Objective To evaluate the clinical efficacy of coronary artery bypass grafting in the treatment of coronary artery disease patients aged over 70 years. Methods A total of 160 patients with coronary atherosclerotic heart disease underwent off-pump coronary artery bypass grafting from January 2013 to December 2017. There were 94 males and 66 females at age of 70–85 (76.67±2.33) years. Operations were performed by using sternal median incision with the assistance of local myocardial surface fixator and shunt plug, and the saphenous vein and internal mammary arterywere used as grafted vessels. Results All the patients were received successful off-pump coronary artery bypass grafting without death, and the cardiac function improved significantly. There were 62 patients with the internal mammary artery bridge and 98 patients with the whole vein bridge. All the patients were followed-up for 1 to 4 years. All the patients had obvious relief of angina pectoris. Conclusion Off-pump coronary artery bypass grafting for the treatment of elderly patients with coronary heart disease is an effective and safe operation, especially for patients with renal insufficiency, cerebrovascular disease, respiratory disease and severe left ventricular dysfunction.
ObjectiveTo explore the influencing factors for the prognosis of intracerebral hemorrhage in extremely old patients. MethodsWe retrospectively analyzed the clinical data of 104 extremely old intracerebral hemorrhage patients (≥80 years old) treated between June 2010 and June 2013. According to Glass Outcome Score, the patients were divided into good outcome group (with a score of 4-5) and poor outcome group (with a score of 1-3). The age, gender, consciousness on admission, mean arterial pressure, systolic blood pressure on admission, and complication rate were analyzed and compared between the two groups of patients. ResultsA total of 104 patients were recruited in our study, with 62 in the good outcome group and 42 in the poor outcome group. The gender, age, average arterial pressure on admission between the two groups were not significantly different (P>0.05). The consciousness score at admission in the good outcome group (13.79±2.38) was significantly higher than that of the poor outcome group (8.24±3.80, P<0.05). The complication rate (45.2% vs. 88.1%) and systolic blood pressure on admission [(168.87±25.03) vs. (181.83±29.82) mm Hg (1 mm Hg=0.133 kPa] in the good outcome group were both significantly lower than those in the poor outcome group (P<0.05). ConclusionFor extremely old intracerebral hemorrhage patients, consciousness score and systolic blood pressure at admission, and complication rate are the influencing factors for the prognosis. In addition, a systolic pressure on admission above 180 mm Hg can be a risk factor for poor prognosis in extremely old patients.
Objective To investigate the efficacy and safety of tranexamic acid in patients with the age>70 years during off-pump coronary artery bypass grafting (OPCABG). Methods From June 2014 to August 2016, 340 patients undergoing elective OPCABG were included in this study. All the patients were more than 70 years old, among whom 282 were males and 58 were females. According to the random number generation method, the patients were randomly assigned to receive either tranexamic acid (30 mg/kg, infusion time was longer than 30 min after anesthesia induction; n=170) or a placebo (infusion equivalent volume of saline solution; n=170). The primary end point was chest tube drainage 6 h and 24 h postoperatively. The secondary end points were blood transfusion volumes, incidence of various thrombotic events, duration of mechanical ventilation, length of ICU and hospital stay. Results Compared with patients in the placebo group, the patients receiving tranexamic acid had a significant reduction in chest tube drainage at postoperative 6 h (275.6±105.1 ml vs. 459.6±110.2 ml, P<0.001) and 24 h (685.3±202.5 ml vs. 915.9±223.6 ml, P<0.001). There was also a significant reduction in allogeneic red blood cell transfusion (0.80±0.66 U vs. 1.60±1.30 U, P<0.001) and fresh frozen plasma transfusion (166±25 ml vs. 257±30 ml, P<0.001). There were no significant differences in incidence of various thrombotic events, duration of mechanical ventilation, length of ICU and hospital stay between the two groups. Conclusion Tranexamic acid can significantly reduce blood loss and transfusion in elderly patients 6 h and 24 h after OPCABG and the incidence of thrombotic events will not increase.
ObjectiveTo investigate the surgical complications and its influence factors of radical surgery in the treatment of elderly patients with colorectal cancer. MethodsTwo hundreds and sixteen patients with colorectal cancer who were treated in the Second People's Hospital of Lianyungang City from January 2010 to September 2014 as the research object, the clinical data were collected by the self-made general data questionnaire, and they were analyzed by descriptive statistics and logistic regression analysis using SPSS 19.0. ResultsFor elderly patients with colorectal cancer radical operation, pulmonary infection and wound infection were the common complications.Single factor and logistic regression analysis showed that medical comorbidity, hypoproteinemia, operation time, Dukes staging, and smoking were risk factors of postoperative complications in the colorectal cancer patients. ConclusionFor elderly patients with colorectal cancer underwent radical operation, pulmonary infection and wound infection are the common complications.It's occurrence by various factors.
Objective To observe the clinical effect of enhanced recovery after surgery (ERAS) in elderly patients with right colon cancer. MethodsA total of 90 elderly patients who were diagnosed as right colon cancer and underwent radical resection of right colon cancer in the Department of Gastrointestinal Surgery of the Affiliated Hospital of Qingdao University from April 2018 to October 2018 were enrolled prospectively. These patients were randomly divided into two groups: ERAS group (n=44) receiving ERAS during perioperative period and control group (n=46) undergoing conventional surgical treatment. To compare the occurrence of postoperative complications, the recovery of gastrointestinal function, and the changes of serum inflammatory factors between the two groups before and after operation. Results① There was no significant difference in the incidence of total postoperative complications and the incidence of complications (including anastomotic leakage, incision infection, postoperative bleeding, intestinal obstruction, cardiovascular complications, pulmonary infection, and urethral infection） between the ERAS group and the control group (P>0.05). ② The first anal exhaust time, postoperative fever time, postoperative hospitalization time, quality of life score, and hospitalization cost of the ERAS group were better than those of the control group (P<0.05). ③ There were no significant difference in serum IL-6, TNF-α, and CRP levels between the two groups before operation (P>0.05), but on the 1st and 3rd day after operation, the three indexes of the control group were higher than those of the ERAS group (P<0.05). ConclusionThe application of the idea of ERAS in the elderly patients with right colon cancer can promote the recovery of gastrointestinal function, shorten the hospitalization time, and improve the clinical outcome.
目的 探讨圆形吻合器在高龄贲门胃底癌经腹切除术中的应用。方法 回顾性分析1999年1月至2009年5月期间在我院接受圆形吻合器经腹切除术的238例70岁以上高龄贲门胃底癌患者的临床资料，并对围手术期结果进行分析。 结果 全组手术时间3～4.5 h，平均3.5 h。出血量50～1 000 ml，平均300 ml。术中并发大出血1例，给予积极止血，无术中死亡。所有病例机械吻合术后未出现吻合口漏。术后60例患者（25%）出现不同程度的并发症，其中吻合口出血2例, 左侧胸腔积液13例，肺部感染15例, 心衰3例, 肺不张2例, 心律失常10例，右侧胸腔积液15例。无围手术期死亡。术后随访3年，出现返流性食管炎45例，吻合口狭窄30例，无吻合口肿瘤复发，3年生存率为64%(152/238)。结论 应用圆形吻合器在高龄胃底贲门癌患者经腹切除术是安全、有效的。
Objective To discuss whether age has an influence on short-term effect of intersphincteric resection (ISR) for elderly (≥75 years old) patients with ultra-low rectal or canal cancer or not. Methods From February 2016 to February 2017, 196 patients with ultra-low rectal or canal cancer received ISR in the Gastrointestinal Surgery Center of West China Hospital were eligible to include in this study, then they were divided into ≥75 years old group and <75 years old group according to the patients’ age. The intraoperative index, postoperative index, and complications rate were compared between these two groups. Results There were 113 cases in the ≥75 years old group, 83 cases in the <75 years old group, the baselines such as the gender composition, body mass index, tumor histology type, differentiation degree, tumor size, and distance from the anal margin had no significant differences ( P>0.05), but the preoperative anaesthetized ASA grade, proportions of pulmonary insufficiency, hypoproteinemia, anemia, hypertension, diabetes, and cardiac insufficiency of the ≥75 years old group were significantly higher than those of the <75 years old group (P<0.05). The operative time, intraoperative bleeding, and total complications rate had no differences between these two groups (P>0.05), the first exhaust time, the first eating time, the first defecation time, the first ambulation time, and hospitalization time of the ≥75 years old group were significantly longer than those of the <75 years old group (P=0.023, 0.037, 0.019, 0.020, and 0.012, respectively). There were no significant differences in the incidences of the anastomotic leakage, perianal infection, intestinal obstruction, and wound infection between these two groups (P>0.05). All the 196 patients were followed-up with an average follow-up of 7 months, there were 4 cases of recurrent patients, of which 3 were in the ≥75 years old group and 1 in the <75 years old group; there were 3 cases of death, of which 2 were in the ≥75 years old group and 1 in the <75 years old group. Conclusions Short-term recovery of elderly patients with ultra-low rectal or canal cancer is slower than younger patients because of poor preoperative conditions. ISR surgery is still safe and effective for elderly patients with ultra-low rectal or canal cancer and postoperative complications rate has no obvious increase, but it needs a surgeon’s skilled operation technology and multi-disciplinary team cooperation.