老年急性胆道感染围手术期的中西医结合治疗

随着社会的老龄化程度日益提高 ,老年急性胆道感染的发病率也相应增加。我院 1998～ 2 0 0 0年间收治 6 0岁以上急性胆道感染 92例。在围手术期间 ,利用中西医结合治疗 ,与 1994～ 1997年间行常规治疗的老年急性胆道感染病例 81例做对照观察 ,发现明显降低了急症手术率 ,减少了术后并发症 ,取得较好疗效。现报告如下。1　临床资料1 1　中西医结合治疗组　本组 92例中 ,男 2 7例 ,女 6 5例 ;年龄为 6 0～ 87岁 ,平均 6 8岁。均有典型右上腹疼痛 ,伴有恶心、呕吐及不同程度右上腹压痛。其中发热者 83例 ,有黄疸者 2 8例 ,符合ｃｈａｒｃｏｔ三…     

乳腺癌围手术期中西医结合临床路径实施分析

目的评估乳腺癌围手术期临床路径实施对住院日、住院费用及医疗质量的影响。方法制订乳腺癌围手术期中西医结合临床路径表,选择2004-2005年可手术的乳腺癌病人167例随机分为2组,临床路径组83例按路径表实施诊疗过程,对照组84例按传统方法完成治疗;同时筛选2003年符合临床路径纳入标准的病人74例,作为前后对照组,比较3组间的治疗效果。结果实施临床路径可降低住院费用(P<0.05),缩短住院天数(P<0.01),且3组间各项医疗质量指标均无差异(P>0.05)。结论乳腺癌临床路径可降低住院费用,缩短住院天数,确保医疗质量,值得推广应用。     

结石性急性胆囊炎中西医结合围手术期治疗

从１９８８年３月～１９９６年１２月，我们采用中西医结合方法对９２例结石性急性胆囊炎进行了围手术期治疗，效果优于单纯常规治疗，现分析报告如下。１临床资料１４８例结石性急性胆囊炎病人，随机将其分２组，中西医结合治疗组９２例（简称治疗组）；其中女性７４例，...     

腹腔镜胆囊切除术的围手术期中西医结合治疗

随着医学的发展 ,腹腔镜胆囊切除术 (ＬＣ)以创伤小 ,手术后恢复快的优势成为胆囊炎、胆囊结石首选的手术方式 ,但围手术期的持续胃肠减压及双肩酸痛、腹胀、恶心呕吐、排便延迟等症状 ,仍给患者带来了许多痛苦。我院于 1997年 9月～ 2 0 0 0年 9月 ,共成功施行ＬＣ 2 0 5例 ,其中 10 5例在围手术期给予中西医结合治疗 ,效果满意 ,现报告如下。1　临床资料本组 2 0 5例 ,均为慢性胆囊炎、胆囊结石。随机分为两组 ,中西医结合治疗组 10 5例 ,男 30例 ,女 75例 ;年龄 31～ 70岁 ,平均 52 1岁。其中胆囊息肉 32例 ,胆囊结石 73例。对照组 10 0…     

老年消化道肿瘤围手术期的中西医结合处理

目的 :观察老年消化道肿瘤围手术期中西医结合处理的临床效果和应用前景。 方法 :手术方式采用个体化、灵活性的设计方案。术后应用醒肺雾化散 ,预防肺部并发症 ,口服或灌肠通腑汤 ,尽早恢复胃肠道功能。术后采用中、小剂量的化疗药物 ,配合参芪扶正注射液 ,减轻化疗的毒副作用。应用百普素和能全力观察肠内营养支持的效果。 结果 :手术的切除率 86 84 % (6 6 / 76 ) ,根治率 84 16 % (6 4 / 76 ) ,围手术期死亡率 6 5 8% (5 / 76 ) ,术后并发症发生率 2 3 6 8% ,其中通腑汤使术后排气、排便时间提前了 36h和 73h ;肺醒气雾散吸入后 ,仅有 4例轻度肺部感染发生 ;参芪扶正注射液较好的保护了机体的造血功能 ,全组顺利完成了化疗全过程 ,白细胞下降不明显 ;应用肠内营养剂 ,提高了各项白蛋白水平。 结论 :本临床研究说明老年消化道肿瘤患者围手术期中西医结合处理方案是合理的、可行的 ,有广阔的应用前景。     

痔瘘病围手术期中西医结合疗法的运用

中西医结合用于痔瘘疾病的围手术期治疗,提高了痔瘘科学术水平,减轻病人痛苦,增加了手术安全性,减少了术后并发症,提高治疗效果,值得临床广泛应用。     

老年乳腺癌围手术期感染的临床观察

目的 分析老年乳腺癌(年龄≥65岁)围手术期感染的特点及相关影响因素.方法老年乳腺癌病人100例,观察感染情况,分离培养阳性菌,并观察感染构成比及特点,分析围手术期感染的影响因素.结果100例病人中,围手术期感染19例(19.0％),其中切口感染比例最高(9例,47.4％),其次为呼吸道感染(5例,26.3％).共检出...     

并存淤胆性肝炎患者的围手术期中西医结合治疗

目的：观察中西医结合围手术期治疗对淤胆性肝炎患者的临床疗效。方法：55例患者半随机分成两组,对照组采用常规综合治疗,治疗组在此基础上辨证应用清胆汤加减,术前术后连续用药并观察疗效。结果：两组患者术前症状、体征及肝功能和黄疸指数略有改善;治疗组术后肝功能和黄疸指数显著改善,与对照组比较有显著性差异（P〈0.05）。结论：淤胆性肝炎患者围手术期应用中西医结合治疗,可显著改善病情,保护肝功能,提高手术成功率。     

胃切除围手术期中西医结合处理——附667例报告

本文通过对667例胃切除病人，采用中西医结合的方法，进行围手术期处理并与同期进行的480例胃切除病人常规采用静脉补液、胃肠减压、禁饮食方法处理进行了临床观察和比较。结果中西医结合组术后较对照组平均肠音恢复时间提前23．5小时；平均排气时间提前33．6小时；平均进流食时间提前71小时；人均补液量减少11630ml，平均胃肠减压量少1717ml；并发症减少15％。经t检验，二者有显著差异(P<0．001)。我们将中西医结合围手术期处理的方法总结为“四早措施”，即“早服中药早针刺、早下床活动早进食”。病人恢复快，并发症少。提示中西医结合方法明显优于常规方法。关键词胃切降围手术期中西医结合处理     

老年胆囊切除术的围手术期治疗

老年胆囊切除术的围手术期治疗王震宇河南省平顶山市第一人民医院（河南４６７０００）１９８５年１月至１９９７年１月，我院共收治胆囊疾病３２７例，其中６０岁以上老年病人６５例。在围手术期间，应用中西医结合措施，取得满意效果，报告如下。１资料与方法１１一般...     

Response Scale Analysis of Perioperative Recovery Scale for Integrated Chinese and Western Medicine

[目的]筛选符合中西医结合围手术期康复量表条目答案的量尺语词.[方法]中西医结合围手术期康复量表的量尺语词包括能力、频率、强度以及评估4类,每类须含有5个序位的量尺语词.选择语词的顺序是先由专家讨论决定序位量尺语词的两个端点的用词.制定包含62个量尺语词的“中西医结合围手术期康复量表量尺语词选择问卷”初稿,问卷中每个量尺语词的两个端点之间有1条10 cm长的线段.邀请40名被调查者在线段上标示每个候选量尺语词相对于两个端点用词的位置,测量两端点的距离并计算均数、中位数和标准差做为评测选择依据.各类量尺语词的选择是根据均数和中位数接近0、2.50、5.00、7.50、10.00为主,并以标准差较小为原则,个别语词需结合条目和中文语言习惯进行调整.[结果]包含频率、能力、评估、强度4类的共20个量尺语词被选出,其中频率类量尺语词为“完全没有”、“有时有”、“有(一般)”、“常常有”、“总是有”;能力类量尺语词为“完全不能”、“不太能”、“中等程度能”、“多数能”、“完全能”;评估类量尺语词为“完全不满意”、“多数不满意”、“一半不满意一半满意”、“多数满意”、“完全满意”;强度类量尺语词为“非常差”、“较差”、“不好也不差”、“较好”、“非常好”.[结论]本研究选出的量尺语词符合中西医结合围手术期康复量表的需要.     

Missed Opportunities for Loco-Regional Treatment of Elderly Women with Breast Cancer

Background

Factors associated with surgery, adjuvant radiotherapy, and chemotherapy and whether there were missed opportunities for treatment in elderly patients were determined in an Asian setting.

Methods

All 5616 patients, diagnosed with breast cancer in University Malaya Medical Centre from 1999 to 2013 were included. In 945 elderly patients (aged 65 years and above), multivariable logistic regression was performed to identify factors associated with treatment, following adjustment for age, ethnicity, tumor, and other treatment characteristics. The impact of lack of treatment on survival of the elderly was assessed while accounting for comorbidities.

Results

One in five elderly patients had comorbidities. Compared to younger patients, the elderly had more favorable tumor characteristics, and received less loco-regional treatment and chemotherapy. Within stage I–IIIa elderly breast cancer patients, 10 % did not receive any surgery. These patients were older, more likely to be Malays, have comorbidities, and bigger tumors. In elderlies with indications for adjuvant radiotherapy, no irradiation (30 %) was associated with increasing age, comorbidity, and the absence of systemic therapy. Hormone therapy was optimal, but only 35 % of elderly women with ER negative tumors received chemotherapy. Compared to elderly women who received adequate treatment, those not receiving surgery (adjusted hazard ratio: 2.30, 95 %CI: 1.10–4.79), or radiotherapy (adjusted hazard ratio: 1.56, 95 %CI: 1.10–2.19), were associated with higher mortality. Less than 25 % of the survival discrepancy between elderly women receiving loco-regional treatment and no treatment were attributed to excess comorbidities in untreated patients.

Conclusion

While the presence of comorbidities significantly influenced loco-regional treatment decisions in the elderly, it was only able to explain the lower survival rates in untreated patients up to a certain extent, suggesting missed opportunities for treatment.

     

老年胃癌患者并存疾病的围手术期处理

目的探讨老年胃癌患者并存疾病的围手术期处理方法。方法回顾性分析我院于1980年3月至2008年11月期间收治的528例70岁及以上胃癌患者并存疾病围手术期处理的临床资料。结果主要并存疾病为心血管疾病（259例,49.05%）、呼吸系统疾病（161例,30.49%）及糖尿病（72例,13.64%）,主要给予调整血压、血糖及改善心、肺、肝、肾功能治疗。术后常见并发症为肠梗阻（10例）、肺部感染（10例）、返流性食管炎（9例）、残胃功能性排空障碍（7例）及吻合口漏（5例）。围手术期死亡10例,包括心肺功能衰竭6例、急性心肌梗死2例,吻合口漏1例及肠梗阻1例。结论老年胃癌患者多并存高血压、支气管炎、糖尿病等疾病。术前全面了解病情,加强对并存疾病的围手术期处理,不仅能降低手术的风险,而且能减少并发症的发生率和降低围手术期死亡率。     

Necessity of Axillary Dissection in Elderly Women with Early Breast Cancer

The need for axillary dissection forstaging and treating early breast cancer has been questioned recently.Can a patient forego axillary dissection, with its associated costs,risks, and morbidity, if it does not affect survival? The studyattempted to find a subset of patients with early breast cancer in whomdisease-free survival was independent of axillary lymph node status. Ifsurvival does not depend on lymph node status, axillary dissectioncould be omitted in the care of these patients. This study included 378women over age 70 with T1 breast cancer diagnosed and treated duringJanuary 1992 to December 1999 at both of our institutions: a largetertiary teaching hospital in Columbus, Ohio and a breast cancertreatment center in West Columbia, South Carolina. We compared thedisease-free survival, using the Kaplan-Meier estimate, in 334node-negative patients and 44 node-positive patients with T1 breastcancer. The 3- and 5-year survival rates of patients with T1N0 tumorswere 86% and 77%, respectively; and the 3- and 5-year survival ratesfor T1 node-positive tumors were 81% and 69%, respectively(p = 0.0673). There was no statistical difference between thenode-negative and node-positive groups. Axillary dissection in womenover 70 years of age with early breast cancer may be unnecessary, asthe presence of lymph node metastases does not appear to affectdisease-free survival rates significantly in this patient group.     

Long-Term Results of Breast Conservation in Chinese Women with Breast Cancer

Abstract:  Between July 1989 and December 2002, 172 women with Stage I/II breast cancer were treated by breast conservation therapy (BCT). All underwent quadrantectomy and axillary node clearance. Minimum follow-up was 5 years and 79 (52%) were followed for >10 years. At 5 years, local relapse-free and overall survival rates were 98.3% and 98.3%. The 10-year rates were 95% and 94%, respectively. The 10-year local recurrence rate was higher in patients with involved margins (33.3% versus 2.7%, p = 0.0272). Furthermore 10-year death rates in margin positive patients were higher (18.2% versus 2.5%, p = 0.0486). Excellent or good cosmetic results were achieved in 54%. BCT is a reasonable option for early stage breast cancer in Chinese women but margin status is the most important determinant of local recurrence. Negative margins are required for optimal local control and minimization of distant metastasis.     

Breast Cancer Detection Rates by Screening Mammography in Elderly Women

Abstract: Breast-cancer risk factors, mammography history, and breast cancer detection rates were compared for women aged 50–64 years versus women 65 years and older. Mammographic screening examinations were performed on 936 women at least 65 years old and 1,926 women aged 50–64 years at a mobile van and an outpatient clinic of a tertiary referral university hospital. Breast-cancer risk factors and frequency and timing of previous mammograms were assessed on all women. Of the 2,862 women screened, 520 (18.2%) were black. Women aged 65 and older were significantly more likely to be nulliparous, and over 30 years old at first pregnancy than women aged 50–64 years. The proportion of women who reported ever having a mammogram did not differ by age. For women who reported a previous mammogram, the intervals of the previous screening did not differ significantly by age group. Cancer detection rates were higher among women aged 65 and over at both locations. Among age and race groupings, the highest cancer detection rate occurred in black women over 65 years (19.7/1,000). Cancer detection rates were high enough to suggest that screening elderly women is efficacious. Because elderly black women may be less aware of breast-cancer risk factors, relying on self-referral for screening this population may be inappropriate. Barriers to mammographic screening among elderly women warrant further study.     

围手术期中西医结合治疗对TURP术后影响的临床观察

目的:探讨中西医结合治疗对经尿道前列腺电切术(TURP)后相关指标的影响。方法:分析2002年6月～2005年10月238例TURP患者围手术期的临床资料,其中中西医结合治疗组(A)179例,西医治疗组(B)59例。结果:两组术后拔尿管时间、住院天数、术后4周最大尿流率、术后1周持续菌尿>5d的发生率差异无显著性(P>0.05)。尿初、尿末疼痛持续时间,A组明显低于B组,差异具有极显著性(P<0.01),尿液转清时间、术后1周急迫性尿失禁及不稳定膀胱的发生率、术后4周IPSS、生活质量评分(QOL),A组均低于B组,差异有显著性(P<0.05)。结论:中西医结合治疗可降低TURP术后相应并发症的发生率,提高手术疗效,改善术后生活质量。     

癌症疼痛中西医治疗进展

癌症疼痛的治疗是世界卫生组织 (ＷＨＯ)对癌症综合规划的四个重点之一 ,也是广大学者极为关注、目前极需解决的问题。据ＷＨＯ统计 ,目前全世界癌症患者 30 %～ 5 0 %伴有不同程度的疼痛。我国各期癌症病人伴有不同程度疼痛的约占 6 0 %左右 ,晚期癌症以疼痛为主诉的约占 71%。从疼痛的发生原因看 ,约 6 5 %的疼痛与肿瘤本身有关 ,2 5 %的疼痛由治疗引起 ,其它因素引起的疼痛占10 % [1] 。由于疼痛对癌症患者的生活质量及对治疗影响很大 ,ＷＨＯ已将控制癌痛列为第三种抗癌手段 ,制定了“癌痛治疗计划”。我国是世界上最大的发展中国家 ,多…     

Selective Application of Axillary Node Dissection in Elderly Women with Early Breast Cancer

Background Routine use of axillary lymph node dissection (ALND) has been questioned in elderly women. This study examines whether selective application of ALND in early stage breast cancer affects breast cancer-related survival. Methods From the Surveillance, Epidemiology, and End Results (SEER) database, records of women ≥70 years of age with stage I or II breast cancer diagnosed between 1990 and 1995 were reviewed. Hazard ratios (HR) of cause-specific survival (CSS) between women receiving ALND and those who did not were compared. To minimize the potential for bias in the selection of women to receive ALND, HR of CSS was compared within propensity analysis deciles. Results 20,151 women entered the analysis. Median follow up was 6 years (interquartile range 4.33–7.67 years). Seventy-five percent underwent ALND. Women with higher risk disease and younger age were more likely to undergo ALND. Five year unadjusted CSS in women who did and did not receive ALND was 92.1% and 90.6%, respectively, with a HR of 0.85, P = 0.002. Using the propensity analysis method, the adjusted HR for CSS associated with ALND was 0.89, P = 0.066. Discussion After adjusting for differences in the probability of receiving ALND, no clinically or statistically significant difference in survival was observed among women who received ALND when compared with those who did not, although we could not account for differences in co-morbidity or use of systemic therapy between groups. Conclusion Surgeons select elderly women with early stage breast cancer for ALND with a negligible impact on CSS.