60岁以上肺癌病人的外科治疗

我们为１５１例（男１２３例，女２８例）６０岁以上肺癌病人行外科治疗。包括鳞癌９０例、腺癌４９例、其他１２例。Ⅰ～Ⅱ期２８例（１８．５％），Ⅲ～Ⅳ期１２３例（８１．５％）。手术切除１３３例（８８．１％），术后并发症１０例（６．６％），死亡２例（１．３％）。５年生存率３６．８％。体会到：加强围术期处理，采取适当的手术方法，是预防术后并发症、降低死亡率的关键；对６０岁以上肺癌病人的手术治疗应持积积极态度。     

老年急性肠梗阻的临床特点及其治疗(附150例报告)

目的：探讨老年急性肠梗阻的临床特点及其治疗，寻找降低死亡率的有效方法。方法：回顾性总结分析150例经手术证实的60岁以上的急性肠梗阻患者的病因、临床特点及其治疗方法。结果：引起肠梗阻的病因中，肿瘤75例（50.0％），肠粘连27例（18.0％），腹外疝11例（7.3％0肠扭转10例（6.7％），其它原因导致梗阻27例（18.0％）。绞窄性肠梗阻34例，术后有并发症35例，死亡12例。结论：老年急性肠梗阻的主要病因为肿瘤，加强围手术期处理、重视老年合并疾病、早期诊断及手术可有效减低术后死亡率。     

急性癌性结肠梗阻的诊断与治疗

目的：探讨急性癌性结肠梗阻的诊断，围手术期处理及手术方式的选择。方法：回顾１９９１年１月至１９９７年１１月手术治疗的急性结肠梗阻５７例，对其中４１例（７１．９％）急性癌性结肠梗阻进行总结分析，结果：急性癌性结肠梗阻术前确诊率仅３１．７％（１３／４１）术前选用预防性抗生素静滴，术中行肠减压及结肠灌洗，行Ｉ期切除手术３４例，占８２．９％（３４／４１）同时Ｉ期吻合２６例，占７６．５％（２６／３４），其中     

老年人消化性溃疡穿孔

目的：探讨老年人消化性溃疡穿孔的治疗措施。方法：分析６２例６０岁以上老年人消化性溃疡急性穿孔的临床资料。其中胃溃疡穿孔３６例，十二指肠球部溃疡穿孔２６例。４８例（７８．１％）有并存病，其中以心血管疾病最常见；并存两种疾病以上者１６例（２５．６％）。６２例手术中，毕Ⅱ式４９例，毕Ⅰ式９例，单纯修补４例；溃疡旷置４例，胃癌淋巴结清扫（Ｒ２式）３例。结果：均治愈，术后并发症１例，无１例死亡。结论：实施妥善的围手术期处理，尤其重视术前对并存病进行有效的控制，老年人是能很好地耐受彻底性手术的。     

老年人胃癌49例手术治疗分析

目的 探讨老年人胃癌围手术期处理的有关问题及适当的手术治疗方式。方法 回顾性分析1993－1998年我院收治70岁以上老年人胃癌53例，其中施行手术49例的临床资料和手术疗效。结果 老年人胃癌起病隐匿，症状多无特异性。术前多数合并有其它疾病；手术证实多数为中晚期胃癌，癌肿多见于幽门窦（77．5％）、大于5cm并累及胃浆膜层（81．6％）。病理检查多为分化型腺癌（73．4％）。49例中30例行胃 切除术，切除率为61．2％；其中根治性切除8例（17％），姑息性切除22例（45％）。其它手术19例（胃－空肠吻合术13例，手术探查取活检6例）。围手术期死亡率2．7％。手术后并发症27例（55％）。根治性切除术后5年生存率2．5％，姑息性切除术后五年生存率为零。结论 老年人胃癌有其特殊性，其围手术期处理至关重要，手术根治性切除率低。手术方式应根据病情而定，对早期或中期胃癌争取行D2以内的胃癌根治术。术前充分准备，提高病人手术耐受能力，手术时间以不超过2h为好，术毕常规残留或空肠造瘘，以期减少术后并发症。术后加强管理，并辅以腹腔灌注化疗，对提高病人生活质量，延长生存期有明显帮助。     

老年腹部手术病人的围手术期处理

为探讨如何作好老年人腹部手术的围手术期处理，以减少并发症，提高疗效，对３０７例老年腹部手术病人临床资料进行了回顾性分析。围手术期处理包括术前全面查体及辅助检查、营养支持、重要脏器的功能维护、并存病的处理及特殊病例手术时机、麻醉方法的选择与术中监护、并发症的防治。结果显示：３０７例中，术后发生各种并发症５６例（１８．２％）死于并发症７例（２．３％）。提示加强围手术期处理对减少并发症，提高疗效，具有重     

老年人胆汁性腹膜炎29例分析

目的:探讨老年人胆汁性腹膜炎的急诊处理.临床资料:分析我院6年来29例老年胆道疾病并发胆汁性腹膜炎治疗的临床资料.29例均经手术治疗,治愈27例,死亡2例.结论:老年人胆汁性腹膜炎早斯诊断较困难,合并疾病多,宜在加强围手术期处理的同时行急诊手术,手术方案应个体化.     

70岁以上老年人胆石症外科手术治疗体会

目的 探讨老年人胆石症的临床特点、手术适应证、手术治疗方法及围术期处理。方法 回顾217例70岁以上老年胆石症患者，针对合并症、手术方式、手术时机、治疗效果等进行综合分析。结果本组70岁以上手术患者217例，并发症65例（30．6％），死亡1例（0．5％），疗效满意。结论 掌握手术的适应证和手术时机、处理合并症、争取择期手术及避免急诊手术盲目性是外科治疗老年胆道疾病、减少并发症、降低死亡率的关键。     

老年人急性坏疽性胆囊炎的诊断与治疗

目的总结老年人急性坏疽性胆囊炎的诊断与治疗，以减少并发症，降低死亡率。方法对112例老年人急性坏疽性胆囊炎的临床资料进行回顾性分析。结果112例患者中有高热l9例（17．0％），黄疸8例（7．1％），右上腹包块11例（9．8％），腹膜炎体征26例（23．2％）；并发急性水肿型胰腺炎11例（9．8％），急性梗阻性化脓性胆管炎5例（4．5％），感染性休克6例（5．4％）．112例均手术治疗，术中发现95例急性结石性胆囊炎中胆囊坏疽79例，坏疽并穿孔16例，穿孔者占16．8％；17例急性非结石性胆囊炎中胆囊坏疽8例，坏疽并穿孔9例，穿孔者占52．9％。112例中行胆囊切除术86例，胆囊大部切除术l8例，胆囊切除加胆道探查T管引流术5例，胆囊造瘘术3例。治愈104例（92．9％），死亡8例（7．1％），治愈104例中出现术后并发症9例（8．7％）。病理报告均为急性坏疽性胆囊炎。结论老年人急性坏疽性胆囊炎应尽早诊断，合理处理并存病，应争取在起病后24h内（或入院后的最短时间内）内急诊手术，并选择适当的手术方式。     

老年腹部手术患者129例合并症的围术期处理分析

目的探讨老年腹部手术患者合并症的围术期处理。方法回顾分析2003年1月～2007年12月我院收治的129例60岁以上腹部手术患者有合并症的围术期临床资料。结果治愈126例，死亡3例，死亡率2．4％。其中并存呼吸系统疾病58例（46．6％），心血管疾病48例（37．3％），糖尿病32例（24．8％），肝肾功能异常20例（15．5％），贫血、低蛋白血症24例（18．6％）。术后并发伤口感染11例，伤口裂开3例，肺部感染5例，肠瘘3例，心功能不全2例。结论年龄不是腹部手术患者的手术禁忌证，做好合并症的围术期处理，可极大地提高手术成功率，降低手术死亡率和并发症发生率。     

Blunt abdominal trauma

Serious intraabdominal injury due to intraabdominal hemorrhage, gastro-intestinal laceration with peritonitis or incarceration of abdominal organs. The most important question in the management is to ascertain a laparotomy or the diagnostic of a specific organ injury is needed. The peritoneal lavage is a great help in making this decision. The x-ray examinations of thorax, abdomen and bones are required. Adjunctive diagnostic modalities for subtile examination of organs are ultrasound, computed tomography and angiography. These examinations have a limited application. Exploratory laparotomy should be done if there are signs of peritoneal irritation with an increased tendency. 168 patients with blunt abdominal trauma where treated in Charity-hospital of Berlin. The laparotomy was necessary in 78 patients. In 70 cases we found organ injuries. It was pointed to splenic repair, the management of liver injury especially the packing of the laceration and the treatment of the injuries of gastro-intestinal tract, pancreas- and diaphragmatic rupture.     

急诊腹腔镜治疗老年人重症胆管炎38例临床分析

目的:探讨老年急性重症胆管炎(acute severe cholangitis,ASCT)急诊腹腔镜治疗的可行性。方法:回顾本院收治的38例老年ASCT的临床资料,对其临床表现、治疗及预后进行分析探讨。结果:38例内镜及腹腔镜治疗均获成功。无严重并发症,围手术期死亡2例,死亡率5.26%。手术时间为60-189min,平均98.5min,住院时间4-12d,平均8.3d,术中出血50-400ml,平均95.8ml。结论:ASCT患者急诊微创腹腔镜手术治疗可行,且手术越早,效果越好。以微创手术为主的综合治疗是降低ASCT病死率的有效措施。延误手术时机、高龄、合并症是死亡的主要原因。     

Results and prospects of treatment of general forms of peritonitis

956 patients with general peritonitis were operated: 596 patients--for diffuse peritonitis, 360--for general peritonitis. The causes of peritonitis were: perforating gastroduodenal ulcers (454), acute destructive appendicitis (190), acute destructive cholecystitis (82), perforation of small intestine and colon (96), postoperative peritonitis (80), other diseases (54). In low degree of bacterial contamination of abdominal cavity (not more Ig 5 CFU/g) operations were completed without abdominal drainage, laparoscopic variant of the operation being optimal. In postoperative period, out of 691 patients with low degree of bacterial contamination wound infection was in 7.9%, intraabdominal infection--in 2.5%, polyorganic insufficiency--in 1.0%; lethality was 5.9%. In high degree of bacterial contamination (more Ig 5 CFU/g) and massive unremovable fibrinous patch on the peritoneum the programmed revisions and sanations of abdominal cavity were performed, sometimes--control laparoscopic revisions. In postoperative period of 256 patients with high degree of bacterial contamination wound infection arose in 6.0%, intraabdominal infection--in 4.2%, polyorganic insufficiency [symbol: see text] in 42.6%; lethality was 18.1%.     

Ultrasound examination for diagnosis of postoperative peritonitis

78 patients with peritonitis after various operations on the organs of abdominal cavity were followed up. Ultrasound examinations (n = 86) were carried out in 59 patients. In 28 of them US has revealed abscesses of the abdominal cavity. Comparative analysis showed coincidence of the diagnosis of peritonitis by clinical and roentgenological data with the results of relaparotomy in 10 (58.8%) of 17 examined patients. The same coincidence of the diagnosis of peritonitis by clinical, roentgenological and sonographic data on one side and of the results of relaparotomy on the other was found in 48 (81.4%) of 59 patients with peritonitis. It is stated, that US examination considerably increases the effectiveness of the diagnosis of postoperative peritonitis and incapsulated cavities.     

Umbilical one-puncture laparoscopic-assisted appendectomy in children

To perform a laparoscopic appendectomy, three trocars are usually needed. In order to reduce abdominal wall trauma, we have adopted an umbilical one-puncture laparoscopic-assisted appendectomy (UOPLAA). We did a retrospective study of UOPLAA performed during last 2 years on 200 children aged from 5 to 18 years (median, 9 years). The patients were selected after clinical examination. No child with advanced generalized peritonitis or an abscess with a palpable mass was a candidate for this technique. UOPLAA was successful in 184 patients (92%). In 16 cases (8%), an additional trocar was required to manage perforated or retrocecal appendicitis. The mean operative time was 15 min, and the mean hospital stay was 2 days. There were no intraoperative complications. There were 10 (5%) postoperative complications (three parietal and seven intraabdominal). Four patients (2%) needed reoperation under general anesthesia. The UOPLAA is our preference in cases of acute nonperforated appendicitis because it is simple and fast, with good cosmetic results; but in 8% of our cases, an intraoperative difficulty (retrocecal location, abnormal adhesive band, peritonitis, etc.) arose that required the introduction of additional devices to ensure the safety of the laparoscopic procedure.     

急性胃扩张的诊治：附19例报告

目的:探讨急性胃扩张的诊断和治疗方法:回顾性分析35年间因急性胃扩张住院治疗的19例患者的临床资料，总结该病典型临床表现及治疗对策。结果:19例中11例（57.9%）误诊。手术治疗15例，包括胃切开减压、胃造口术（6例），胃切开减压后再缝合创口（3例），胃切开减压、胃造口、空肠造口术（1例），胃底部分切除术（2例），十二指肠空肠吻合术（1例），空肠造口术（1例），开腹探查术未切开胃壁（1例），死亡4例(26.7%)。非手术治疗4例，主要措施为持续胃肠减压和液体复苏,死亡1例(25.0%)。结论:急性胃扩张少见，临床表现不典型，误诊率高。如果行胃肠减压不见好转或有明确的腹膜炎体征应积极手术治疗。     

166例老年患者胆囊炎胆囊结石症临床分析

目的探讨老年人急性胆囊炎胆囊结石患者的临床特征及手术治疗经验。方法对我院2000年至2008年手术治疗的166例老年人急性胆囊炎胆囊结石患者的临床资料进行回顾性分析。结果166例患者中治愈164例(98.9%),死亡2例(1.1%),104例(62.7%)合并有其他疾病,24例(14.5%)术后出现并发症。结论选择合适的手术时机、手术方式及麻醉方法,加强围手术期处理是手术成功的关键。     

Relaparotomy in abdominal injuries

Relaparotomies in the postoperative period were performed in 56 out of 529 patients (10,6%) operated upon for injuries of organs of the abdominal cavity. Twenty-two of them died. In most cases relaparotomies were caused by peritonitis, intraabdominal bleedings and abscesses.     

Postoperative complications in patients with peritonitis

One thousand three hundred and ten patients with peritonitis have undergone surgery: local limited peritonitis was in 230 patients, local unlimited--in 342, general--in 738 patients. After surgery suppuration of the wound was seen in 92 (7.1%) patients, phlegmons of the abdominal wall--in 16 (1.3%), progressive peritonitis--in 40 (3.1%), abscesses of abdominal cavity--in 13 (1.0%), eventration--in 19 (1.5%), adhesive intestinal obstruction--in 17 (1.3%). Laparoscopy was used for diagnosis of intraabdominal complications in 47 patients. This allowed to avoid unjustified laparotomies in 20 patients. Application of laparoscopy is limited by degree of bacterial contamination of peritoneal exudates. Early adhesive intestinal obstruction in 7 patients was treated with endoscopic procedure. Sonography is effective in diagnosis of intraabdominal complications, detection of site of safe puncture before postoperative laparoscopy and drainage of abscesses.     

Acute surgical pathology in elderly patients

The consequence of demographic aging is an increase of surgical pathology of the elderly, concerning both number and complexity of the cases. To asses the nature of geriatric surgical pathology and the effect of co-morbidities on surgical outcome, a retrospective study was carried out on a series of 401 patients aged over 75, treated in the IIIrd Surgical Unit in the period 2002-2003. 132 patients were admitted as acute cases and 94 of them were operated: 62 required immediate surgery and 32 required delayed operations. According to the nature of the diseases, benign surgical conditions were encountered in majority of the cases (78 cases). The diagnostics requiring immediate operations were: complicated hernias, perforated peptic ulcer, lower limb acute ischemia. Delayed emergency operations were performed for: acute cholecystitis, biliary lithiasis with angiocholitis and complicated gastric cancer. Cardiovascular pathology was recorded as the most frequent co-morbidity. Hospital mortality rate of 32.9% resulted mainly from cases with mesenteric infarction and generalized peritonitis, as well as from delayed emergencies such as complicated gastric and colon cancer. The most frequent causes of death following surgery were: cardiac failure, sepsis and multiple organ failure.