Objective To explore the effectiveness of bipolar femoral head replacement combined with tension band wire fixation for intertrochanteric fracture in elderly osteoporotic patients. Methods Bipolar femoral head replacement combined with tension band wire fixation were used for intertrochanteric fracture in 48 elderly osteoporotic patients between January 2004 and December 2010. Of 48 patients, 15 were male and 33 were female, aged 90-99 years (mean, 94.1 years). All fractures were caused by falling, and pathological fracture was excluded. It was 2-7 days (mean, 4.2 days) from fracture to surgery. According to the Tronzo Evans classification, 25 cases were rated as type IV, 20 cases as type III, and 3 cases as type II. And all of the cases were accompanied with severe osteoporosis and accompanied by more than one medical diseases, and 10 cases had spinal compression fracture. Results All patients underwent the operation successfully. Six cases died of underlying medical illness within 2 years postoperatively. A total of 39 cases were followed up 2-7 years, averaged 3.1 years. After operation, short-term mental disorders occurred in 9 cases, suspected urinary tract infection in 2 cases, sacral rear bedsore in 1 case, hip pain in 1 case, thigh pain in 1 case, and deep vein thrombosis of affected limb in 1 case. All the incisions healed by first intension, and X-ray film showed bone union in all cases; no complications of bone osteolysis, prosthesis loosening, subsidence, rupture, and heterotopic ossification occured postoperatively. No case needed revision. According to the Harris score system, the results were excellent in 5 cases, good in 28 cases, fair in 5 cases, and poor in 1 case, with an excellent and good rate of 84.6%; the score at 2 years was significantly higher than that at 6 weeks (t= — 14.79, P=0.00). The physical health score and mental health score of SF-12 at 2 years postoperatively were significantly higher than those at 6 weeks postoperatively (P lt; 0.05). The visual analogue scale (VAS) scores at 6 weeks and 2 years postoperatively were significantly lower than those at preoperation (P lt; 0.05), and the score at 2 years was significantly lower than that at 6 weeks (P lt; 0.05). Conclusion The bipolar femoral head replacement combined with tension band wire fixation for intertrochanteric fracture in elderly osteoporotic patients has the advantages of firm fixation, early function exercise with load bearing, pain relieving, improving hip function, and avoiding complication in bed.
目的探讨高龄胰腺癌的外科治疗方法。方法回顾性分析1995～2000年间我科收治的33例70岁以上胰腺癌患者的外科治疗资料。结果高龄胰腺癌患者发病隐匿，并发疾病多（88.9%），根治性切除困难，术后并发症发生率高（21.2%）。结论手术切除是治疗高龄胰腺癌最好的方法，早期诊断、早期治疗、加强围手术期处理以及有效地预防和治疗并发症是提高疗效的关键。
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.
Objective To observe the short-term efficacy and the incidence of adverse cardiovascular events in patients aged over 80 years with multivessel coronary artery disease following two-stage Hybrid surgery. Methods We retrospectively analysed the clinical data of 67 patients aged over 80 years with multivessel coronary artery disease undergoing surgery in our hospital. The were 44 males and 23 females with an anverage age of 82.4±2.1 years. According to the operation pattern, the patients were divided into two groups: a two-stage Hybrid surgery group (n=29, 19 males, 10 females, aged 83.2±3.1 years) and a traditional thoracotomy group (n=38, 25 males, 13 females, aged 83.3±3.4 years). We compared the clinical results of perioperation between the two groups. Results Conpared with the traditional thoracotomy group, the two-stage Hybrid surgery group had shorter postoperative duration of mechanical ventilation (6.7±2.2 hvs. 18.2±3.4 h) and hospitalization stay (15.7±3.0 dvs. 20.7±5.6 d) and had less volume of chest drainage during the first 24 h after surgery (176.5±32.3 mlvs. 443.8±51.5 ml). The incidence of adverse cardiovascular events in the two-stage Hybrid surgery group was significantly lower than that in the traditional thoracotomy group (6.9%vs. 23.1%, P<0.05). Conclusion The two-stage Hybrid surgery in patients aged over 80 years with multivessel coronary artery disease can significantly decrease the postoperative incidence of adverse cardiovascular events, shorten the postoperative duration of mechanical ventilation and hospitalization stay, reduce the volume of chest drainage during the first 24 h after surgery and improve prognosis of surgery for the elderly patients.
ObjectiveTo compare the perioperative results of hybrid coronary revascularization (HCR), off-pump coronary artery bypass (OPCAB) and percutaneous coronary intervention (PCI) in elderly patients with three-vessel coronary artery disease involving left anterior descending (LAD) branch and explores the safety of surgery.MethodsWe prospectively enrolled patients with coronary heart disease over 65 years who were admitted to General Hospital of People’s Liberation Army from January 2018 to September 2019. Coronary angiography results were all three-vessel lesions involving the anterior descending artery. After preoperative examination and assessment by the cardiovascular team, all patients were suitable for OPCAB or PCI treatment. According to the patient’s preference, HCR, OPCAB or PCI were performed. The preoperative baseline data and perioperative results were collected, and SPSS 22.0 was used for statistical analysis.ResultsA total of 110 patients met the criteria and were included in the study, 28 in the HCR group, 45 in the OPCAB group, and 37 in the PCI group, with an average age of 71.4±5.6 years. There was no statistical difference in the preoperative baseline data of patients among the three groups. The intubation time (P=0.039), perioperative drainage volume (P<0.001), blood transfusion (P=0.021) in the HCR group were lower than those in the OPCAB group. There was no statistical difference in the main organ adverse events (MOAE, P=0.096) and in-hospital mortality (P=0.784) among the three groups of patients. The use of antibiotics in the PCI group was significantly lower than the other two groups (P<0.001).ConclusionHCR combines the advantage of CABG and PCI including proved long-term patency rate with left internal mammary artery-LAD grafting, less trauma and superior long-term patency with PCI in non-LAD territory. Compared with OPCAB and PCI, there is no increase in perioperative major organ adverse events and in-hospital mortality. It is a safe and reliable minimally invasive myocardial revascularization technique for elderly patients with three-vessel coronary artery disease involving the anterior descending artery.
Objective To investigate the clinical characteristics, risk factors and perioperative outcome of prolonged mechanical ventilation (PMV) in elderly patients undergoing coronary artery bypass grafting (CABG). Methods The data of elderly patients receiving CABG in the Nanjing First Hospital from January 2013 to June 2019 were collected. All patients were divided into a control group and a PMV group according to whether ventilation time≥24 h.The clinical characteristics and risk factors of PMV were compared between the two groups. Variables were 1∶1 balanced through propensity score matching (PSM) and perioperative outcomes of two groups was analyzed. Results Finally 956 patients were collected, including 187 in the PMV group and 769 in the control group. There were 586 males and 370 females aged 70-94 (74.3±3.5) years. Compared with the control group, the PMV group had higher rates of smoking, preoperative renal impairment, intraoperative blood transfusion and intra-aortic balloon pump (IABP) implantation, worse cardiac function, lower glomerular filtration rate and ejection fraction, larger left atrial diameter, longer cardiopulmonary bypass time and aortic cross-clamping time (P<0.05). There was no statistical difference in other clinical data between the two groups (P>0.05). Binary multivariate logistic regression analysis showed that females, smoking, chronic obstructive pulmonary disease, left ventricular ejection fraction≤56.0%, cardiopulmonary bypass time>106.0 min, IABP implantation and intraoperative blood transfusion were independent risk factors for PMV in elderly patients. After PSM, there were 146 patients in the control group and the PMV group, respectively. The PMV group had longer ICU stay and length of hospital stay and more drainage volume compared with the control group (all P<0.05). There was no statistical difference in perioperative mortality or other complications between the two groups (all P>0.05). ConclusionThere are a lot of factors associated with PMV of the elderly patients undergoing on-pump CABG. In order to establish a complete and formal PMV prediction model, clinicians can make a further step of assessment according to perioperative elements, and improve the prognosis of such patients.
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.
ObjectiveTo investigate influencing factors of postoperative cognitive dysfunction (POCD) in elderly patients underwent laparoscopic surgery. MethodsThe elderly patients underwent laparoscopic surgery were collected in the Daye City People's Hospital and Yangxin County People's Hospital from September 14, 2014 to January 1, 2016 and the Traditional Chinese Medicine Hospital of Daye City from June 19, 2014 to January 1, 2016. Factors included in the registration of patients in general and a variety of influencing factors during perioperative period were recorded. The independent factors associated with POCD were analyzed by multivariate logistic regression analysis. ResultsThree hundred and seventy-eight elderly patients underwent laparoscopic surgery were included according to the inclusion and exclusion criteria, of which 43 patients with POCD and 335 patients without POCD within 3 days after laparoscopic surgery. The baseline data had no significant differences between the patients with POCD and without POCD. The cerebral infarction, preoperative fear, preemptive analgesia, use of dexmedetomidine before laparoscopic surgery, general anesthesia combined with epidural anesthesia, operation time, low SpO2 during anesthesia induction, PaCO2 after pneumoperitoneum, postoperative patient controlled epidural analgesia (PCEA), postoperative VAS score on day 3 were associated with the POCD (P < 0.05). The results of logistic regression analysis showed that the preemptive analgesia, use of dexmedetomidine before laparoscopic surgery, general anesthesia combined with epidural anesthesia, and postoperative PCEA were the independent protective factors of the POCD (P < 0.05). The operation time and PaCO2 after pneumoperitoneum were the independent risk factors of the POCD (P < 0.05). ConclusionFor elderly patients underwent laparoscopic surgery, clinicians should be alert to occurrence of POCD according to the influence factors of it, and timely screen relevant scale so as to early diagnose and early intervent and effectively delay progress of patient's POCD.
Objective To analyze the quality control results of forced vital capacity ( FVC) test in elderly patients. Methods 534 lung function test reports of the elderly patients ( ≥ 80 years old) from January 2010 to December 2010 were collected from pulmonary function testing laboratory in Shougang Hospital of Peking University. Based on the report results, the selected patients were divided into four groups, ie. a normal group, a restricted group, an obstructed group, and a mixed group. The results of lung function tests that met the criteria of quality control in each group were statistically analyzed. Results A total of 534 reports were collected, of which 36 were not credible and treated as test failure. Of the 498 credible reports, 99.6% ( 496 /498) met the start-of-test criteria for quality control. 95. 8% ( 477/498) met the exhalation process test criteria for quality control with the highest rate of 98.6% ( 217 /220) in the obstructed group and the lowest rate of 85. 9% ( 55 /64) in the restricted group. The difference between two groups was significant (Plt;0.01) . 68.1% ( 339/498) met the end-of-test criteria for quality control with the highest rate of 88.6% ( 195/220) in the obstructed group and the lowest rate of 18.8% ( 12/64) in the restricted group. The difference between two groups was significant (Plt;0.01) . 16.7% (88/498) of the reports could be analyzed for repeatability, and the obstructed group had the highest rate of 22.3% (49/220) while the restricted group had the lowest rate of 6.3% ( 4/64) . The difference between two groups was significant too (Plt;0.01) . Only 14.6% (73/498) of the reports met all of the criteria listed above. Conclusions Elderly patients can also complete FVC test but the result may be not credible. There are still lots to be improved in FVC test for elderly patients.