经腹腔镜实施结直肠癌根治术对高龄患者胃肠功能的影响

目的:探讨结直肠癌高龄患者经腹腔镜实施结直肠癌根治术对胃肠功能产生的影响。方法:选取92例接受结直肠癌根治手术的结直肠癌患者,将其随机数字表法随机分为试验组和对照组两组,其中对照组患者均采用开腹手术进行治疗,而试验组患者则采取腹腔镜下结直肠癌根治手术。观察比较两组患者的术中情况和术后的胃肠功能。结果:两组患者之间的淋巴结清扫数目和标本切除长度均无明显差异(均P0.05),试验组患者的术中出血量以及手术时间均低于对照组患者(t=10.394,P0.05;t=6.983,P0.05)。胃泌素和胃动素水平和患者术后的肛门排气时间以及腹胀持续时间呈显著的负相关关系;试验组患者的术后肛门排气时间和腹胀持续时间均低于对照组患者,并且其胃泌素和胃动素含量均明显高于对照组患者(均P0.05)。结论:腹腔镜下结直肠癌根治手术较开腹手术具有创伤小的优势,并且对于高龄结直肠癌患者术后的胃肠功能具有较好的恢复效果。     

能量平台在腹腔镜结直肠癌根治术中的临床研究

目的:探讨能量平台在腹腔镜结直肠癌根治术中的应用价值,为指导临床治疗提供参考依据。方法:按照随机数字表法将2012年3月~2014年3月我院收治的结直肠癌患者分为两组,观察组行能量平台腹腔镜结直肠癌根治术,对照组行传统开腹结直肠癌根治术,术后比较两组的手术效果及并发症情况。结果:观察组的手术时间、术中出血量以及术后住院时间均小于对照组,淋巴结清扫数量大于对照组,差异均有统计学意义(P0.05),两组的术后引流量比较,差异无统计学意义(P0.05)。手术后两组的并发症主要有切口感染、吻合口瘘、局部病灶复发、肠梗阻以及腹腔内出血,其中观察组切口感染发生率为1.85%,低于对照组的14.55%,差异有统计学意义(P0.05),两组的其它并发症发生率比较,差异无统计学意义(P0.05)。结论:能量平台辅助腹腔镜结直肠癌根治术能有效地减少术中出血量、手术时间以及术后住院时间,术后感染几率小,因此在临床上有一定的推广应用价值。     

腹腔镜下行直肠癌根治术围手术期的护理

由于直肠癌手术治疗创伤大,禁食时间长,留置管道多,术后患者的身体比较虚弱,抵抗力差,对患者的负面影响大。因此,为减少不良因素的影响,促进患者机体康复,我院于2011年8月～2012年8月对收治的28例直肠癌患者在围     

直肠癌腹腔镜与开腹根治术的近远期疗效及安全性评估

目的:比较分析腹腔镜直肠癌根治术与开腹根治术的近远期疗效及安全性.方法:将116例我院收治的行直肠癌根治术的患者随机分为2组,腹腔镜组(56例)采用腹腔镜直肠癌根治术,开腹组(60例)采用开腹直肠癌根治术,并对患者进行为期5年的随访.比较分析两组患者术后l、3、5年的生存率.记录两组手术时间、术中出血量、术后排气时间留置时间及术后并发症等近期疗效指标,并比较分析两组患者术后1、3、5年的生存率.结果:与开腹组比较,腹腔镜组的手术时间延长,术中出血量、术后排气时间及术后导管留置时间明显减少(P＜0.05);两组淋巴结清除数目比较,差异无统计学意义(P＞0.05);腹腔镜组伤口感染、肠梗阻的并发症发生率显著低于开腹组(P＜0.05);两组术后l、3、5年生存率比较无显著性差异(P＞0.05),而术后3年、5年,腹腔镜组＞60岁患者的生存率显著高于开腹组(P＜0.05).结论:腹腔镜直肠癌根治术的近期疗效优于开腹手术,肿瘤根治性与开腹手术相似,且可减少术后并发症,提高高龄患者的术后远期生存率.     

经穴电针刺激麻醉对老年直肠癌根治术患者麻醉效果、应激反应及免疫功能的影响

目的：观察经穴电针刺激麻醉对老年直肠癌根治术患者麻醉效果、应激反应及免疫功能的影响。方法：采用随机数字表法将2022年1月～2023年5月期间在我院行直肠癌根治术的97例老年患者分为对照组(n=48,全凭静脉麻醉)和观察组(n=49,对照组的基础上接受经穴电针刺激麻醉)。对比两组麻醉药物追加量、血流动力学、疼痛评分、免疫功能指标、应激反应指标和不良反应情况。结果：与对照组相比,观察组的罗库溴铵用量、丙泊酚用量、瑞芬太尼用量更少(P<0.05)。与对照组相比,观察组麻醉诱导期(T1)～麻醉结束时(T3)时间点平均动脉压、呼吸频率更低(P<0.05)。与对照组相比,观察组术后6 h、12 h、24 h的疼痛视觉模拟评分(VAS)更低(P<0.05)。与对照组相比,观察组术毕CD8⁺更低,CD4⁺、自然杀伤(NK)细胞、CD4⁺/CD8⁺更高,去甲肾上腺素、肾上腺、皮质醇更低(P<0.05)。两组不良反应发生率组间对比未见差异(P>0.05)。结论：经穴电针刺激麻醉用于老年直...     

腹腔镜下直肠癌根治术在治疗老年患者中的临床研究

目的:探讨老年直肠癌患者行腹腔镜微创手术的治疗效果。方法:回顾性分析了2008年7月至2011年1月本院收治的91例老年直肠癌患者,按治疗方式分为腹腔镜组39例和开腹组52例,术后随访3年,比较分析两组患者围手术期、手术并发症及预后情况。结果:腹腔镜组患者的术中出血量、肠功能恢复时间、术后发热请况及住院时间均优于开腹组(P0.05);腹腔镜组并发症发生率为2.6%,低于开腹组的21.1%(P0.05);腹腔镜组局部复发率、远处转移率及死亡率与开腹组比较均无统计学差异(P0.05)。结论:老年直肠癌患者行腹腔镜手术与开腹手术效果相当,且安全、微创,但远期疗效尚需进一步研究证明。     

腹腔镜下结直肠癌根治术围手术期肠外营养的应用研究

目的:探讨腹腔镜下结直肠癌根治术围手术期肠外营养的运用.方法:对我院收治的98例接受腹腔镜下结直肠癌根治术的患者作为研究对象,将其分为实验组以及对照组,实验组患者采用卡文进行营养支持,对照组患者采用自制营养液进行治疗,对两组患者术前2d以及术后5d营养学指标进行评价.结果:术后实验组血红蛋白、总蛋白、血清白蛋白以及前白蛋白含量明显高于对照组(P＜0.05),实验组患者其肛门排气时间、住院时间、arnofsky评分、Zubrod-ECOG-WHO分级明显优于对照组(P＜0.05).结论:采用卡文进行腹腔镜下结直肠癌根治术围手术期肠外营养有助于改善患者术后营养不良,提高患者预后.     

靶控输注静脉麻醉和腰硬联合麻醉对直肠癌根治术患者免疫功能的 影响研究

目的：探讨靶控输注静脉麻醉和腰硬联合麻醉对直肠癌根治术患者免疫功能的影响。方法：选择在我院行直肠癌根治术的 72 例患者,将其分为观察组和对照组各36 例,其中观察组给予靶控输注静脉麻醉,对照组采用腰硬联合麻醉,对两组患者手术时 间、术中出血量以及免疫球蛋白水平（IgG、IgA、IgM）、血清白介素-6 水平（IL-6）、肿瘤坏死因子-a 水平（TNF-a）以及T 细胞亚群 （CD3、CD4）水平进行对比。结果：观察组手术平均时间为（130.5± 11.7）min,术中平均出血量为（271.3± 37.8）ml,与对照组比较差 异均无统计学意义（P>0.05）;两组IgG、IgA 及IgM,在T1、T2、T3 及T4 时刻水平比较差异均无统计学意义（P>0.05）;两组IL-6、 TNF-a、CD3 及CD4 在麻醉后较T1 时均有明显变化,比较差异均有统计学意义（P<0.05）,且观察组变化较对照组更为明显,两组 比较差异有统计学意义（P<0.05）。结论：靶控输注静脉麻醉和腰硬联合麻醉对直肠癌根治术患者免疫功能均存在抑制作用,且以 抑制细胞免疫功能为主,而腰硬联合麻醉抑制作用较低,值得推广应用。     

腹腔镜结直肠癌根治术与传统开腹手术比较分析

目的:分析腹腔镜结直肠癌根治手术与传统开腹术治疗结直肠癌的临床效果,探讨腹腔镜手术的特点及优势,为临床外科手术提供参考。方法:选择2009年7月至2013年5月在我院进行腹腔镜手术的186例结直肠癌患者的临床资料进行分析,并与择期接受开腹手术的181例结直肠癌患者的临床效果进行对比。比较两组患者的平均手术时间、平均术中出血量、术后肛门排气时间、下床活动时间、平均住院时间及并发症的发生率等。结果:与传统手术组相比,腹腔镜组患者的平均手术时间短、平均术中出血量少、术后肛门排气时间早、平均住院时间短,差异显著且具有统计学意义(P0.05);腹腔镜组患者术后出现下肢静脉血栓1例、皮下气肿9例、高碳酸血症8例,并发症的发生率为7.14%;传统手术组术后出现切口感染10例、消化道出血13例,吻合口漏11例、并发症的发生率为12.90%。腹腔镜根治术患者术后并发症的发生率明显低于传统开腹手术组,差异具有统计学意义(P0.05);腹腔镜组患者的平均住院时间为(8.34±2.12)天,明显短于传统开腹手术组的(11.58±1.98)天,差异具有统计学意义(P0.05)。结论:腹腔镜结直肠癌根治术具有很好的临床效果,术中出血少、术后恢复快,能够减少手术对患者机体造成的损伤,值得临床推广应用。     

GCC mRNA和hTERT mRNA在腹腔镜结直肠癌根治术患者外周血中的表达及意义

目的:探讨腹腔镜和开腹手术对结直肠癌根治术患者外周血鸟苷酸环化酶C(GCC)m RNA和人端粒酶逆转录酶(h TERT)m RNA表达的影响及其意义。方法:按照随机数字表法将2009年8月-2014年4月我院收治的结直肠癌患者分为腹腔镜组和开腹手术组,通过逆转录-聚合酶链反应技术(RT-PCR)检测并比较两组患者外周血GCC m RNA和h TERT m RNA的表达情况。结果:与开腹手术组相比较,腹腔镜组患者手术时间长、术中出血量少、术后排气早、住院时间短,差异有统计学意义(P0.01);两组患者手术前GCC m RNA和h TERT m RNA阳性率无显著差异(P0.05);两组患者手术后GCC m RNA和h TERT m RNA阳性率显著升高,差异有统计学意义(P0.05)。结论:腹腔镜和开腹手术均会增加结直肠癌患者血行微转移,但腹腔镜结直肠根治术不会增加术后肿瘤血循环微转移的危险性。     

七氟醚静吸复合麻醉对腹腔镜胆囊切除术中患者应激反应的影响

目的:探讨腹腔镜胆囊切除术中采用七氟醚静吸复合麻醉对老年患者应激反应.方法:60例拟行腹腔镜下胆囊切除(LC)的患者分为七氟醚组和丙泊酚组.七氟醚组采用七氟醚吸入和静脉泵入雷米芬太尼麻醉,丙泊酚组采用丙泊酚靶控输注和静脉泵入雷米芬太尼麻醉.分别于麻醉诱导前10min(T1)、诱导后10min(T2)、气腹后30min(T3)、气腹后60min(T4)和术后30min(T5)测定血浆肾上腺素(AD)、去甲肾上腺素(NE)和皮质醇含量.结果:两组T1和T2时血浆AD、NE和皮质醇含量无明显差异(P＞0.05).与T1时比较,两组在T3～T5三个时点血浆AD、NE含量均显著下降(P＜0.05),皮质醇含量显著上升(P＜0.05),且在T3～T5三个时点,七氟醚组血浆AD、NE和皮质醇含量与丙泊酚组比较显著下降(P＜0.05).结论:对老年LC手术患者七氟醚静吸复合麻醉可抑制交感神经兴奋,减轻机体的应激反应.     

老年住院患者口咽部念珠菌定植状况及菌种分布调查

目的调查老年住院患者口咽部念珠菌定植状况及菌种分布特点,为有效预防念珠菌感染提供参考。方法对解放军第44医院收治的894例住院患者口咽部念珠菌定植状态进行调查分析。结果894例住院患者口咽部标本共培养出念珠菌121株,念珠菌定植率为13．5％,老年患者的定植率高于非老年患者。念珠菌定植以白色念珠菌所占比例最大,占74．5％。年龄≥80岁、肺部基础疾病的存在及使用抗菌药物患者口咽部念珠菌定植率高于普通患者,两者比较差异有统计学意义（P〈0．05）。结论老年患者口咽部念珠菌定植率较高,菌种分布以白色念珠菌最为常见。念珠菌定植与患者年龄、肺部基础疾病的存在及抗菌药物使用情况密切相关。     

The mechanism of reducing thiopentone dose in elderly patients undergoing surgery

The dose of thiopentone required to induce anesthesia in adults decreasing with age is not due to pharmacodynamic change. The change of pharmacokinetic properties of thiopentone with age in undergoing surgery patient's arterial blood was investigated in seven elderly (67-82 yr) and six young (21-33 yr) patients of both sexes. Thiopentone (3 mg kg-1) was administered intravenously and arterial blood samples were obtained immediately after the injection to measure plasma and red blood cell thiopentone concentrations by an HPLC method. Plasma protein binding was studied using ultracentrifuge method. The disappearance of thiopentone from the arterial blood was described by a two-compartment open model. The distribution rate constant (alpha) was significantly larger in the young patients (p less than 0.001). The distribution half-life was longer in the elderly (p less than 0.05). Both the input microscopic rate constant, K21, and the exit microscopic rate constant, K12, with the central compartment were significantly larger in the young patients. (p less than 0.02 and p less than 0.001, respectively). The difference between the exit and input microscopic rate constant, K12-K21, was much larger in the young patients (p less than 0.001). The plasma protein binding was significantly reduced in the elderly (p less than 0.05). The apparent overall volume of distribution, Vd was not significantly different between young and elder patients. However, the volume of distribution of the central compartment was smaller in the young patients (p less than 0.05). This was probably due to the difficulty of estimation of initial thiopentone plasma concentration post-equilibrium in the central compartment after administration of thiopentone.(ABSTRACT TRUNCATED AT 250 WORDS)     

A comparison of different methods used for the quantitative evaluation of biomass of freshwater phytoplankton

Although in a strict sense the term phytoplankton biomass only refers to living algal material, in aquatic ecology the term has been associated with a variety of biological and biochemical procedures used to quantify the particulate matter suspended in natural waters. Relative merits of different biomass characteristics have been studied in three Dutch freshwater lakes with great differences in absolute biomass. Parallel determinations have been made of seston dry weight and supplementary elementary and caloric analyses of seston, of chlorophyll-a concentration and supplementary paper chromatographic analyses of pigment extracts, of particle concentration and particle size distribution as studied with an electronic particle counter, and of phytoplankton cell volume as calculated from the results of microscopic enumeration and sizing of algae. In this way an attempt was made to create a detailed picture of the nature of the seston of the three freshwater lakes.Different analytical techniques give strikingly different information, the accuracy of any method is largely dependent on the circumstances present, and different biomass characteristics therefore are only of value in limited spheres. It is suggested to distinguish between total seston characteristics (e.g. seston dry weight, particulate organic carbon, total particle volume) and strictly algological biomass characteristics (e.g. chlorophyll-a concentration, phytoplankton cell volume). The pattern of growth of phytoplankton populations shown by e.g. chlorophyll-a concentration may differ markedly from that indicated by e.g. total particle volume or seston dry weight. Also, to more or less extent the wax and wane of phytoplankton populations may go undetected among the total seston. Apparently, there is no one method of estimating biomass and no conversion factor that may serve for general purposes. In general, unambiguous information on the nature of the seston of natural waters may only be obtained by estimating total seston characteristics and algological biomass characteristics simultaneously. Depending on the objective of the investigation supplementary component analyses should be carried out to guarantee the correct interpretation of the results.     

老年结直肠癌患者肠道菌群变化与机体免疫炎症营养相关性

目的探讨老年结直肠癌患者肠道菌群变化与机体免疫、炎症、营养指标的相关性,为结直肠癌的防治提供参考。方法纳入2016年1月至2018年6月在我院接受治疗的老年结直肠癌患者30例和同期健康查体的老年人群30例,收集粪便标本,采用FloraCheck~(TM)高通量测序技术对粪便样本中所有细菌的16S rRNA V3-V4区进行DNA测序,序列通过MiSeq 16S宏基因组APP及QIIME软件,分析两组人群间属水平上显著差异性菌群。比较两组人群炎性指标(TNF-α、IL-6、IL-1、IL-12)、营养指标(总蛋白、白蛋白、前白蛋白、转铁蛋白)和免疫指标(CD3~+、CD4~+、CD8~+、NK)的差异。分析老年结直肠癌患者肠道菌群变化与营养、炎症、免疫的内在联系。结果老年结直肠癌组和老年健康组人群免疫指标CD3~+、CD4~+、CD8~+、NK和CD4~+/CD8~+比较差异无统计学意义;炎性指标老年结直肠癌组TNF-α含量较对照组明显增高(t=3.769,P=0.001),两组人群IL-1、IL-6、IL-12比较差异无统计学意义;营养指标老年结直肠癌组白蛋白、前白蛋白较对照组明显下降(t=-4.107,P=0.001;t=-4.366,P=0.001),两组人群总蛋白、转铁蛋白比较差异无统计学意义。老年结直肠癌组肠道差异性菌属变化,包括Eubacterium、Ruminococcaceae_UCG-002、Peptostreptococcus、Porphyromonas和部分炎症指标、营养指标、免疫指标有明显相关性。结论老年结直肠癌患者肠道菌群结构和功能异常,可能是导致患者机体免疫损伤、炎症反应、营养不佳的主要原因之一。有针对性地对肠道菌群结构进行优化,改善肠道菌群对宿主的影响,是一种帮助老年结直肠癌患者促进健康的策略。     

Assessment of health status in elderly patients with cancer

Background

Health status assessment of senior adults is one of the most important aspects of a treatment decision making process. A group of elderly cancer patients is very heterogeneous according to the health status – some of them are fit enough for aggressive treatment, but others are frail and vulnerable. Treatment for the latter group has to be adapted and carefully monitored.

Aim

To review and analyze relevant literature on the usage and optimization of Comprehensive Geriatric Assessment (CGA).

Materials and methods

Medline search of studies published between 2000 and 2011, containing key words: Comprehensive Geriatric Assessment, aging, cancer in senior adults, frailty.

Results

To recognize and address individual needs of senior adults, a special holistic approach has been developed – comprehensive geriatric assessment (CGA). This tool is a gold standard in gerontooncology, recommended by International Society of Geriatric Oncology. CGA evaluates all important health domains, from physiology to social and economical problems, using sets of different tests. Assessment has to be performed by a trained team, including a physician, nurse and social worker. CGA has been clinically validated in many studies, but it is still not clear whether CGA improves the outcome of treatment of the elderly with cancer.

Conclusions

Complexity and multidimensionality of CGA pose a logistic challenge for everyday clinical practice. Special senior programs, which could be developed inside comprehensive cancer center, focusing attention on seniors’ problems and needs seem to be a way forward for geriatric oncology.     

Antioxidants in patients receiving total parenteral nutrition after gastrointestinal cancer surgery

Total parenteral nutrition (TPN) is essential for patients with postoperative impairing gastrointestinal function who are unable to receive and absorb oral/enteral feeding for at least 7 days. Oxidative stress plays a major role in the ethiopathogenesis of cancers. In this study, total antioxidant status (TAS), glutathione peroxidase (GPx), superoxide dismutase, malondialdehyde and ascorbic acid were studied in patients operated because of small intestine, colorectal or pancreatic cancer and subsequently receiving TPN in comparison with patients receiving standard nutrition after the operation. TAS level and GPx activity were decreased in patients with small intestine cancer but did not differ in patients with colorectal and pancreatic cancer before and after surgery. In all patient groups receiving TPN, superoxide dismutase activity after the surgery was kept at the same level as before. On the fifth day after the surgery, malondialdehyde concentration in each group was restored to the value observed before surgery. On the fifth day of TPN treatment, ascorbic acid concentration was increased in every group of patients. TPN applied during the postoperative period alleviates oxidative stress resulting from surgery. In the case of small intestine cancer, the addition of vitamins and antioxidants to the nutrition mixture seems to result in depletion of antioxidant enzymes' activities.     

多烯磷酯酰胆碱预防抗结核药对老年患者肝损害作用

目的 探讨多烯磷脂酰胆碱在老年肺结核患者中预防抗结核药物的肝功能损害的作用.方法 选取老年肺结核患者80例,随机分为治疗组和对照组,各40例,均用异烟肼、利福平、吡嗪酰胺、乙胺丁醇四联强化抗结核方案治疗,治疗组加用多烯磷脂酰胆碱胶囊456 mg,po,tid.共观察8周.结果 治疗组累计肝功能损害发生5例,对照组累计肝功能损害发生12例(P＜0.05),在有肝功能损害的患者中,对照组ALT升高明显,与治疗组比较差异有统计学意义(P＜0.05),对照组TBIL升高,治疗组无明显升高.结论 多烯磷脂酰胆碱可以预防老年肺结核患者抗结核药所致肝损害的发生,减轻肝损害程度,而且安全可靠,值得临床推广应用.     

多学科协作诊治模式下的营养干预在老年骨折患者围术期的应用

目的研究多学科协作诊治模式(MDT)下的营养干预对围术期老年骨折患者的干预效果。方法选取新疆维吾尔自治区人民医院骨科2018年9月至2019年9月收治的42例行常规治疗的围术期老年患者作为非MDT组,选取同期43例实施MDT模式并给予营养干预的围术期老年患者作为MDT组,比较两组患者术后基本情况、并发症发生情况及恢复情况。结果术后MDT组患者总蛋白、白蛋白水平均高于非MDT组,NRS2002评分、CRP、IL-6水平均低于非MDT组,差异均有统计学意义(t=-3.679 6、-4.138 8、9.073 3、-6.669 5、-4.500 2,P=0.000 4、0.000 1、0.000 1、0.000 1、0.000 1)。MDT组患者住院时间少于非MDT组,差异有统计学意义(髋关节置换术:t=2.154 8,P=0.034 1;膝关节置换术:t=2.491 9,P=0.018 9)。MDT组患者肠道功能恢复情况明显优于非MDT组,差异有统计学意义(χ~2=10.512 1,P=0.001 2)。结论 MDT模式下的营养干预能够有效促进老年骨折患者的术后康复,有利于预防并发症的发生。     

传统开腹手术与腹腔镜手术治疗子宫肌瘤的效果分析

目的探讨传统开腹手术与腹腔镜手术治疗子宫肌瘤的临床疗效。方法选择2013年2月~2015年11月在我院接受治疗的子宫肌瘤患者140例为研究对象,按患者自愿原则分为对照组和观察组各70例,对照组采用传统开腹手术治疗,观察组采用腹腔镜手术治疗,并对两组患者手术时间、术中出血量、术后感染情况和住院时间进行比较。结果观察组在手术时间、术中出血量、术后感染率及住院时间等方面均优于对照组,差异具有显著统计学意义(P0.05)。结论腹腔镜下子宫肌瘤切除术与传统开腹手术比较,具有出血量少、住院时间短、恢复快、并发症少等优点,值得临床推广应用。