老年妇科病人的围手术期处理

目的总结老年妇科病人的围手术期处理经验,提高老年妇女手术治疗水平.方法对1997年1月至1999年12月本院收治的老年妇科手术病人304例围手术期资料进行分析.结果资料显示老年妇科手术患者中82.2%的病人合并有心血管方面的疾病和糖尿病等疾患.老年妇女的手术疾病中以恶性肿瘤占第一位(41.8%)、子宫脱垂占第二位(30.3%)、其次为良性肿瘤(27.9%).术后有发生心衰、肺部感染、切口愈合不良等并发症.其中有1例术后并发心律失常死亡.结论只要术前充分准备,对合并症积极控制,选择适当的术式和麻醉,术中术后严密监护,老年妇科患者是可以安全度过围手术期的.     

老年妇科手术特点及其围手术期处理(附588例临床分析)

目的:探讨老年妇女妇科手术的特点及其围手术期处理原则.方法:对我院588例老年妇科手术患者临床资料进行回顾性分析,并随机抽取同期300例中年妇女(40～59岁)作比较,分析两者术前合并症,术中、术后的并发症及其防治措施.结果:老年组中生殖道肿瘤占74.8%,以恶性肿瘤为主,占35.5%.老年组中38.6%患者有心血管疾病、糖尿病和慢性阻塞性肺部疾病等合并症,明显高于中年组(P＜0.01).老年组术中、术后并发症与中年组差异无统计学意义.结论:60岁以上的老年妇科手术以妇科肿瘤为主,掌握老年妇科手术特点、在围手术期做好周密准备和术后严密监测,老年妇科手术是安全的.     

糖尿病患者妇科手术的围手术期处理

目的总结妇科疾病合并糖尿病的围手术期的处理经验。方法分析26例需行妇科手术的糖尿病患者手术前后血糖的控制及并发症的预防。结果26例糖尿病患者术中、术后合理使用胰岛素使患者预后良好，全部安全度过围手术期，无严重并发症发生，伤口一期愈合率88．46％，二期愈合率11．54％。结论糖尿病患者术前较好地控制血糖，并于术中、术后积极监测及治疗，使围手术期的血糖相对稳定，是手术成功及减少术后并发症的关键。     

70岁以上老年妇科疾病152例分析

目的探讨70岁以上老年妇科疾病的临床特征及手术治疗有关问题.方法对152例70岁以上妇科患者的资料进行回顾性分析.结果资料显示老年妇科疾病中以生殖器恶性肿瘤(37.50%)和子宫脱垂伴/或阴道壁膨出(32.80%)最常见.140例行手术治疗的患者均安全度过围手术期.结论如能根据老年妇科疾病的临床特征进行早期诊断,手术选择适宜,术前充分准备,术中、术后加强监护,大多数老年妇科病人能恢复健康.     

心脏移植术后5例患者妇科手术临床分析

目的探讨心脏移植受者进行妇科手术围手术期处理。方法回顾分析北京安贞医院2014年5月到2015年12月5例心脏移植受者接受妇科手术临床病例,对围手术期情况进行分析。结果 5例患者均顺利完成手术,围手术期未出现严重出血及感染,术后均恢复正常生活,术后1个月、半年、1年随访均未见异常,移植心脏功能良好。结论心脏移植受者术后均处于免疫抑制状态,围手术期需要积极处理,多科协作,制定相应的治疗方案,以取得满意的治疗效果。     

老年心血管合并症对妇科手术的影响及危险因素干预

非心脏手术围手术期心脏事件是选择性手术病人围手术期并发症及死亡率增加的重要原因[1] 。老年患者心血管疾病占各系统合并症的首位 ,直接影响手术及预后[2 ] 。因此 ,预测选择性手术病人围手术期并发症的危险 ,筛选出能够从进一步干预治疗中得到益处的病例进行干预 ,降低围手术期危险性 ,对降低围手术期死亡率具有重要意义。1　资料与方法1.1　研究对象以我院自 1998年 1月至 2 0 0 1年 12月 4年间在我院妇科住院的 6 5岁以上老年妇女 97例作为研究对象。其中年龄最大的 82岁 ,平均年龄 71 2岁。1.2　方法对 6 5岁以上的老年病人在入院后…     

65岁以上老年妇科急症45例临床分析

目的:探讨65岁以上的老年妇科急症的临床特征及治疗。方法:对本院近15年的45例老年妇科急症患者的临床资料进行回顾性分析。结果:老年妇科急症以生殖器肿瘤(71.11%)和子宫脱垂(15.56%)最常见,术前21例(46.67%)有合并症,以糖尿病和高血压病为主;术后6例(13.33%)有并发症,在44例需手术治疗患者中有40例行手术治疗,手术治疗率为90.91%。结论:只要对合并症积极控制,术前充分准备,术中、术后严密监护,选择适当的手术时机与手术方式,老年妇科急症患者是可以安全渡过围手术期的,高龄不是手术的绝对禁忌证。     

老年妇女腹腔镜手术适应证及利弊分析

我国目前老年人口所占比例逐渐上升,因妇科疾患而需行手术治疗的老年妇女亦越来越多。如何选择老年患者的手术方式以及围术期的处理越来越受到关注。近年来,随着腹腔镜手术的逐渐提高和普及,70%~80%的妇科手术均可在镜下完成,腹腔镜以其创伤小、恢复快、术后疼痛轻、住院时间短等优点也逐渐在老年妇科手术中得到应用。本文就老年妇科的特点及腹腔镜手术的利弊进行讨论。1老年妇女的生理特点老年妇科疾病患者机体组织形态和功能在逐渐发生退行性变化。对创伤的应激能力降低,修复能力差,基础代谢及体温调节能力降低,肝肾功能减退,药物的药理作…     

妇科疾病合并系统性红斑狼疮的围手术期管理

系统性红斑狼疮(systemic lupus erythematosus,SLE)是一种表现为多系统损害的慢性系统性自身免疫病,经常继发心、肺、肾等多脏器功能障碍,不能耐受围手术期应激及手术创伤,导致病情进展,甚至出现严重围手术期并发症。手术是妇科疾病尤其是妇科肿瘤的重要治疗手段,SLE患者的妇科围手术期管理是非常棘手的临床问题。本文从术前评估、围手术期用药、术中及术后的处理等方面综合,论述围手术期系统性红斑狼疮患者行妇科手术的处理。     

妇科腹腔镜手术围手术期护理与观察

目的研究分析妇科腹腔镜手术围手术护理方法和效果。方法选取我院2013年5月~2014年6月收治的行妇科腹腔镜手术的患者63例作为研究对象,对所有患者的临床资料进行回顾性分析,并观察护理效果。结果通过对患者围手术期护理,所有患者的手术顺利完成,术后有2例患者出现轻微的恶心、呕吐等不良反应,护理后,患者恢复正常。所有患者均在术后3~7天出院。结论对妇科腹腔镜手术的患者进行围手术期护理,可以有效提高护理效果和治愈率,降低并发症的发生,对患者预后具有较好的促进作用,其具有较高的临床应用价值。     

老年妇科疾病的调查分析

目的探讨老年妇科疾病的临床特征,提出早期诊断的意见,为开展老年妇女的治疗保健提供参考。方法调查１９８９～１９９３年间老年妇科病人４６６例,统计病种５２８例次。结果资料所示老年妇科疾病的发病数以生殖道肿瘤最多（占５７２０％）,生殖道陈旧性创伤性疾病占２３４８％,非肿瘤性的异常子宫出血性疾病占９２８％,生殖道炎症性疾病占７３９％,其它占２６５％。恶性肿瘤占全部老年患者的３４６６％,其中卵巢癌占首位,其次是子宫内膜癌,第３位是宫颈癌。在卵巢肿瘤患者中,恶性肿瘤占４２７７％。结论老年妇科疾病种类虽多,如能抓住其临床特征进行早期诊断和治疗,多数患者能恢复健康。     

Perioperative morbidity and mortality from major gynecologic surgery in the elderly woman

OBJECTIVE: To report perioperative morbidity and mortality rates in elderly women who underwent major gynecologic surgery. STUDY DESIGN: The charts of 110 women between 80 and 91 years of age who underwent major gynecologic surgery between July 1995 and May 2003 were retrospectively reviewed. RESULTS: The mean age was 83.1 years. Forty-nine procedures (44.1%) were performed for cancer, 32 (28.8%) for a mass and 23 (20.7%) for pelvic organ prolapse or urinary incontinence. Sixty-nine (62.7%) procedures were performed abdominally, 36 (32.4%) vaginally and 5 (4.5%) laparoscopically. Fifty (44.6%) patients experienced a postoperative complication, and 9 (8.1%) experienced a major one. Major complications included serious morbidity, in 5 (4.5%) patients, and mortality, in 4 (3.6%). Advanced age (> 85 years) was not associated with any of the outcomes of interest, while prior surgical history was significantly associated with a decreased hospital stay (p < 0.001). Increased hospital stay was associated with a moderate or severe medical history (p < 0.05) and laparotomy/laparoscopy vs. vaginal surgery (p < 0.01). CONCLUSION: Postoperative complications occurred frequently among women > 80 years of age who underwent gynecologic surgery. The increased perioperative morbidity in the elderly should be considered when performing surgery on women in that age group.     

Early feeding and the incidence of gastrointestinal symptoms after major gynecologic surgery

OBJECTIVE: To compare early feeding with traditional postoperative dietary management for development of postoperative gastrointestinal symptoms, including ileus after major gynecologic surgery for benign conditions. METHODS: Women who had major gynecologic surgery for benign conditions were randomly allocated to early feeding of low residue diets 6 hours postoperatively or traditional dietary management of clear liquids with normal bowel sounds, and regular diet with passage of flatus. Demographic and perioperative data were collected, and patients answered questionnaires on their perception of bowel function and pain using the McGill Pain Scale. Power analysis found that 130 women were needed to find a twofold greater incidence of ileus in the early feeding group with 80% power and alpha =.05. RESULTS: Complete data were available for 139 women, 67 allocated to the early feeding group and 72 to the late feeding group. The incidence of postoperative ileus for the study population was 4.4% and did not differ between groups (early 3% versus late 5. 8%, P =.68). There were no differences in patient demographics, surgical procedures, anesthesia used, and intraoperative complications between groups. With the exception of more complaints of nausea in the late feeding group (23% versus 13%, P =.04), there were no differences in other postoperative variables, including other perioperative complications, pain medicine requirements, fluid and caloric intake, median pain scores, and gastrointestinal function. The low incidence of perioperative complications made the power to detect differences between groups low. CONCLUSION: Low residue diet 6 hours after major gynecologic surgery for benign indications was not associated with increased postoperative gastrointestinal complaints, including ileus.     

Morbidity and mortality rates of elective gynecologic surgery in the elderly woman

OBJECTIVE: The purpose of this study was to report perioperative morbidity and mortality rates in elderly women who undergo gynecologic surgery. STUDY DESIGN: The charts of 54 consecutive women ages 70 to 85 years who underwent major gynecologic surgery between June 1998 and November 2002 were reviewed retrospectively. RESULTS: The mean age was 76.7 years. Fifty procedures (92.6%) were performed for pelvic organ prolapse and/or urinary incontinence. Forty-nine of the procedures were performed vaginally, and 27 of the procedures (50%) were performed with the use of general anesthesia. Postoperative cardiac complications occurred in five patients (10%), including three myocardial infarctions, two of which were fatal. Other complications included benign cardiac arrhythmias in two patients, slow return of gastrointestinal function in five patients (9.3%), and transient mental status changes in four patients (7.4%). The mean length of stay was 4 days. CONCLUSION: Postoperative complications occurred infrequently among elderly women who underwent gynecologic surgery. Although age alone is not a contraindication to elective surgery, there may be increased risks for geriatric women.     

Enhanced Recovery and Surgical Optimization Protocol for Minimally Invasive Gynecologic Surgery: An AAGL White Paper

This is the first Enhanced Recovery After Surgery (ERAS) guideline dedicated to standardizing and optimizing perioperative care for women undergoing minimally invasive gynecologic surgery. The guideline was rigorously formulated by an American Association of Gynecologic Laparoscopists Task Force of US and Canadian gynecologic surgeons with special interest and experience in adapting ERAS practices for patients requiring minimally invasive gynecologic surgery. It builds on the 2016 ERAS Society recommendations for perioperative care in gynecologic/oncologic surgery by serving as a more comprehensive reference for minimally invasive endoscopic and vaginal surgery for both benign and malignant gynecologic conditions. For example, the section on preoperative optimization provides more specific recommendations derived from the ambulatory surgery and anesthesia literature for the management of anemia, hyperglycemia, and obstructive sleep apnea. Recommendations pertaining to multimodal analgesia account for the recent Food and Drug Administration warnings about respiratory depression from gabapentinoids. The guideline focuses on workflows important to high-value care in minimally invasive surgery, such as same-day discharge, and tackles controversial issues in minimally invasive surgery, such as thromboprophylaxis. In these ways, the guideline supports the American Association of Gynecologic Laparoscopists and our collective mission to elevate the quality and safety of healthcare for women through excellence in clinical practice.     

Surgical Outcomes in Benign Gynecologic Surgery Patients during the COVID-19 Pandemic (SOCOVID study)

Study ObjectiveTo determine the incidence of perioperative coronavirus disease (COVID-19) in women undergoing benign gynecologic surgery and to evaluate perioperative complication rates in patients with active, previous, or no previous severe acute respiratory syndrome coronavirus 2 infection.DesignA multicenter prospective cohort study.SettingTen institutions in the United States.PatientsPatients aged >18 years who underwent benign gynecologic surgery from July 1, 2020, to December 31, 2020, were included. All patients were followed up from the time of surgery to 10 weeks postoperatively. Those with intrauterine pregnancy or known gynecologic malignancy were excluded.InterventionsBenign gynecologic surgery.Measurements and Main ResultsThe primary outcome was the incidence of perioperative COVID-19 infections, which was stratified as (1) previous COVID-19 infection, (2) preoperative COVID-19 infection, and (3) postoperative COVID-19 infection. Secondary outcomes included adverse events and mortality after surgery and predictors for postoperative COVID-19 infection. If surgery was delayed because of the COVID-19 pandemic, the reason for postponement and any subsequent adverse event was recorded. Of 3423 patients included for final analysis, 189 (5.5%) postponed their gynecologic surgery during the pandemic. Forty-three patients (1.3% of total cases) had a history of COVID-19. The majority (182, 96.3%) had no sequelae attributed to surgical postponement. After hospital discharge to 10 weeks postoperatively, 39 patients (1.1%) became infected with severe acute respiratory syndrome coronavirus 2. The mean duration of time between hospital discharge and the follow-up positive COVID-19 test was 22.1 ± 12.3 days (range, 4–50 days). Eleven (31.4% of postoperative COVID-19 infections, 0.3% of total cases) of the newly diagnosed COVID-19 infections occurred within 14 days of hospital discharge. On multivariable logistic regression, living in the Southwest (adjusted odds ratio, 6.8) and single-unit increase in age-adjusted Charlson comorbidity index (adjusted odds ratio, 1.2) increased the odds of postoperative COVID-19 infection. Perioperative complications were not significantly higher in patients with a history of positive COVID-19 than those without a history of COVID-19, although the mean duration of time between previous COVID-19 diagnosis and surgery was 97 days (14 weeks).ConclusionIn this large multicenter prospective cohort study of benign gynecologic surgeries, only 1.1% of patients developed a postoperative COVID-19 infection, with 0.3% of infection in the immediate 14 days after surgery. The incidence of postoperative complications was not different in those with and without previous COVID-19 infections.