Abstract:Since 1978 the definition of prosthesis-patient mismatch（PPM） was first introduced by Rahimtoola, it has attracted the attention of foreign researchers. The PPM phenomenon is concerned to be an important factor which will affect patients＇ survival rate and quality of life. Till now, a lot of effort should still be put on this problem. But unfortunately, this problem is still being neglected in our country. This paper is a review of PPM from it＇s many aspects, such as definition, current research status, prevention, and it＇s research prospect. We hope this paper will intensify the clinicians＇ knowledge on PPM.
Objective To evaluate the feasibility of laparoscopic rectal resection (LR) in elderly and younger patients with rectal cancer. Methods From January 2008 to March 2009, 76 patients with rectal cancer undergoing elective rectal resection were included in this study. Older than 70 years named elderly group, in which LR was given to 16 cases, and open resection (OR) to 18 cases. Younger than 70 years named younger group, in which LR was performed in 23 cases, and OR in 19 cases. The results after LR and OR in rectal cancer between 2 groups of patients were compared. Results No surgery-assisted death occurred in either group. In 2 groups, ventilation time, intake food time and hospitalization after operation in LR were shorter than those of OR (P＜0.05， P＜0.01); intraoperative blood loss and the proportion of postoperative analgesia in LR were less than those of OR in 2 groups (P＜0.01); there were no significant differences between LR and OR (Pgt;0.05) in mean operation time or number of lymph node resected. In addition to the incision infection rate, the other complications rates and the postoperative life self-care rate between LR and OR were no significantly different in younger group (Pgt;0.05). In the elderly group, every complication rates of LR were lower than those of OR (P＜0.05), oppositely, the postoperative life self-care rate was higher (P＜0.01). Conclusions LR of rectal cancer can be applied to both elderly and younger patients. It is suggested that advanced age should not be the contraindication for LR, and by contrary elderly patients may be particularly indicated for lower postoperative complications rate compared to open surgeries.
Objective To explore the perioperative management of the coexisting diseases for the elderly patients with gastric cancer. Methods The clinical data of perioperative management for coexisting diseases in 528 patients with gastric cancer over 70 years old treated in the First Affiliated Hospital of China Medical University from March 1980 to November 2008 were analyzed retrospectively. Results The main coexisting diseases included cardiovascuclar disease (259 cases, 49.05%), respiratory disease (161 cases, 30.49%), diabetes (72 cases, 13.64%). Adjusting blood pressure and blood glucose, improving cardiopulmonary function, and hepatic and renal function were mainly given. The common postoperative complications included intestinal obstruction (10 cases), pneumonia (10 cases), reflux esophagitis (9 cases), functional evacuation disorder of gastric remnant (7 cases), and anastomotic leakage (5 cases). Ten patients died during perioperative period: 6 died of heart and lung failure, 2 of acute myocardial infarction, 1 of anastomotic leakage, 1 of intestinal obstruction. Conclusions The common coexisting diseases in the elderly patients with gastric cancer are hypertension， bronchitis and diabetes. Complete assessment of the patient’s general health before operation and intensive perioperative management of the coexisting diseases not only can decrease the risk of surgical procedures， but also decrease the incidence of complication and perioperative mortality.
ObjectiveTo evaluate the effectiveness of Othofix pertrochanteric fixator for fixation of intertrochanteric fracture. MethodA retrospective analysis was made on the clinical data from 36 cases of intertrochanteric fracture treated with Othofix pertrochanteric fixator (OPF group) and 47 cases treated with Gamma nail (Gamma group) between October 2012 and March 2015. There was no significant difference in gender, age, cause of injury, side, AO fracture classification, combined medical disease, and injury to operation time between 2 groups (P>0.05) . The operation time, intraoperative blood loss, hospitalization time, fracture union time, and complication rate were recorded and compared between 2 groups. Hip function was evaluated with Sanders post-trauma criteria. ResultsThe operation time, intraoperative blood loss, and hospitalization time of the OPF group were significantly less than those of the Gamma group (P<0.05) . All the cases were followed up 6-12 months (mean, 8.8 months) in 2 groups. Healing of incision by first intention was obtained. Bone union was achieved in 2 groups, and the fracture union time of the OPF group was significantly shorter than that of the Gamma group (t=14.780, P=0.000) . There was no deep wound or pin track infection in 2 groups. Superficial skin reactions developed around the screw and the pins in 14 cases (38.9%) of the OPF group, but no incision infection in the Gamma group, showing significant difference (χ2=22.010, P=0.001) . Mild varus of the hip and pin cutting-out occurred in 3 cases (8.3%) and 2 cases (5.6%) of the OPF group, and in 4 cases (8.5%) and 3 cases (6.4%) of Gamma group, showing no significant difference (χ2=0.001, P=0.960; χ2=0.025, P=0.830) . According to Sanders post-trauma criteria, the results were excellent in 16 cases, good in 15 cases, fair in 3 cases, and poor in 2 cases, with an excellent and good rate of 86.1% in the OPF group; the results were excellent in 22 cases, good in 20 cases, fair in 4 cases, and poor in 1 case, with an excellent and good rate of 89.4% in the Gamma group; and there was no significant difference (χ2=0.200, P=0.610) . ConclusionsThe Othofix pertrochanteric fixator has good effectiveness in the treatment of intertrochanteric fracture, which has the advantages of simple operation, less operation time, little bleeding, and early functional recovery.
ObjectiveTo assess whether the geriatric nutritional risk index (GNRI) of elderly patients can be used as an evaluation index for complications after endovascular aneurysm repair (EVAR) of abdominal aortic aneurysm (AAA).MethodsA total of 265 patients with EVAR who received abdominal aortic aneurysm between January 2011 to December 2017 were included in this study from West China Hospital of Sichuan University. All patients included in this study were subrenal arterial AAA. Statistical analysis of clinical data was performed. The value of GNRI in evaluating postoperative complications of EVER patients was evaluated.ResultsOf the 372 patients, 158 were included in the GNRI abnormal group (GNRI≤98), and 214 were included in the normal group (GNRI>98). Univariate analysis showed that the age (P=0.04), drinking (P=0.04), serum albumin level (P<0.001), BMI (P<0.001), GNRI (P=0.004), and stroke (P<0.05) were risk factors that affects postoperative complications of AAA. Multivariate analysis showed that preoperative GNRI [HR=0.687, 95%CI: (0.487, 0.968), P=0.032] abnormality was one of the risk factors affecting postoperative complications of AAA.ConclusionFor patients undergoing endovascular aneurysm repair of abdominal aortic aneurysm, the GNRI is one of the important indicator for predicting postoperative complications.
Forty critical patients with respiratory failure in the intensive care unit were randomly divided into two groups,Group A with administration of parenteral nutritino(PN) and Group B,no parenteral nutrition given.Blood gas analysis and respiratory monitoring showed that the respiratory rate,pH、PaO2、PaCO2 and HCO3- had no marked difference between the two groups.But in Group A there was a slight decrease of Pao2/FiO2 and a marked increase of A-aDO2 and the pulmonary shunt.This study indicates that the content of fat emulsion and hydrocarbon in PN may be the main factor that affects the respiratory function.
Objective To evaluate the safety and efficacy of laparoscopic-assisted gastrectomy (LAG) comparing with conventional open gastrectomy (COG) in elderly patients with gastric cancer. Methods Databases included PubMed, EMBASE, Web of Science, Cochrane Library, CNKI, Wanfang, and VIP were searched to collect the case-control studies about LAG versus COG for elderly patients with gastric cancer, and the searched time was from inception to May 2017. Then meta-analysis was performed by using RevMan 5.2 software. Results Finally, ten case-control studies included 1 522 patients were enrolled. There were 757 patients in observation group (underwent LAG) and 765 patients in control group (underwent COG). Results of meta-analysis showed that: the observation group was associated with less intraoperative blood loss ［MD=–121.12, 95% CI was (–179.93, –62.31), P<0.000 1］, more harvested lymph nodes ［MD=1.62, 95% CI was (0.60, 2.65), P=0.002］, shorter time to the first ambulation ［SMD=–2.58, 95% CI was(–4.58, –0.58), P=0.01］, shorter the postoperative intestinal function recovery time ［SMD=–0.85, 95% CI was (–1.20, –0.51), P<0.000 01］, shorter the time of oral intake ［MD=–0.90, 95% CIwas (–1.27, –0.52), P<0.000 01］, shorter hospital stay ［MD=–4.03,95% CI was (–5.62, –2.44), P<0.000 01］, lower incidences of overall postoperative complications ［OR=0.49, 95% CI was (0.38,0.64), P<0.000 01］, surgical-related complications ［OR=0.54, 95% CI was (0.39, 0.74), P=0.000 1］, incision relatedcomplications ［OR=0.42, 95% CI was (0.22, 0.81), P=0.010］, and respiratory complications ［OR=0.60, 95% CI was (0.38, 0.95), P=0.03］, but there was no significant difference on the operative time ［MD=8.36, 95% CI was (–10.97, 27.69), P=0.40］ and incidence of anastomotic fistula ［OR=0.60, 95% CI was (0.27, 1.31), P=0.20］. Conclusions The available evidences suggest that LAG is equally safe and feasible compared with COG, it has a significant advantages in reducing intraoperative blood loss and ensuring the number of lymph node dissected during surgery, with less trauma, shorter postoperative hospital stay, lower overall postoperative complications rate, and other short-term efficacy advantages.
ObjectiveVideo electroencephalography (VEEG) monitoring for health education of elderly patients based on a process-based communication model, and explore the impact of this model on the success rate, negative emotions, nursing satisfaction, and active cooperation rate of such patients.MethodsFrom September 2017 to September 2019, 118 patients with suspected epilepsy, encephalitis and other diseases who required VEEG monitoring in Suining Central Hospital were selected for this study (patients aged 61 to 73 years; 54 males and 64 females). Patients were divided into 2 groups using a random number table method, 59 patients in each group.A group received routine nursing, and B group received health education based on the process communication model. The monitoring success rate, negative emotion, active cooperation rate, and nursing satisfaction were compared between the two groups.ResultsThe total effective rate in the B group was 86.44%, which was significantly higher than 76.27% in the A group (P<0.05). After nursing intervention, the scores of anxiety and depression in the two groups were significantly decreased, but the decline was greater in the B group (P<0.05). The active cooperation rate and nursing satisfaction of the B group were significantly higher than those of the A group (P<0.05).ConclusionCompared with conventional nursing, health education based on process communication mode can significantly improve the success rate of VEEG monitoring in elderly patients, alleviate the negative emotions of patients, improve the active cooperation rate and nursing satisfaction.