高龄大肠癌病人的围手术期处理及营养支持

目的：探讨高龄大肠癌病人的围手术期处理及营养支持。方法；回顾分析了1990～2003年间70岁以上大肠癌126例资料。结果：根治切除89例（70.6％），姑息切除12例，Hartmann手术15例，单纯造口6例，短路手术4例。无手术死亡。术后并发症73例（57.9％），死亡8例（6.3％），术后因合并症放弃治疗2例（1.6％）。结论：重视高龄大肠癌病人的围手术期处理、营养支持及术后加强监护治疗（ICU），对提高手术切除率（耐受性）、减少手术并发症，改善预后有积极作用。     

高龄大肠癌外科治疗56例分析

目的探讨高龄大肠癌外科治疗与围手术期处理的有关问题。方法回顾分析2005年6月至2010年6月手术治疗的56例75岁以上高龄大肠癌病例。手术切除50例（89．2％）,其中根治性切除37例（66．1％）,姑息性切除13例（23．2％）,单纯结肠造瘘术6例（10．7％）。结果术后并发症16例（28．6％）,无围手术期死亡。结论充分针对高龄患者特点的围手术期处理、合理选择手术方式是减少高龄大肠癌术后并发症和病死率、改善生存质量的关键。     

80岁以上胰十二指肠切除术体会

目的探讨80岁以上高龄病人行胰十二指肠切除术的可行性。方法回顾性分析我院1999—2003年收治的7例80岁以上病人胰十二指肠切除术资料。结果7例高龄病人并发症发生3例（42．9％），其中胃潴留3例次（42．9％），肺部感染2例次（28．6％），胰瘘、消化道出血、ARDS、切口感染均1例次（14．3％）。结论高龄不是手术禁忌证．力Ⅱ强围手术期处理和胰腺专业组手术是手术安全性和规范性的保证；对高龄病人强调术前或术中病理诊断。     

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。     

高龄大肠癌手术治疗体会

目的探讨高龄大肠癌围手术期处理的有关问题,提高外科手术治疗效果。方法回顾性分析1990年1月～2004年6月90例70岁以上的大肠癌病人的外科治疗资料。结果多数大肠癌病人术前并存疾病多(75.6%),肿瘤切除率为85.6%,根治性切除率为66.7%,术后并发症发生率为47.8%,围手术期死亡6例,病死率为6.7%。结论外科手术切除是多数大肠癌首选治疗方法,术前对并存疾病的合理有效治疗以及围手术期的严格监测处理是减少术后并发症、降低病死率、提高治疗效果的关键。     

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目的 探讨高龄结、直肠癌病人的外科治疗方法。方法 回顾性分析１９９４￣１９９８年间９０例７０岁以上结、直肠癌病人的外科治疗资料。结果 高龄结、直肠癌病人入院前误诊率高（５７％）,并存病多（５９％）,肿瘤切除率为９０％,术后并发症发生率为３６．５％,围手术期病死率为６％。结论 手术切除是高岭结、直肠癌病人最好治疗方法,但早期诊断,早期治疗,合理处理并存病,充分的肠道准备,适当的麻醉和手术方式,有效的     

高龄大肠癌外科治疗158例分析

目的 探讨高龄大肠癌围手术期处理的有关问题。方法 回顾性分析了１９９１年和１０月至１９９７年５月１５８例７０岁以上大肠癌病人的外科处理。结果 根治性切除１１３例，切除率７１．５％，姑息性切除１５例，Ｈａｒｔｍａｎｎ术９例，结肠造口１８例，短路３例，术后并发症４３例，围手术期死亡１２例，病死率７．６％。结论 对高龄大肠癌病人除加强围期营养支持外，充分的术前准备，适当的手术时机与手术方式的选择，完善的     

高龄胃癌的围手术期处理

目的 探讨高龄胃癌围手术期的处理。方法 回顾分析了49例70岁以上高龄胃癌的术前准备、手术方式及术后处理。结果 高龄胃癌患者多数有其他合并症，本组行根治性胃大部切除术33例，根治性全胃切除术3例，姑息性切除8例，仅行胃肠吻合或探查5例。术后10例出现并发症，围手术期死亡3例。结论 正确的围手术期处理是减少高龄胃癌病人术后并发症和死亡率的关键因素。     

老年人急性腹膜炎的临床研究

为探讨７０岁以上老年人急性腹膜炎围手术期处理，对２８３例施行了急诊剖腹手术的７０岁以上老年人急性腹膜炎的临床资料进行了分析。结果显示：原发疾病有腹内脏器急性感染１５２例（５３．７％），腹内脏器急性穿孔９６例（３３．９％），各种绞窄性肠梗阻３０例（１０．６％），原发性腹膜炎５例（１．８％）。其临床表现不典型（６７．４％），易被误诊、漏诊（３４．８％）；直肠指诊和诊断性腹腔穿刺对诊断意义重大。结果提示：７０岁以上老年人急性腹膜炎围手术期处理关键是术前在处理好并存疾病的同时做到早诊断、早手术，术中严密监测病人生命体征、血气和水电解质酸碱平衡，术后维护重要脏器的功能，控制并发症的发生     

高龄低肺功能食管、贲门癌患者的外科治疗

目的探讨高龄低肺功能食管、贲门癌患者的外科手术治疗、手术方式的选择及围手术期的合理处理。方法回顾性分析1990年1月~2003年12月44例70岁以上低肺功能食管、贲门癌患者的手术切除方式、围手术期处理及术后呼吸机的应用。结果术后19例行呼吸机辅助呼吸,围手术期死亡3例,其中2例死于呼吸衰竭,1例吻合口瘘患者死于胸腔感染,全身衰竭。结论由于手术技术的改进、术后呼吸机的应用及围手术期的正确处理,高龄低肺功能食管、贲门癌患者的手术适应证可相对扩大。     

重症高龄高危胸部肿瘤患者外科治疗经验

重症高龄高危胸部肿瘤患者开胸根治术后处理的关键在于围手术期呼吸道管理。作者总结１９８４年５月至１９９５年１１月外科治疗胸部肿瘤１６６１例中，符合重症高龄高危者１９８例，由于围手术期强化呼吸道管理和正确处理并发症，收到满意结果。作者强调围手术期强化呼吸道管理的三个环节七个步骤，特别是环甲膜穿刺硬膜外导管留置定时注药刺激咳嗽排痰，气管镜检查吸痰抗菌药液支气管灌洗，酌情合理使用呼吸机等，均为成功扩大手术切除适应范围安全度过手术关创造十分有利的条件。     

80岁以上高龄患者行腹腔镜胆囊切除术的临床研究

目的:探讨为80岁以上高龄患者行腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)的安全性及手术时机.方法:回顾分析为63例80岁以上患者施行LC的临床资料.结果:本组63例,占全部LC的0.76%(63/8 270),患者平均83.7岁.其中26例急诊手术;2例(3.2%)中转开腹,7...     

42例老年性食管癌手术治疗分析

本文报告４２例老年食管癌病人的外科治疗结果，男性３５例，女性７例，年龄６０～８０岁，平均６５．７岁。术前２３例病人有心电图异常，９例有慢性肺疾患，１２例有其它的伴存疾病。本文对老年食管癌的特点、术前准备，围手术期的监护和处理进行了讨论。     

Perioperative Complications of Breast Cancer Surgery in Elderly Women (≥80 Years)

Purpose

There has been much controversy regarding the optimal management of breast cancer in very elderly women. Some clinicians are reluctant to offer surgical treatment for women older than aged 80 years because of the assumed higher operative risk associated with advanced age. This study was designed to investigate the perioperative complications of breast cancer surgery in women of this age group.

Methods

Data were reviewed of all women ≥80 years of age who underwent breast cancer surgery at a university clinic during the period 1990–2005. Symptoms, comorbidities, preoperative risk assessment, type of operation, postoperative histological diagnosis, hospital stay, morbidity, and mortality were documented and analyzed.

Results

During this 16-year period, 140 operations for breast cancer were performed in 129 women. The majority of the patients (37.9%) underwent a modified radical mastectomy, 32.1% underwent a simple mastectomy, 24.3% underwent breast-conserving therapy, and 5.7% underwent an axillary lymph node dissection. Complications occurred in 37.1% of the cohort: 31.4% were minor complications and only 5.7% were major. Intraoperative morbidity was 18.6% and postoperative morbidity was 20%. Late complications occurred in 5% of patients. The most common complications were associated with the wound region (50%). The perioperative mortality in this group of elderly women was zero.

Conclusions

Breast cancer surgery has acceptable perioperative morbidity and mortality in women aged ≥80 years. Surgery is the cornerstone of breast cancer treatment and should be offered as first-line treatment for all patients regardless of their age.     

Mortality associated with emergency abdominal surgery in the elderly.

INTRODUCTION: Elderly patients with life-threatening abdominal disease are undergoing emergency surgery in increasing numbers, but emergency procedures generally are associated with increased morbidity and mortality. We carried out a retrospective and prospective study at a tertiary centre in Spain to analyze the factors contributing to death after emergency abdominal surgery in elderly patients and to determine whether there were differences in the death rate between those aged 70-79 years and those aged 80 years and older. METHODS: The study population comprised 710 patients aged 70 years or older who underwent emergency surgery for intra-abdominal disorders. Between 1986 and 1990, we reviewed the charts of 302 patients, and between 1991 and 1995, we collected prospective data on 408 patients. The patients were divided by age into 2 groups: group 1 - 364 patients aged 70-79 years; and group 2 - 346 patients aged 80 years or older. In the analysis, we considered patient age, sex, perioperative risk, the time between onset of symptoms and admission to hospital and between admission to hospital and surgery, diagnosis, type of operation, operative findings, morbidity, mortality and length of hospital stay. RESULTS: The overall mortality was 22% (19% in group 1 and 24% in group 2). Multiple regression analysis showed that American Society of Anesthesiologists (ASA) grading (p = 0.0001), interval from onset of symptoms to admission (p = 0.007), mesenteric infarction (p = 0.005), a defunctioning stoma and palliative bypass (p = 0.003) and nontherapeutic laparotomy (p = 0.0003) were predictive of death. CONCLUSIONS: Mortality in elderly patients operated on for an acute abdomen can be predicted by ASA grade (perioperative risk), delay in surgical treatment and conditions that permit only palliative surgery. Increasing age (70-79 yr or > or = 80 yr) does not affect mortality, morbidity or length of hospital stay.     

老年全麻患者围术期血清兴奋性氨基酸浓度的变化及临床意义

目的 观察老年全麻患者围术期血清兴奋性氨基酸(EAA)浓度的动态变化.方法 择期行非心脏手术气管内全麻患者41例.根据年龄不同分为老年组31例,年龄≥65岁;青年组10例,年龄25～45岁.所有患者术后均使用静脉镇痛.采用简易智力状态检查法(MMSE)分别评估患者麻醉前及术后24、48、72 h内的认知功能.于麻醉前(T1)、术毕(T2)、术后24 h(T3)、48 h(T4)、72 h(T5)经颈内静脉采血2 ml.采用反相高效液相色谱荧光法(RP-HPLC)检测血清氨基酸浓度.结果 MMSE评分老年组术后24、48 h明显低于麻醉前和青年组(P<0.05).与T1时比较,T3、T1时老年组血清谷氨酸(Glu)、天冬氨酸(Asp),甘氨酸(Gly)浓度升高(P<0.05或P<0.01),T5时恢复.T1时老年组血清Glu、Asp、Gly浓度低于青年组,但差异无统计学意义;T3时老年组Glu、Asp、Gly明显高于青年组(P<0.05).结论 老年患者术后早期存在EAA水平升高,Glu可能参与术后认知功能障碍(POCD)的病理生理过程.老年患者全麻术后早期血清EAA水平较高可能是老年POCD发病率高的原因之一.     

52例高龄肺癌病人的外科治疗分析

目的分析高龄肺癌患者围手术期的管理及其有效性与安全性。方法手术治疗的52例高龄肺癌患者,平均年龄75岁,行全肺切除2例,单肺叶切除33例,双肺叶切除10例,右肺袖状切除2例,肺楔形切除5例。行根治性手术48例（92.3%）,姑息性手术者4例（7.7%）。结果本组无围术期死亡,术后并发症17例（32.6%）,其中肺不张5例,肺部感染6例,心衰8例,室上性心动过速3例,心绞痛2例,下肢静脉栓塞1例,均经积极治疗痊愈出院。结论高龄肺癌患者在加强围手术期管理的前提下行外科手术治疗是安全有效的。     

The value of radionuclide angiography as a predictor of perioperative myocardial infarction in patients undergoing abdominal aortic aneurysm resection

To define the group of patients at high risk for myocardial infarction (MI) and death associated with abdominal aortic aneurysm repair, resting gated blood pool studies were obtained on 50 such aneurysm patients preoperatively. The results indicated that three groups could be distinguished among these patients by cardiac ejection fraction. Group I (n = 25) had preoperative ejection fractions ranging from 56% to 85%. None of the patients in group I suffered an acute perioperative MI. Group II (n = 20) comprised patients with ejection fractions ranging from 36% to 55%. There was a 20% incidence of MI in group II but no cardiac deaths. Group III included five patients with ejection fractions ranging from 27% to 35%. There was an 80% incidence of perioperative MI in these patients, with one cardiac death and one cardiac arrest. All perioperative MIs occurred within the first 48 hours after surgery. In addition there was a 50% incidence of perioperative MI among all those patients who were 80 years of age or older. These results indicate guidelines for the management of patients undergoing abdominal aortic aneurysm repair based on their preoperative ejection fraction. The data further suggest that the noninvasive gated blood pool method of determining ejection fraction may serve a more broadly useful function in helping to determine which of those patients about to undergo major surgical procedures are at high risk for perioperative MI.     

Hernias of the abdominal wall in patients over the age of 70 years.

OBJECTIVE: To find out if the patients' age affects the treatment of abdominal hernias and the results in relation of the age increase. DESIGN: Retrospective and prospective study. SETTING: University hospital, Spain. SUBJECTS: 664 patients aged 70 years or more operated on for abdominal hernia between 1986-1998. Patients were divided into three groups: 443 aged 70-79; 202 aged 80-89; and 19 patients aged 90 years or more. MAIN OUTCOME MEASURES: Perioperative risk, type of surgery and deaths. RESULTS: 117 women (52%) had femoral hernias, compared with 32 men (7%) (p = 0.0001). The incidence of femoral hernia over 80 years of age was 79/221 (36%) compared with 70/443 (16%) among patients in their seventies (p = 0.0001). 97 of the patients aged 70-79 (22%) were operated on as emergencies, 107 of those aged 80-89 (53%), and 17 in patients 90 or older (89%, p = 0.0001). The mortality rate was 1% in the 70-79 group (n = 6), 5% (n = 10) in the 80-89 group, and 3/19 died in the over 90 group (p = 0.0001). No deaths were reported after elective surgery. CONCLUSION: Emergency operations in elderly patients with abdominal wall hernias are increasingly more common as the patient get older. As result, there is an unacceptable increase in postoperative mortality.     

Assessment of outcomes after colorectal cancer resection in the elderly as a rationale for screening and early detection

BACKGROUND: Clinical, social and survival outcomes in elderly patients undergoing bowel cancer surgery were studied to explore the justification for the current upper age limit in colorectal cancer screening programmes. METHODS: Scottish national data were analysed to determine age-specific population survival following a diagnosis of colorectal cancer. Detailed analysis of outcome variables was undertaken in a cohort of 180 patients aged over 80 years who underwent resection of colorectal cancer. RESULTS: Population analysis revealed that the absolute risk of developing colorectal cancer was highest in those aged over 80 years, but relative survival was disproportionately poor. Of 180 patients in this age group, 30.0 per cent required an emergency procedure and only 4.6 per cent had Dukes' stage A tumours. Determinants of all-cause mortality were tumour stage (P < 0.001) and degree of co-morbidity (P = 0.004). Some 88.0 per cent of elderly patients returned to the same category of accommodation as that before admission. CONCLUSION: Colorectal cancer is increasingly common in people aged over 80 years and survival is disproportionately poor compared with that in other age groups. Elective management of early-stage cancer has a better outcome than emergency surgery. The majority of patients maintain social independence. These population and hospital data provide a rationale for early, and even presymptomatic, detection of colorectal cancer in the elderly.