Objective To evaluate the clinical efficacy of coronary artery bypass grafting in the treatment of coronary artery disease patients aged over 70 years. Methods A total of 160 patients with coronary atherosclerotic heart disease underwent off-pump coronary artery bypass grafting from January 2013 to December 2017. There were 94 males and 66 females at age of 70–85 (76.67±2.33) years. Operations were performed by using sternal median incision with the assistance of local myocardial surface fixator and shunt plug, and the saphenous vein and internal mammary arterywere used as grafted vessels. Results All the patients were received successful off-pump coronary artery bypass grafting without death, and the cardiac function improved significantly. There were 62 patients with the internal mammary artery bridge and 98 patients with the whole vein bridge. All the patients were followed-up for 1 to 4 years. All the patients had obvious relief of angina pectoris. Conclusion Off-pump coronary artery bypass grafting for the treatment of elderly patients with coronary heart disease is an effective and safe operation, especially for patients with renal insufficiency, cerebrovascular disease, respiratory disease and severe left ventricular dysfunction.
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.
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.
Objective To conclude the research progress of unicompartmental knee arthroplasty (UKA) in the treatment of elderly patients with knee osteoarthritis (KOA). Methods The literature on UKA at home and abroad in recent years was reviewed to summarize the clinical characteristics of elderly patients with KOA, perioperative management (including evaluating indications preoperatively, intraoperative prosthesis selection, postoperative complication management, etc). Results Through reasonable preoperative evaluation, prosthesis selection, and advanced perioperative management, for elderly patients with KOA who meet the indications, UKA can be considered. Compared with total knee arthroplasty, the incidence of postoperative complications in elderly patients undergoing UKA is lower, joint awareness is reduced, functional improvement and satisfaction are higher. Meanwhile, choosing appropriate prostheses and fixation methods can lead to a good survival rate. ConclusionUKA can provide a safe and effective treatment option for elderly patients with KOA within a certain range of indications.
Objective To explore the effectiveness of bipolar femoral head replacement combined with tension band wire fixation for intertrochanteric fracture in elderly osteoporotic patients. Methods Bipolar femoral head replacement combined with tension band wire fixation were used for intertrochanteric fracture in 48 elderly osteoporotic patients between January 2004 and December 2010. Of 48 patients, 15 were male and 33 were female, aged 90-99 years (mean, 94.1 years). All fractures were caused by falling, and pathological fracture was excluded. It was 2-7 days (mean, 4.2 days) from fracture to surgery. According to the Tronzo Evans classification, 25 cases were rated as type IV, 20 cases as type III, and 3 cases as type II. And all of the cases were accompanied with severe osteoporosis and accompanied by more than one medical diseases, and 10 cases had spinal compression fracture. Results All patients underwent the operation successfully. Six cases died of underlying medical illness within 2 years postoperatively. A total of 39 cases were followed up 2-7 years, averaged 3.1 years. After operation, short-term mental disorders occurred in 9 cases, suspected urinary tract infection in 2 cases, sacral rear bedsore in 1 case, hip pain in 1 case, thigh pain in 1 case, and deep vein thrombosis of affected limb in 1 case. All the incisions healed by first intension, and X-ray film showed bone union in all cases; no complications of bone osteolysis, prosthesis loosening, subsidence, rupture, and heterotopic ossification occured postoperatively. No case needed revision. According to the Harris score system, the results were excellent in 5 cases, good in 28 cases, fair in 5 cases, and poor in 1 case, with an excellent and good rate of 84.6%; the score at 2 years was significantly higher than that at 6 weeks (t= — 14.79, P=0.00). The physical health score and mental health score of SF-12 at 2 years postoperatively were significantly higher than those at 6 weeks postoperatively (P lt; 0.05). The visual analogue scale (VAS) scores at 6 weeks and 2 years postoperatively were significantly lower than those at preoperation (P lt; 0.05), and the score at 2 years was significantly lower than that at 6 weeks (P lt; 0.05). Conclusion The bipolar femoral head replacement combined with tension band wire fixation for intertrochanteric fracture in elderly osteoporotic patients has the advantages of firm fixation, early function exercise with load bearing, pain relieving, improving hip function, and avoiding complication in bed.
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.
ObjectiveTo evaluate the feasibility and safety of da Vinci robotic surgery for elderly patients with radical surgery of lung cancer.MethodsWe retrospectively analyzed the clinical data of 59 patients aged over 70 years who underwent radical surgery of lung cancer in our hospital between 2016 and 2019. These patients were divided into two groups including a da Vinci robot group and a single-utility port video-assisted thoracoscopic surgery (VATS) group according to the patients’ selection of the treatments. There were 32 patients with 20 males and 12 females aged 73.1±2.3 years in the da Vinci robot group and 27 patients with 16 males and 11 females aged 71.2±1.3 years in the VATS group. The clinical data of the two groups were compared.ResultsThere was no statistical difference in surgery time between the two groups (t=–0.341, P=0.484). Compared with the VATS group, the da Vinci robot group had more number of lymph nodes dissected (t=1.635, P=0.015), less intraoperative blood loss (t=–2.569, P <0.001), less postoperative drainage amount within 3 days after surgery (t=–6.325, P=0.045), lower visual analogue scale (VAS) scores at postoperative 3rd day (t=–7.214, P=0.021).ConclusionThe da Vinci robot system is safe and efficient in the treatment for elderly patients with radical surgery of lung cancer with less trauma.
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。
目的探讨高龄胰腺癌的外科治疗方法。方法回顾性分析1995～2000年间我科收治的33例70岁以上胰腺癌患者的外科治疗资料。结果高龄胰腺癌患者发病隐匿，并发疾病多（88.9%），根治性切除困难，术后并发症发生率高（21.2%）。结论手术切除是治疗高龄胰腺癌最好的方法，早期诊断、早期治疗、加强围手术期处理以及有效地预防和治疗并发症是提高疗效的关键。