老年急性心肌梗死患者直接PCI的治疗评价

目的观察直接经皮冠状动脉介入治疗(PCI)对高龄ST段抬高的急性心肌梗死(STEMI)患者治疗的安全性、可行性及治疗现状。方法62例急性STEMI患者分成两组(≥70岁和<70岁)并予梗死相关血管(IRA)给予直接PCI治疗。比较各组患者心血管事件的发生。结果≥70岁组与<70岁组血管再通率、术中及术后24h内死亡和恶性心律失常及心源性休克不良心血管事件的发生及两组患者接受直接PCI治疗的比例差异无显著性。结论年龄≥70岁的STEMI患者可以安全接受直接PCI治疗,并且有较好疗效。     

侵犯邻近脏器的70岁以上肺癌患者的外科治疗

日本癌症研究所附属医院积14年经验,对侵犯邻近脏器的70岁以上肺癌患者进行临床研究。全组29例均作肺切除及合并受侵脏器切除术,收到一定疗效。资料1970～1983年的14年间收治原发性肺癌781例,外科治疗394例,手术切除的70岁以上者103例,其中伴邻近脏器受侵者29例。为了专题研究高龄晚期肺癌病人的外科治疗,作者将伴邻近脏器受侵的肺癌患者分为70岁以上高龄组(Ⅰ组)29例和70岁以下对照组(Ⅱ组)85例。各种肺切除合并邻近脏器切除:Ⅰ组有壁层胸膜     

高龄大肠癌85例外科治疗体会

大肠癌(包括盲肠、结肠和直肠癌)是消化道常见的恶性肿瘤.近20年来,大肠癌发病率逐年上升,其中高龄患者(＞70岁)占10%～17%.本文就我院1999年5月至2002年12月行外科治疗的85例高龄大肠癌患者临床资料进行分析,并就高龄大肠癌患者的特点及围手术期治疗进行讨论.     

老年食管癌患者术后心律失常26例

心律失常是食管癌术后常见的心血管并发症,文献报告在13%～50%之间〔1〕,高龄患者更高,60岁以上术后并发心律失常比60岁以下者多3倍〔2〕。高龄患者心肺功能差,心律失常是患者手术后常见并发症之一。本文回顾性分析手术后心律失常高龄肺癌患者临床特征。1资料与方法1.1研究对象我院2006年6月至2010年6月70～82〔平均(74.6±4.2)〕岁食管癌患者92例,男68例,女24例,胸上     

国产替罗非班在高龄急性冠状动脉综合征患者介入治疗中的应用

目的评价高龄(≥70岁)非ST段抬高急性冠状动脉综合征(ACS)患者冠状动脉介入治疗(PCI)中应用国产血小板膜糖蛋白Ⅱb/Ⅲa受体拮抗剂替罗非班的安全性和近期疗效。方法108例行PCI的非ST段抬高ACS患者按年龄分为高龄组(≥70岁,42例)和非高龄组(<70岁,66例),分析两组基础资料特征、即刻手术成功率、出血和血小板减少发生率;观察住院和随访30天期间不良心血管事件(再发心绞痛、心肌梗死、心力衰竭及猝死)。结果高龄组甘油三酯、脂蛋白a高于非高龄组,体重指数和吸烟比例低于非高龄组(P均<0.05);高龄组多支病变比例高于非高龄组(71%比39%,P<0.01);两组PCI即刻成功率均为100%。高龄组发生小出血5例、血小板减少6例;非高龄组小出血2例,血小板减少2例;两组均无大出血发生。高龄组血小板减少及总副反应发生率高于非高龄组(P均<0.05),小出血发生率差异无统计学意义(P>0.05)。高龄组住院和随访期间再发心绞痛5例、心肌梗死1例、心力衰竭2例、猝死0例;非高龄组再发心绞痛7例、心力衰竭1例,无心肌梗死和猝死。两组间复合心血管事件发生率差异无统计学意义(P>0.05)。结论高龄非ST段抬高ACS患者PCI中应用国产替罗非班是安全的。     

我国胸心血管外科奠基人吴英恺院士逝世

本刊讯2003年11月13日凌晨4时50分,我国胸心血管外科奠基人、中国科学院院士、一代名医吴英恺溘然长逝,享年93岁。 吴英恺院士从医70多年以来,为我国胸心血管外科和心血管流行病学的发展做出了重要贡献。1940年他在北京协和医院首次成功切除食管癌。五十年代后期他在中国医学科学院阜外医院组织开展心脏血管外科,在心脏外     

我国心血管外科研究的主要成就

心血管外科是医学领域中的一门新兴的高技术学科,随着我国社会主义建设的发展和医药卫生事业的进步,我国的心血管外科经过几代专业医护人员的艰苦努力已全面发展起来,目前能独立完成心脏直视手术的医院据不完全统计已达600余家,遍及全国所有的省市自治区,每年可完成各种心脏直视手术5万余例。我国心血管外科的整体水平有较大的提高,这主要表现在:(1)接受手术治疗患者的年龄从出生几天的新生儿到近80岁高龄的老人,技术上已从简单畸形的修补和矫正发展到复杂畸形根治术和大动脉调转术,各种复合技术广泛应用。人工瓣膜置换、冠状动脉旁路移植术…     

老年食管贲门癌术后并发症的防治

随着人民生活水平的提高和医疗条件的改善，人均寿命的延长，高龄食管贲门癌的比例随之增加，因而发病率也增高。由于外科手术、麻醉管理及术后监护技术的飞速发展，其手术的安全性大大增加，≥70岁患者总体围手术期病死率与＜70岁患者相比差异无显著性。但在临床实践中我们发现，     

高龄与青年胃癌临床病理的对比

胃癌是我国常见消化道肿瘤之一,好发年龄在50岁以上,随着平均寿命延长,高龄(≥70岁)胃癌患者临床上越来越常见,高龄胃癌在临床、病理等方面与青年胃癌相比有不同特点,且病例报道较少.本研究对我院168例高龄(≥70岁)和62例青年(≤35岁)胃癌患者作对比,分析高龄胃癌患者临床病理特点,以提高对高龄胃癌的认识和诊治水平.     

高原地区老年胃癌患者的临床特点及外科治疗

目的　探讨高原地区高龄胃癌患者的临床特点及合理的外科治疗。方法　回顾分析了 1 990～ 2 0 0 2年我院收治的 56例 70岁以上胃癌患者的治疗情况。结果　患者平均患病年龄 73 8岁 ,男女患病构成比为 4 :1 ,平均病程 3 4个月 ,术前并存疾病的发生率为 53 5 % ,术后并发症发生率为 55 3%。结论　对高原地区高龄胃癌患者 ,加强术前并存疾病和并发症的处理 ,选择适当的手术 ,可以降低手术风险 ,减少并发症。     

Outcomes of cardiac surgery in patients > or = 80 years: results from the National Cardiovascular Network

OBJECTIVES: The purpose of this study was to evaluate characteristics and outcomes of patients age > or =80 undergoing cardiac surgery. BACKGROUND: Prior single-institution series have found high mortality rates in octogenarians after cardiac surgery. However, the major preoperative risk factors in this age group have not been identified. In addition, the additive risks in the elderly of valve replacement surgery at the time of bypass are unknown. METHODS: We report in-hospital morbidity and mortality in 67,764 patients (4,743 octogenarians) undergoing cardiac surgery at 22 centers in the National Cardiovascular Network. We examine the predictors of in-hospital mortality in octogenarians compared with those predictors in younger patients. RESULTS: Octogenarians undergoing cardiac surgery had fewer comorbid illnesses but higher disease severity and surgical urgency than younger patients. Octogenarians had significantly higher in-hospital mortality after cardiac surgery than younger patients: coronary artery bypass grafting (CABG) only (8.1% vs. 3.0%), CABG/aortic valve (10.1% vs. 7.9%), CABG/mitral valve (19.6% vs. 12.2%). In addition, they had twice the incidence of postoperative stroke and renal failure. The preoperative clinical factors predicting CABG mortality in the very elderly were quite similar to those for younger patients with age, emergency surgery and prior CABG being the powerful predictors of outcome in both age categories. Of note, elderly patients without significant comorbidity had in-hospital mortality rates of 4.2% after CABG, 7% after CABG with aortic valve replacement (CABG/AVR), and 18.2% after CABG with mitral valve replacement (CABG/MVR). CONCLUSIONS: Risks for octogenarians undergoing cardiac surgery are less than previously reported, especially for CABG only or CABG/AVR. In selected octogenarians without significant comorbidity, mortality approaches that seen in younger patients.     

The management of bleeding peptic ulcer in the elderly with heater probe thermocoagulation

BACKGROUND/AIMS: The aim of this study was to compare the clinical characteristics of bleeding peptic ulcers in the elderly with those in younger patients, retrospectively. METHODOLOGY: Between 1986 and 1994, 274 patients with bleeding peptic ulcers were treated with heater probe endoscopically. They were divided into 2 groups: 48 in the elder group (70 years of age or older) and 226 in the younger group (<70). We evaluated the rate of concomitant disease, rebleeding rate, incidence of emergency surgery, mortality and blood transfusion requirement between the 2 groups. RESULTS: The incidence of concomitant disease was significantly higher in the elderly group (83.3%) than in the younger group (33.3%) (p<0.01). The rate of rebleeding (younger group 23.5% vs. elderly group 31.3%), the incidence of emergency surgery (5.8% vs. 6.3%, respectively) and the rate of mortality due to hemorrhage (2.2% vs. 4.2%, respectively) were similar in the 2 groups. There was no significant difference in the mean volume of blood transfused. CONCLUSIONS: It was revealed that aggressive endoscopic hemostasis improved the mortality rate and the incidence of emergency surgery in elderly patients as well as in younger patients, provided that their general condition was monitored carefully.     

Management of hepatocellular carcinoma in the elderly

Mean age of hepatocellular carcinoma(HCC) patients has been progressively increasing over the last decades and ageing of these patients is becoming a real challenge in every day clinical practice. Unfortunately, international guidelines on HCC management do not address this problem exhaustively and do not provide any specific recommendation. We carried out a literature search in MEDLINE database for studies reporting on epidemiology, clinical characteristics and treatment outcome of HCC in elderly patients. Available data seem to indicate that in elderly patients the outcome of HCC is mostly influenced by liver function and tumor stage rather than by age and the latter should not influence treatment allocation. Age is not a risk for resection and older patients with resectable HCC and good liver function could gain benefit from surgery. Mild comorbidities do not seem a contraindication for surgery in aged patients. Conversely, major resection in elderly, even when performed in experienced high-volume centres, should be avoided. Both percutaneous ablation and transarterial chemoembolization are not contraindicated in aged patients and safety profile of these procedures is acceptable. Sorafenib is a viable option for advanced HCC in elderly provided that a careful evaluation of concomitant comorbidities, particularly cardiovascular ones, is taken into account. Available data seem to suggest that in either elderly and younger, treatment is a main predictor of outcome. Consequently, a nihilistic attitude of physicians towards under- or no-treatment of aged patients should not be longer justified.     

Clinical outcome and survival after esophagectomy for carcinoma in elderly patients

Advances in perioperative management have allowed more and more elderly patients to undergo major surgery with postoperative morbidity and mortality rates comparable to those of younger individuals. The aim of this study was to evaluate the impact of age on the clinical outcome and long-term survival of patients with esophageal carcinoma undergoing esophagectomy. Nine-hundred patients with esophageal carcinoma were divided into two groups: A (n = 403) with age > or = 65 years, and B (n = 497) with age < 65 years. One-hundred and fifty three (38%) patients of group A underwent surgery compared to 272 (55%) of group B (P < 0.01). Postoperative mortality, and the prevalence of anastomotic leak and respiratory complications were similar in both groups; conversely, there was a higher prevalence of cardiovascular complications in group A (13% vs 3%, P < 0.01). Five-year survival was about 35% in both groups. In conclusion, advanced age should no longer be considered an absolute contraindication to esophagectomy for carcinoma in selected patients. In fact, the postoperative mortality and long-term survival rates of elderly patients undergoing resection are comparable to that of younger individuals.     

老年心血管病患者白内障围手术期心律失常的变化及对策

目的应用动态心电图(DCG)观察老年心血管病患者行白内障摘除术围手术期心律失常发生情况,为制定干预措施提供依据。方法对66例(72只眼)年龄≥60岁伴有心血管病史的白内障手术摘除患者,在围手术期间进行24 h DCG监测,观察术前2 h、术中以及术后2 h的心律失常变化,所得DCC数据用统计学方法进行对比分析研究。结果 66例患者在围手术期间心律失常的总发生率为87.9%,以房性心律失常最高(86.2%),室性心律失常次之(72.4%);短暂房性心动过速和短暂室性心动过速分别为24.1%和3.4%。术中和术后2 h房性心律失常发生率明显高于术前2 h(P=0.000);而术中和术后2 h室性心律失常明显低于术前2 h(P=0.000)。23例(34.8%)有眼心反射的发生。术后出院视力脱残率为86.1%,脱盲率为93.1%。手术中无严重全身并发症发生。结论老年心血管病患者白内障围手术期心律失常发生率较高,术前应予全面综合分析和评估,针对其变化特点采取相应措施,尽可能减少心律失常的发生,使手术风险降至最低。     

Influence of age on outcome of total laparoscopic fundoplication for gastroesophageal reflux disease

AIM： To demonstrate that age does not influence the choice of treatment for gastroesophageal reflux disease （GERD）. We hypothesized that the outcome of total fundoplication in patients 〉 65 years is similar to that of patients aged ≤ 65 years. METHODS： Four hundred and twenty consecutive patients underwent total laparoscopic fundoplication for GERD. Three hundred and fifty-five patients were younger than 65 years （group Y）, and 65 patients were 65 years or older （group E）. The following elements were considered： presence, duration, and severity of GERD symptoms; presence of a hiatal hernia; manometric evaluation, 24 h pH-monitoring data, duration of operation; incidence of complications; and length of hospital stay. RESULTS： Elderly patients more often had atypical symptoms of GERD and at manometric evaluation had a higher rate of impaired esophageal peristalsis in comparison with younger patients. A mild intensity of heartburn often leads physicians to underestimate the severity of erosive esophagitis. The duration of the operation was similar between the two groups. The incidence of intraoperative and postoperative complications was low and the difference was not statistically significant between the two groups. An excellent outcome was observed in 92.9% young patients and 91.9% elderly patients. CONCLUSION： Laparoscopic antireflux surgery is a safe and effective treatment for GERD even in elderly patients, warranting low morbidity and mortality rates and a significant improvement of symptoms comparable to younger patients.     

Appendicitis in the elderly: the case for better diagnosis

Appendicitis in the elderly is a serious disease with increased morbidity and mortality. This and other studies show that there is a delay in operating on patients over age 55 who may have appendicitis. While symptoms are milder in the elderly, they are of the same kind as in younger patients. The same is true of physical findings. Greater suspicion and early surgery should improve the outcome in caring for elderly patients with appendicitis.     

Comparison between surgical outcomes of colorectal cancer in younger and elderly patients

AIM:To compare the outcome of surgical treatment of colorectal adenocarcinoma in elderly and younger patients.METHODS:The outcomes of 122 patients with colorectal adenocarcinoma who underwent surgical treatment between January 2004 and June 2009 were analyzed.The clinicopathological and blood biochemistry data of the younger group(<75 years) and the elderly group (≥75 years) were compared.RESULTS:There were no significant differences between the two groups in operation time,intraoperative blood loss,hospita...     

Syncope in the elderly

This report describes the evaluation of syncope in 210 elderly patients as compared with 190 younger patients. The elderly group had a mean age of 71 years (range 60 to 90) and the younger group had a mean age of 39 years (range 15 to 59). A cardiovascular cause was found in 33.8 percent of the elderly and in 16.8 percent of the young (p = 0.0001), a noncardiovascular cause in 26.7 percent of the elderly and 37.9 percent of the young (p = 0.02), and unknown cause in 38.5 percent of the elderly and 45.3 percent of the young (NS). Prolonged electrocardiographic monitoring established the diagnosis in 17 percent of the elderly but in only 8 percent of the young (p = 0.008). Syncope resulted in trauma in 39 percent of the elderly and in 32 percent of the young, but the elderly more often had major trauma. The two-year overall mortality was 26.9 +/- 3.4 percent in the elderly and 8.3 +/- 2.1 percent in the young (p less than 0.0001). The overall mortality and incidence of sudden death in the elderly with a cardiovascular diagnosis were similar to those in the young; however, in the elderly with a noncardiovascular diagnosis and syncope of unknown cause, the mortality and incidence of sudden death were higher. Multivariate analyses using mortality and sudden death as endpoints revealed that a cardiovascular cause of syncope was a very strong risk factor. In patients with a noncardiovascular cause or unknown cause of syncope, a history of congestive heart failure, older age, and male sex are important prognostic factors.     

Characterization of inflammatory bowel disease in elderly patients: A review of epidemiology,current practices and outcomes of current management strategies

The authors review and summarize the current literature regarding the epidemiology, clinical presentation and management of inflammatory bowel disease (IBD) in elderly patients.Among elderly patients, the incidence of ulcerative colitis (UC) is higher than that of Crohn disease (CD). Elderly patients with a new diagnosis of UC are more likely to be male and have left-sided colitis. Elderly patients with a new diagnosis of CD are more likely to be female and have colonic disease. Conversely, increasing age at diagnosis has been associated with a lower likelihood of having any of a family history of IBD, perianal disease in CD and extraintestinal manifestations. Although response to drug therapies appears to be similar in elderly patients and younger individuals, the elderly are more likely to receive 5-aminosalicylic acid agents, and less likely to receive immunomodulators and biologics. Corticosteroid use in the elderly is comparable with use in younger individuals. The rates of surgical intervention appear to be lower for elderly CD patients but not elderly UC patients. Elderly individuals with UC are more likely to need urgent colectomy, which is associated with an increased mortality rate. Elective surgery is associated with similar outcomes among the elderly and young patients with IBD. Therefore, the use of immunomodulators and biologics, and earlier consideration of elective surgery for medically refractory disease in elderly patients with IBD, should be emphasized and further evaluated to prevent complications of chronic corticosteroid(s) use and to prevent emergency surgery.