糖尿病病人围手术期的处理

糖尿病是一种因胰岛素绝对不足或相对不足引起的以高血糖为主要症状的疾病,外科围手术期糖尿病人情况直接影响到围手术期并发症的发生率和死亡率,因此围手术期糖尿病病人的处理非常重要。     

老年髋部骨折合并帕金森病的围手术期处理策略

目的总结老年髋部骨折合并帕金森病行手术治疗的风险及其对策。方法对本院收治的18例老年髋部骨折合并帕金森患者行手术治疗,对围手术期风险和并发症给予积极处理。结果 1例术后2月出现假体松动,进行了髋关节翻修手术;1例术后3天出现髋关节脱位,手法复位成功;2例出现肺部感染转内科治疗;1倒出现术后精神障碍对症处理后症状消失。其余患者髋关节功能恢复良好,无围手术期并发症发生。结论老年髋部骨折合并帕全森病患者围手术期并发症发生率较高,手术治疗时应充分评估,积极应对处理。     

快速康复外科理念在肝胆外科围手术期护理中的应用

目的探讨快速康复外科理念在肝胆外科围手术期护理中的应用效果。方法随机将100例肝胆外科手术的患者分为2组,每组50例。对照组围手术期行常规护理,观察组在快速康复外科理念指导下进行围手术期护理,比较2组护理效果。结果观察组患者术后下床活动时间、进食时间、肛门排气时间、住院时均优于对照组,组间比较,差异均有统计学意义(P0.05)。结论围手术期运用快速康复外科理念,可促进肝胆外科手术患者的康复。     

老年胆结石围手术期处理的临床体会(附82例报告)

在胆结石的发病人群中,老年人的发病率相当高,且绝大多数老年患者并存有诸多慢性内科疾患。因此,老年胆结石的外科手术风险较大,术后并发症相对多,手术死亡率相对较高。做好老年胆结石的围手术期处理,有着重要的意义。总结我科对82例60岁以上的老年胆结石患者施行围手术期处理,报道如下。     

围手术期镇痛在肝胆手术中的应用进展

疼痛是影响肝胆外科患者术后康复的重要因素,术后疼痛可引起一系列的并发症,如何有效地控制肝胆手术后的疼痛是重要的研究课题。本文以肝胆手术围手术期镇痛的机制及方法为论点,就目前肝胆外科常用的镇痛方法及镇痛药物以及国内外最新进展进行综述。     

老年人腹腔镜胆囊切除术的围手术期处理体会

老年人腹腔镜胆囊切除术的围手术期处理体会广州军区总医院肝胆外科（５１００１０）霍枫陈国忠詹世林我院自１９９３年２月至１９９６年６月对６３例老年胆囊疾病病人行腹腔镜胆囊切除术（ＬＣ）。现就老年胆囊疾病病人行ＬＣ的围手术期处理问题进行讨论。临床资料本组６...     

肝切除术围手术期过度炎症反应调控的多学科专家共识(2014版)

随着肝脏外科技术的成熟,围手术期管理的重要性也日益彰显.大量的研究结果表明:肝切除术后过度炎症反应是导致各种并发症的重要原因,严重时可能危及患者生命.为此,中国抗癌协会肝癌专业委员会多次组织国内肝胆外科、麻醉科和重症医学领域的专家经过广泛和深入地研讨,在综合国内外相关领域的最新研究进展和专家经验的基础上制订了《肝切除术围手术期过度炎症反应调控的多学科专家共识(2014版)》.本共识涵盖了肝切除术围手术期过度炎症反应的发生、危害、评估方法和处理原则等方面内容,供临床医师参考,希望能有助于减少肝切除术后并发症的发生,促进患者康复.     

肝胆外科中手术应激与脏器损伤

随着肝胆外科技术的不断进步,手术本身所致的危险性已显著降低,但由手术应激和过度应激带来的危害日益成为影响肝胆外科病人治疗效果和康复的突出问题。通过围手术期的各种调控措施控制手术应激反应进而影响疾病的预后和转归已成为肝胆外科临床诊疗中的重要内容。但目前手术应激的机制尚不完全明了,对过度应激的处理和调控仍存在较多的空白和争议。因此,需要更多的基础和临床研究来论证和探索。     

老年腹部手术病人的围手术期处理

为探讨如何作好老年人腹部手术的围手术期处理，以减少并发症，提高疗效，对３０７例老年腹部手术病人临床资料进行了回顾性分析。围手术期处理包括术前全面查体及辅助检查、营养支持、重要脏器的功能维护、并存病的处理及特殊病例手术时机、麻醉方法的选择与术中监护、并发症的防治。结果显示：３０７例中，术后发生各种并发症５６例（１８．２％）死于并发症７例（２．３％）。提示加强围手术期处理对减少并发症，提高疗效，具有重     

老年骨折患者伴2型糖尿病围手术期处理

目的研究老年骨折患者伴有2型糖尿病围手术期处理方案。方法对24例老年骨折患者伴有2型糖尿病围手术期血糖控制的方法进行分析。结果24例均安全渡过围手术期,切口均一期愈合,未出现明显并发症。结论在围手术期积极控制好血糖水平可以降低手术风险,减少并发症。     

Efficacy of oncologic surgery. Does anesthesia influence the postoperative outcome?

Major surgical interventions in tumour surgery are still associated with perioperative cardiopulmonary, infectious, thromboembolic, cerebral, and gastrointestinal complications. There are different prophylactic and therapeutic possibilities to anticipate or counteract these perioperative complications. The most important, including beta blockers and alpha-2-agonists for patients at coronary risk, preoperative optimisation of oxygen transport in high risk surgical patients and the concept of multimodal perioperative therapy (analgesia, early mobilisation, early enteral nutrition, and others) combined with high perioperative inspiratory oxygen concentration and maintenance of normothermia to reduce wound infection and cardiac complications are described in this paper.     

围手术期外科之家——克罗恩病外科治疗的必由之路

手术是克罗恩病的重要治疗手段,外科治疗的克罗恩病病人常处于疾病活动期,存在肠梗阻、腹腔感染及营养不良等围手术期风险因素,属于术后并发症的高危人群.术前使用激素、免疫抑制剂及生物制剂等药物对围手术期安全性的影响亦不能忽视.无术后并发症是克罗恩病外科治疗的安全保障,高质量的克罗恩病手术不但要求病人平稳度过围手术期,还应该使...     

������ٿ��������ڸε����������Ӧ����״������

??Implementation of enhanced recovery protocols after hepatobiliary and pancreatic surgery BAI Xue-li, LI Guo-gang, LIANG Ting-bo.Department of HBP Surgery, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009,China
Corresponding author:LIANG Ting-bo,E-mail:liangtingbo@zju.edu.cn
Abstract Enhanced recovery after surgery (ERAS) is a multimodal perioperative care pathway designed to achieve early recovery for patients undergoing major surgery. Its primary aim is to decrease surgery-related stress, complications, and hospital stay, and also to facilitate recovery. The ERAS pathway has been widely applied and approved to be efficient in gastrointestinal surgery, colorectal surgery, thoracic surgery, urology, orthopedics, and gynecology. However, it’s not adapted as a standard of care in hepatobiliary and pancreatic (HBP) surgery patients in China. Most HBP surgeons in China worried that it may put the patients in danger owing to the complexity of surgery procedure and the high incidence of perioperative complications in HBP surgery. In fact, our experiences and other’s studies indicated to the contrary that the ERAS pathway is not only applicable but also very useful in HBP surgery, especially in patients who underwent longer operation and more severe injuries.     

�ε����������Ӧ������������

??Surgical stress and organs injury in hepatobiliary surgery WANG Jie, SUN Jian. Department of Hepatobiliopancreatic Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou510120, China
Corresponding author:WANG Jie,E-mail: sumsjw@163.com
Abstract With advances in hepatobiliary surgery technology, dangers caused by the surgery itself has been significantly reduced, but the impairment caused by surgical stress and excessive surgical stress is becoming prominent issue affecting the treatment and recovery of patients. The reduction of surgical stress response through a variety of perioperative control measures has become an important part of clinical practice in hepatobiliary surgery. But the mechanism of surgical stress is not yet fully understood, and there are still many gaps and controversy in the treatment of excessive stress, therefore, more basic and clinical researchs are needed to demonstrate and explore this issue.     

Complex hepatobiliary surgery in the community setting: is it safe and feasible?

Background

Complex hepatobiliary surgical procedures for benign and malignant conditions are regularly performed at tertiary academic referral centers with excellent outcomes, but whether similar surgical outcomes are achievable in community hospitals is not well documented.

Methods

Eighty-four patients underwent complex hepatobiliary surgery between December 2004 and December 2008. Data were prospectively analyzed, including patient demographics, operative procedures, perioperative parameters, pathology, complications up to 30 days postoperatively, and long-term outcomes.

Results

The most frequent procedures performed were isolated segmentectomy or segmentectomies (n = 41 [49%]). Major hepatic resections (n = 32 [38%]) included 25 lobectomies (30%) and 7 trisegmentectomies (8%). Nine patients (11%) had surgical complications, and the most common indications for surgery was metastatic carcinoma (n = 42 [50%]).

Conclusions

Complex hepatobiliary surgery can be performed safely at a community-based teaching hospital with excellent outcomes. In the ongoing debate centering on mandatory referral and centralization of complex surgical procedures, tertiary community hospitals with well-determined outcomes should be included.     

合并糖尿病的胃肠外科手术围手术期处理分析(63例)

【摘要】〓目的〓探讨糖尿病病人胃肠手术围手术期的处理经验。方法〓对2009年5月至2013年2月间,我科63例合并糖尿病的胃肠外科手术病人围手术期治疗进行回顾性分析,比较高血糖单因素对手术并发症和死亡率的影响以及血糖控制的临床意义。结果〓63例中择期手术11例,限期手术45例,急症手术7例。治愈率88.30%(55/63),好转率9.52%(6/63),病死率3.17%(2/63)。糖尿病组手术后多数并发症与感染有关,感染相关并发症占比68.00%(17/25),其中手术切口感染最常见,其次为泌尿系感染和肺部感染;最严重的并发症为术后败血症、高糖高渗非酮性昏迷、酮症酸中毒和心肺功能不全,围手术期病人的死亡均与这些并发症有关。结论〓合并糖尿病的胃肠外科手术风险增大,易出现并发症,正确掌握围手术期的处理原则和方法,有利于病人平稳渡过手术及降低术后并发症的发生率。     

Präoperative Evaluation und perioperatives Vorgehen bei kardialen Risikopatienten

Due to the increasing age in western countries, combined with high rates of major surgical interventions in high-risk patients, perioperative reduction of cardiovascular complications becomes increasingly more important for perioperative physicians. After identifying patients with increased perioperative risk, specific interventions need to be considered to reduce their risk for cardiovascular complications, either by perioperative medical therapy or specific treatment options (e.g. coronary intervention). Several trials have demonstrated an effect of perioperative beta-blocker-therapy in reducing cardiovascular complications among high-risk patients. Additionally, several monitoring techniques are effective in detecting cardiovascular complications. Nevertheless, it remains unclear whether they are associated with a measurable improvement of outcome. Based on the ACC/AHA-guidelines, the present review describes a stepwise approach to surgical patients to identify perioperative risks, based on specific patient related risk factors, the kind of surgery and on the specific setting (emergency versus elective surgery). In addition, strategies to reduce perioperative cardiovascular complications are discussed.     

术后加速康复理念在肝胆胰外科手术应用现状及策略

术后加速康复（enhanced recovery after surgery,ERAS）是一系列重要的围手术期管理方法的优化整合,以达到减少手术应激反应和并发症的发生,缩短住院日,促进功能恢复。目前,已在胃肠外科、结直肠外科、胸外科、泌尿外科、骨科、妇科等成功应用。与其他外科相比,由于肝胆胰外科手术操作复杂、难度大、并发症发生率高等原因, ERAS尚未能在肝胆胰外科广泛应用。然而,由于肝胆胰外科手术时间长、创伤大,病人应激反应更强,很多临床实践经验表明,肝胆胰外科病人术后同样可以应用和实施ERAS理念和措施。     

Combined carotid and cardiac procedures: improved results and surgical approach

Severe cerebrovascular complications following cardiac surgical procedures remain a major concern, particularly in patients with significant carotid atherosclerotic involvement (14% of perioperative stroke). Operative mortality for carotid operations in patients with documented Coronary Artery Disease (CAD) may be as high as 20%. Seventy patients underwent combined operations (unilateral carotid stenosis >70%, unilateral stenosis >50% with ulcerated plaque or bilateral stenoses >50%; and this also included patients with unilateral occlusion). Cardiac procedures were 69 coronary artery bypass grafts, four left ventricular aneurysmectomies, three aortic valve replacements and surgery on two mitral valves. Seven perioperative deaths occurred, which were all caused by cardiac events. There were no perioperative strokes. Carotid endarterectomy immediately before cardiopulmonary bypass is a safe and expeditious approach to coexisting significant cardiac and carotid disease. In our experience, technical details in monitoring and minimizing cerebral ischemia are possibly more crucial in these severe vasculopathic patients. Moreover, it is probably advantageous from an economic standpoint compared with other therapeutic treatments.