70岁以上老年食管、贲门癌的外科治疗

近年来,老年食管、贲门癌患者不断增多。老年患者一般情况差,合并不同程度的营养不良、心肺等重要器官功能减退,术后并发症明显增多。因此,加强老年食管、贲门癌患者围手术期处理尤为重要。本文对199例≥70岁食管、贲门癌患者外科治疗的体会报道如下。1临床资料1.1一般资料我院     

70岁以上老年食管癌36例外科治疗

我院从 1986～ 2 0 0 2年手术治疗 70岁以上食管癌患者 36例 ,占同期食道癌手术治疗的 3 7%(36 /95 8) ,现就其临床特点及外科治疗情况分析如下。1　临床资料1 1　一般情况　全组男 33例 ,女 3例 ,年龄 70～ 79岁 ,平均 (74 5± 4 5 )岁 ,出现症状至就诊时间 <3月者 12例 ,>3月 2 4例 ,能进普食者 4例 ,半流质饮食 2 1例 ,流质饮食 10例 ,完全梗阻 1例。1 2　伴发疾病　 2 8例伴发其他系统疾病 ,其中心血管疾病 (冠心病、陈旧性心肌梗死、高血压、心律失常等 ) 14例 ,肺部疾病 (慢性支气管炎、肺气肿、陈旧性肺结核等 ) 10例 ,糖尿病 2例 ,…     

65岁以上老年人胃癌332例临床分析

目的 探讨老年胃癌患者的临床特点及其外科治疗方法的选择及预后。方法 回顾性分析1990年1月至2003年6月收治的332例65岁以上老年人胃癌的临床资料和生存资料。结果 本组临床好转率为97．0％，围手术期病死率为3．0％，手术并发症发生率为24．7％。根治性胃切除组术后1、3、5年生存率分别为89.6％、63.2％和40.6％，姑息性胃切除组分别为68.6％、15．7％和0，未切除组平均生存10个月。各组术后生存率比较差异有显著性(P＜0．05)。结论 老年人胃癌术后并发症较多，围手术期处理至关重要。术中应尽量采用硬膜外麻醉，缩短手术时间。手术方式应视患者全身情况、癌肿所在部位、大小及侵犯范围而定，对早中期患者力争行根治性胃切除术(D1或D2)。     

70岁以上老年乳腺癌围手术期处理的探讨

老年人常合并症较多，手术耐受力较差，围手术期病情比较复杂，总结我院1994—2004年间收治的90例≥70岁老年乳腺癌病例资料，探讨围手术期的处理。     

70岁以上老年人食管癌196例放射治疗

1995年 1月至 1997年 12月我科收治单纯放疗 ,≥ 70岁老年人食管癌患者196例 ,现总结报道如下。1　资料和方法1 1　一般资料　 196例患者中男 14 2例 ,女 5 4例 ,年龄 70～ 84岁 ,中位年龄 75岁。病变部位 :颈段及胸上段 43例 ,胸中段12 2例 ,胸下段 31例。病变长度 :≤ 5 0cm 36例 ,5 1～ 8 0cm 12 6例 ,>8 0cm 34例。经食管镜或食管拉网检查确诊 85例 ,均为鳞癌 ,其余 111例患者经食管钡餐X线片检查确诊。 196例中 17例有锁骨上淋巴结转移 ,无远处转移 ;其中 83例(42 3%)有伴发病 ,主要为高血压、冠心病、慢性支气管炎等。1.2　治疗方…     

70岁以上患者冠脉支架术后联合抗栓治疗的安全性观察

由于人口的老龄化,>70岁冠心病患者接受直接经皮冠状动脉内介入手术(PCI)明显增多。在PCI后联合应用氯吡格雷和阿司匹林已成为预防支架内再狭窄和血栓性并发症最常用的方法之一。本文旨在探讨>70岁老年患者联合用药的安全性。1资料与方法1.1对象选择2002年5月至2005年2月收入我     

老年人胃癌行全胃切除术30例治疗体会

198 5年 1月～ 2 0 0 1年 1 2月 ,我院共收治经病理证实 70岁以上胃癌患者 6 8例 ,其中 3 0例行全胃切除手术治疗。现将治疗体会总结如下。1　资料与方法1 .1　一般资料　本组 3 0例中 ,男 2 3例 ,女 7例 ;年龄 70～ 86岁 ,平均 74.5岁。其中 80岁以上 3例。肿瘤发生部位 :胃窦胃体 1 5例 ,胃体 1 0例 ,胃体胃底贲门 3例 ,弥漫型 2例。肿瘤直径大多 7～ 1 0 cm,侵及其它脏器 7例 ,广泛腹腔转移 3例。本组有 2 0例术前合并其他脏器疾病。1 2例合并 2种以上慢性病 ,其中慢性支气管炎 1 0例 ,阻塞性肺气肿 7例 ,肺心病 1例 ,高血压病 1 0例 ,心…     

胃癌全胃切除消化道重建术式临床研究进展

全胃切除术是治疗胃癌的重要术式，全胃切除后消化道重建的方式包括Roux-en—Y和空肠间置两大基本术式和其他一些改良术式。尽管种类繁多，但何种更好尚无定论，目前的争议主要集中在十二指肠径路、储袋以及是否切断空肠三方面。现对主要术式作简要总结，并就主要争议方面的研究进展作一综述。     

胃癌全胃切除消化道重建术式临床研究进展

全胃切除术是治疗胃癌的重要术式,全胃切除后消化道重建的方式包括Roux-en-Y和空肠间置两大基本术式和其他一些改良术式。尽管种类繁多,但何种更好尚无定论,目前的争议主要集中在十二指肠径路、储袋以及是否切断空肠三方面。现对主要术式作简要总结,并就主要争议方面的研究进展作一综述。     

基层医院老年全胃切除术47例治疗体会

近年来，随着我国逐渐步入老龄化社会及人民生活水平的提高，要求接受手术治疗的老年胃癌病人逐年增多，我们1998-01／2004-01，共开展60岁以上老年胃上部癌全胃切除术47例，现总结分析如下。     

70岁以上老年胃癌患者临床特点及预后

目的探讨70岁以上高龄胃癌患者的临床表现、诊治方法和预后特点。方法回顾性分析我院1997年～2010年间128例胃癌患者临床资料,比较两组患者(≥70岁,高龄组;<70岁,低龄组)的临床特点和预后。结果高龄组48例,占37.5%,与低龄组患者相比,其男性发病率(93.7%vs 76.2%)、心脏病发生率(70.8%vs 27.5%)、脑血管病发生率(20.8%vs 6.3%)、二重癌发生率(6.3%vs 1.3%)及无症状发病率(20.8%vs 11.2%)显著增高(P<0.001～0.035),但吸烟率(18.7%vs 37.5%)较低(P=0.025)。高龄组贲门胃底癌多见,占27.1%,中-高分化癌占31.2%,而低龄组胃窦癌占42.5%,多为低分化-未分化癌(80.0%);发病时两组TNM分期未见显著差异,但长期随访高龄组肿瘤远处转移发生率显著低于低龄组(8.3%vs 35.0%,P=0.0048)。两组共75.0%的患者接受手术治疗,两组根治性切除率相似(60.4%vs 61.25%,P=0.21);而接受化疗的高龄组患者显著低于低龄组(56.2%vs 85.0%,P<0.001),其中因不良反应终止化疗高龄组患者占10.4%,略高于低龄组(6.2%),但差异无统计学意义。高龄组患者中位生存时间(27.8个月)较低龄组患者(19.3个月)有延长趋势,但差异无统计学意义(P=0.062)。结论 70岁以上胃癌患者男性多见,多无症状起病或缺乏典型症状,贲门胃底癌多见,中-高分化癌比例超过70岁以下患者,较少发生远处转移。虽高龄患者有较高的心脑血管疾病合并率,但多数可耐受规范的根治性手术和术后化疗。积极治疗可有效延长老年患者的平均生存时间。     

75岁以上尿毒症患者血液透析的临床研究

本文回顾性地研究了１９００例血液透析患者的临床资料，其中≥７５岁的高龄患者２００例，占同期血液透析（ＨＤ）患者的１０．５３％。资料完整者１４６例，平均年龄８０．５岁。ＨＤ１年存活率为３４．２５％，３年存活率为１４．３８％，与同期５０岁以下组比较差异显著（Ｐ〈０．０１）。死亡原因以心衰为首位，坏死性肠炎及脑出血亦不少见。预后与年龄增加、原发病及透析开始的时机有关。随着透析技术的不断完善，长期存活率不     

Clinical application of immune-enhanced enteral nutrition in patients with advanced gastric cancer after total gastrectomy

OBJECTIVE: To determine whether immune‐enhanced enteral nutrition (EN) was effective on nutritional status, immune function, surgical outcomes and days of hospitalization after total gastrectomy for patients with advanced gastric cancer (AGC). METHODS: From August 2005 to May 2011, 78 patients with AGC who underwent a total gastrectomy were enrolled and divided randomly into three groups: immune‐enhanced EN (EN + glutamine [Gln]) group, standard EN group and control group. Serum parameters including total protein, albumin, proalbumin and transferrin were examined on preoperative day 1, postoperative day 2 and day 12. Levels of immunoglobulin M (IgM), immunoglobulin G (IgG), natural killer (NK) cells, CD4⁺ and CD8⁺ T cells were also compared. RESULTS: The formulas were tolerated well in all the patients except 5 with mild complications. The EN + Gln and EN groups showed a faster onset of flatus and shorter hospitalization duration than the control group. On postoperative day 12, serum total protein, albumin, proalbumin and transferrin levels of the EN + Gln and EN groups were significantly higher than those of the control group (P < 0.05). CD4⁺ T cells, NK cells, IgM and IgG levels of the EN + Gln group increased prominently, and were significantly higher than those before the operation as well as those in the EN and control groups. CONCLUSION: Immune‐enhanced EN can improve nutritional status and immune function for the patients with AGC after total gastrectomy.     

70岁以上老年女性乳腺癌39例分析

目的 分析70岁以上老年女性乳腺癌患者的临床、病理特点,生存率和影响预后的因素.方法收集我院1997-01～2007-12收治的39例70岁以上老年乳腺癌患者的临床资料,并对患者的生存情况和临床特点进行统计分析.结果 39例老年乳腺癌占同期收治乳腺癌患者的28.26%.89.79%的患者以乳房肿块为首发症状,53.8%患者合并其他疾病.主要病理类型为浸润性导管癌(82.1%).免疫组化分析显示,雌孕激素受体阳性者占66.9%.结论老年乳腺癌具有独特的临床和病理特点,手术和内分泌治疗是主要和有效的治疗方式.     

70岁以上高龄冠状动脉旁路移植患者的临床特征分析

目的探讨高龄因素对冠状动脉旁路移植术(CABG)治疗安全性的影响及围术期管理。方法收集2016年1月至2019年2月于首都医科大学宣武医院接受CABG治疗冠状动脉(冠脉)病变70岁以上高龄患者共71例,其中男性48例,女性23例,发病年龄为(70~83)岁,平均为(74.23±6.8)岁。按照手术方法的不同,分为停跳和不停跳两组,比较两组患者的术前、围手术期以及住院死亡的情况。结果高龄患者中,53例实施了停跳CABG治疗,18例实施了不停跳CABG治疗。高血压和糖尿病病史多见于停跳CABG治疗的患者,差异有显著统计学意义(P<0.01),其他合并症两组间均无统计学差异(P>0.05)。冠脉三支病变患者接受停跳CABG治疗比例高于不停跳CABG患者,差异有统计学意义(P<0.01)。在CABG中,使用左侧乳内动脉和完全血管重建多见于停跳CABG治疗中,差异有统计学意义(P<0.01)。胸腔积液多见于不停跳CABG治疗后的患者,差异有统计学意义(P<0.05),其他术后并发症两组之间均无统计学差异(P>0.05)。总住院时间为(19.1±7.3)d,住院死亡率为5.6%,两组之间均无统计学差异(P>0.05)。结论术前全面详尽检查,术中严密监测生命体征、维持血流动力学稳定,及早发现并处理并发症,对于高龄患者行CABG具有重要意义。     

Bladder cancer in patients over 80 years old

We studied 86 patients with bladder cancer who were 80 years old and over. All were studied at the time of their first presentation for treatment in our hospital. About 40% of then were somewhat limited in performing usual daily activities before the first treatment, and they could not come to the hospital by themselves. Tumors in patients were larger, of higher grade and more invasive than those in younger patients. Transurethral resection of the bladder tumor (TUR-Bt) was done in 94% of patients with a superficial tumor and in 56% of those an invasive tumor. The recurrence rates after TUR-Bt for superficial tumor were 48%, 64% and 89% in 1 year, 3 years and 5 years, respectively. Recurrence rates were significantly different in younger patients. Overall cancer related survival rates were 86%, 60%, and 56% in 1 year, 3 years and 5 years, respectively. The outcome were significantly worse in patients over 80 years old than in those under 79 years old. To improve the outcome of treatment for bladder cancer in patients over 80 years old, cooperation among doctors, patients and families was important.     

Tuberculosis first detected in subjects over 70 years old

Characteristics of the tuberculosis process were studied in 43 patients at the age of 71 to 84 years. Patients with extended extrapulmonary tuberculosis and concomitant diseases predominated. Analysis of the causes of the late tuberculosis detection is presented and it is indicated that efficient prophylactic examination of the persons of this age group is needed. Investigation of the clinical picture of tuberculosis in the patients over 70 years revealed a number of peculiarities in its process under conditions of the Krasnoyarsk Territory.     

80岁以上老年高血压病的临床分析

目的探讨80岁以上老年高血压的降压治疗方法及安全性。方法回顾分析80岁以上老年高血压患者[男性55例,女性70例,平均年龄（83．72±3．84）岁]血压控制的临床资料。结果选用1种降压药占32％,2种以上占68％;用CCB占52％、8受体阻滞剂占55．2％、利尿剂占19．2％、ACEI占24％、ARB占46．4％。血压由（175．64±19．31）／（99．13±13．11）mmHg,降至（125．15±14．55）／（73．70±8．83）mmHg,治疗前、后比较差异有统计学意义（P〈0．01）,未见体位性低血压。结论老年人降压应个体化,平均血压降至125／74mmHg也安全。     

Management of colorectal cancer in elderly patients over 80 years old

AIM: The incidence of colorectal cancer is increasing. Surgery and chemotherapy for elderly patients are also increasing. We evaluated the characteristics of elderly colorectal cancer to clarify issues related to surgical therapy for elderly patients. METHOD: We studied 67 patients (38 men, 29 women) over 80 years old on whom we operated for colorectal cancer from 1990 to 2004. We compared them with 130 patients aged from 70 to 74 who were operated on in the same period, examining clinicopathological factors, operative methods, preoperative morbidity, postoperative complications, chemotherapy and postoperative survival ratio. RESULTS: In the elderly patients aged over 80, the rate of Dukes' B was high, whereas the rate of Dukes' A was high in patients aged from 70 to 74. No significant differences were observed in operative methods for colon cancer but Hartmann's operation and transanal local excision were frequent for rectal cancer in patients aged over 80. The rate of lymph node dissection was low in patients aged over 80 with rectal cancer. A significant difference was observed in lymph node dissection of rectal cancer between patients aged over 80 and those aged from 70 to 74, but there was no significant difference in curative ratio. Preoperative morbidity were recognized in 76% of patients aged over 80. Postoperative complications occurred in 51% of patients aged over 80. There were many cases showing delirium, but no differences in other complications between patients aged over 80 and those aged from 70 to 74. There was no operative mortality in patients aged over 80. CONCLUSION: Even elderly patients can anticipate safe operations without postoperative complications or decreased quality of life, if the appropriate operative procedure is selected with regard to their general condition.