<0.05), and no significant difference was found in ROM, VAS score, and FTA between the two groups (P>0.05). X-ray film showed no adverse position of the prosthesis, infection around the prosthesis, prosthesis loosening, or pathological bright lines.ConclusionUKA combined with reasonable perioperative management in the treatment of super-age patients over 85 years with knee osteoarthritis is safe and feasible, and can obtain satisfactory short-term effectiveness.
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。
Objective To explore clinical effect of primary suture following laparoscopic common bile duct exploration (LCBDE) in treatment of patients aged over 70 years old with common bile duct (CBD) stones. Methods The clinical data of 62 patients aged over 70 years old with CBD stones underwent the LCBDE from January 2013 to December 2016 were retrospectively analyzed. Among them, 30 patients underwent the T tube drainage (T tube drainage group) and 32 patients underwent the primary suture (primary suture group) following the LCBDE. The intraoperative and postoperative statuses of these two groups were compared. Results There were no significant differences in the gender, age, body mass index, preoperative comorbidities and ASA classification, number and maximum diameter of CBD stone, and diameter of CBD between the two groups (P>0.05). There were no significant differences in the operative time, hospitalization cost, rates of total postoperative complications and readmission between the two groups (P>0.05). Compared with the T tube drainage group, the amount of intraoperative bleeding was less (P<0.05) and the postoperative hospital stay was shorter (P<0.05) in the primary suture group. Conclusion Primary suture is safe and feasible following LCBDE for patients aged over 70 years old with CBD stones in case of strict indications and proficiency intraoperation and it is more beneficial to recovery of patient.
Objective To analyze the quality control results of forced vital capacity ( FVC) test in elderly patients. Methods 534 lung function test reports of the elderly patients ( ≥ 80 years old) from January 2010 to December 2010 were collected from pulmonary function testing laboratory in Shougang Hospital of Peking University. Based on the report results, the selected patients were divided into four groups, ie. a normal group, a restricted group, an obstructed group, and a mixed group. The results of lung function tests that met the criteria of quality control in each group were statistically analyzed. Results A total of 534 reports were collected, of which 36 were not credible and treated as test failure. Of the 498 credible reports, 99.6% ( 496 /498) met the start-of-test criteria for quality control. 95. 8% ( 477/498) met the exhalation process test criteria for quality control with the highest rate of 98.6% ( 217 /220) in the obstructed group and the lowest rate of 85. 9% ( 55 /64) in the restricted group. The difference between two groups was significant (Plt;0.01) . 68.1% ( 339/498) met the end-of-test criteria for quality control with the highest rate of 88.6% ( 195/220) in the obstructed group and the lowest rate of 18.8% ( 12/64) in the restricted group. The difference between two groups was significant (Plt;0.01) . 16.7% (88/498) of the reports could be analyzed for repeatability, and the obstructed group had the highest rate of 22.3% (49/220) while the restricted group had the lowest rate of 6.3% ( 4/64) . The difference between two groups was significant too (Plt;0.01) . Only 14.6% (73/498) of the reports met all of the criteria listed above. Conclusions Elderly patients can also complete FVC test but the result may be not credible. There are still lots to be improved in FVC test for elderly patients.
Objective To investigate the clinical characteristics, risk factors and perioperative outcome of prolonged mechanical ventilation (PMV) in elderly patients undergoing coronary artery bypass grafting (CABG). Methods The data of elderly patients receiving CABG in the Nanjing First Hospital from January 2013 to June 2019 were collected. All patients were divided into a control group and a PMV group according to whether ventilation time≥24 h.The clinical characteristics and risk factors of PMV were compared between the two groups. Variables were 1∶1 balanced through propensity score matching (PSM) and perioperative outcomes of two groups was analyzed. Results Finally 956 patients were collected, including 187 in the PMV group and 769 in the control group. There were 586 males and 370 females aged 70-94 (74.3±3.5) years. Compared with the control group, the PMV group had higher rates of smoking, preoperative renal impairment, intraoperative blood transfusion and intra-aortic balloon pump (IABP) implantation, worse cardiac function, lower glomerular filtration rate and ejection fraction, larger left atrial diameter, longer cardiopulmonary bypass time and aortic cross-clamping time (P<0.05). There was no statistical difference in other clinical data between the two groups (P>0.05). Binary multivariate logistic regression analysis showed that females, smoking, chronic obstructive pulmonary disease, left ventricular ejection fraction≤56.0%, cardiopulmonary bypass time>106.0 min, IABP implantation and intraoperative blood transfusion were independent risk factors for PMV in elderly patients. After PSM, there were 146 patients in the control group and the PMV group, respectively. The PMV group had longer ICU stay and length of hospital stay and more drainage volume compared with the control group (all P<0.05). There was no statistical difference in perioperative mortality or other complications between the two groups (all P>0.05). ConclusionThere are a lot of factors associated with PMV of the elderly patients undergoing on-pump CABG. In order to establish a complete and formal PMV prediction model, clinicians can make a further step of assessment according to perioperative elements, and improve the prognosis of such patients.
目的 回顾分析不同内固定方式对老年股骨粗隆间骨折的临床疗效。 方法 1999年3月－2009年5月采用内固定手术治疗121例股骨粗隆间骨折患者，根据内固定方式不同分为4组：动力髋螺钉（DHS；A组43例）、经皮加压钢板（PCCP；B组19例）、股骨近端髓内钉（PFN；C组27例）、Gamma钉（D组32例）。4组患者年龄、骨折类型（Tronzo-Evans分型）等一般资料比较差异无统计学意义（P＞0.05），具有可比性。记录手术时间、术中出血量及术后引流量、术中术后并发症、骨折临床愈合时间、术后髋关节功能恢复程度，比较评价各组临床疗效。 结果 术后各组患者切口均Ⅰ期愈合，无伤口感染等早期并发症发生。患者均获随访，随访时间18～108个月，平均56.4个月。与A组比较，B、C、D组手术时间明显缩短，术中出血量及术后引流量减少，骨折愈合时间缩短，差异均有统计学意义（P＜0.01），A组较差；B、C、D各组间两两比较差异无统计学意义（P＞0.05）。术后并发症发生率A组较高，与其余各组比较差异有统计学意义（P＜0.05）。末次随访时各组髋关节功能Harris评分比较差异无统计学意义（P＞0.05）。 结论 B、D组及C组3种手术方法在治疗老年患者股骨粗隆间骨折具有创伤小、并发症少等优势，与A组法比较更有利于老年患者术后康复，但应注意骨折的良好复位及内固定物位置。