ABSTRACT
ObjectiveTo investigate the features and methods of clinical diagnosis and treatment of elderly patients with acute calculous cholecystitis. MethodsA retrospective analysis was performed for the clinical data of elderly patients who were diagnosed with acute calculous cholecystitis in 451 Hospital of PLA from June 2012 to June 2015. After admission, all patients received fasting treatment, electrocardiographic monitoring, anti-infective therapy, and maintenance of body fluid balance and stable blood pressure and glucose. According to patients condition choose laparoscopic cholecystectomy open cholecystectomy, open cholecystectomy and common bile duct exploration. ResultsA total of 129 patients were enrolled; among these patients, 119 had acute calculous cholecystitis, 2 had gallstones with adenomatous hyperplasia of the gallbladder mucosa, 6 had pyogenic cholecystitis, and 2 had gallbladder gangrene. Among the patients enrolled, 52 were complicated by at least one internal disease. Among them, 67 underwent emergency surgery since there were no significant improvements in symptoms, and 62 showed relief of symptoms and underwent surgical treatment at other times. Of all patients, 108 underwent laparoscopic cholecystectomy, 9 underwent laparoscopy and were converted to open cholecystectomy, and 9 underwent open cholecystectomy and common bile duct exploration. All the surgeries were successful and all the patients were cured and discharged. There were no deaths. ConclusionElderly patients with acute calculous cholecystitis are in a critical condition and often complicated by various internal diseases. Laparoscopic cholecystectomy is the most commonly used therapeutic method. Clinicians should be fully prepared before surgery, take the perioperative management seriously, and accurately judge the surgical indications and timing.
ABSTRACT
Objective To analyze the relationship between CT characteristics of chronic subdural hematoma (CSDH) and its recurrence, as well as relevant pathological mechanism. Methods The study involved 178 patients with CSDH who underwent surgery, of whom 38 patients (40 lesions) experienced recurrence of CSDH. Univariate and multivariate logistic analyses were performed to assess the correlation among CT characteristics ( including side, density, width, subtype and midline shift of the hematoma) and CSDH recurrence. Results ( 1 ) The width of hematoma, midline shift, type of hematoma were found to be correlated with the recurrence of CSDH in the univariate analysis. The odds ratio (OR)and 95% confidence interval (CI) value of patients with hematoma width ＞30 mm, midline shift ＞10 mm and the separated type were 18. 400 (2.024-167. 301 ), 4. 643 ( 1. 815-11. 877 ) and 14. 385 (3. 601-57.467 ), respectively. (2) The midline shift and type of hematoma were found to be correlated with the recurrence of CSDH in the multivariate analysis, when the OR and 95% CI value of patients with hematoma midline shift ＞ 10 mm and separated type were 5. 280 ( 1. 339-20. 823) and 19. 125 (4. 175-87.619), the OR and 95% CI value of patients with hematoma width ＞30 mm was 14. 838 ( 1. 353-162.698). Conclusions Type of hematoma and midline shift are found to be independently correlated with the recurrence of CSDH, and the width of hematoma is also related with its recurrence.