Early outcomes of emergency operations in neonates with pulmonary atresia and intact ventricle septum / 中国小儿急救医学

Objective:To study the early outcomes of emergency operation employed with one of the prevalent surgical methods in neonates diagnosed as pulmonary atresia with intact ventricle septum(PA/IVS) and critical pulmonary stenosis(CPS), and to analyze the risk factors related to its early results.Methods:A retrospective analysis was conducted to collect the data of neonates suffered from PA/IVS and CPS from January 2016 to January 2020 in cardiothoracic surgery department at Shanghai Children′s Medical Center.According to their Z score, which reflects the development degree of right ventricle, the neonates received one of the relevant popular operations.Early outcomes were summarized and risk factors related to its early stage mortality were analyzed.Results:A total of 65 neonates were enrolled, including 27 CPS cases.They were operated on the basis of their respective Z scores, and also according to these data, the primary surgical procedure was chosen from the following methods: Blalock-Taussig(B-T) shunt, pulmonary valvulotomy and right ventricular outlet enlargement.Totally seven cases died, and mortality was 10.7%.Nine cases received re-operation in several following days because of severe hypoxemia and low cardiac output.All patients had mild improvement in oxygen saturation after operation and relied on large dose of inotropic agent.Multivariate Logistic regression analysis showed that B-T shunt and re-operation in early period were risk factors for death in neonates with PA/IVS and CPS.Conclusion:There is a higher mortality in neonates who received emergency operation for PA/IVS and CPS.Accurate assessment of the right ventricle development degree and selecting the corresponding appropriate surgical method is critical for the optimal result.B-T shunt and early stage re-operation are the risk factors for death in neonates with PA/IVS and CPS who received emergency operation.

Diagnosis and treatment of emergency inguinal hernia / 中华消化外科杂志

Objective:To investigate the diagnosis and treatment of emergency inguinal hernia.Methods:The retrospective cross-sectional study was conducted. The clinical data of 236 patients with emergency inguinal hernia who were admitted to the First Affiliated Hospital of Soochow University from January 2015 to May 2020 were collected. There were 194 males and 42 females, aged (69±30)years. Hospitalized patients received routine blood biochemistry test and imaging examinations for evaluation of characteristics of hernia contents and intestinal obstruction. Manual reduction and surgical treatment were selected according to the conditions of patients. Observation indicators: (1) treatment; (2) follow-up. Follow-up using outpatient examination and telephone interview was performed to detect hernia recurrence and late-onset mesh infection up to August 2020. Measurement data were described as M (range) or M ( P25, P75), and comparison between groups was analyzed using the Wilcoxon rank sum test. Count data were represented as absolute numbers, and comparison between groups was done using the chi-square test. Results:(1) Treatment: of the 236 patients, 106 cases had successful manual reduction, 124 cases underwent emergency operation, 6 cases refused surgery. ① For 106 cases with successful manual reduction (including 4 cases guided by B-ultrasonography), the manual reduction time was 5 minutes (2 minutes,7 minutes). Ninety-three of 106 patients underwent selective operation after manual reduction, including 89 cases with indirect hernia, 2 cases with direct hernia and 2 cases with compound hernia. The time to selective operation was 3 days(2 days,5 days) after manual reduction. Patients underwent mesh repair, of which the operation time, volume of intraoperative blood loss, time to postoperative first flatus, duration of postoperative hospital stay were 44 minutes (29 minutes, 66 minutes),10 mL(5 mL,20 mL), 1 day(1 day,2 days), 1 day(1 day,2 days), respectively. Eleven patients didn't undergo selective operation. Two patients with abdominal pain and fever after manual reduction were diagnosed with perforation of intestine by emergency surgical exploration, and then underwent partial intestinal resection combined with high ligation of hernial sac. ② There were 93 of 124 patients undergoing emergency operation with indirect hernia, 18 cases with femoral hernia, 6 cases with obturator hernia, 6 cases with compound hernia and 1 case with direct hernia. There were 54 of 124 patients undergoing open operation, including 21 cases with Bassini surgery, 18 cases with Lichtenstein surgery, 9 cases with Mc Vay surgery, 6 cases with high ligation of hernia sac. There were 70 patients undergoing laparoscopic operation, including 57 cases with laparoscopic transperitoneal preperitoneal hernia repair (TAPP), 10 cases with laparoscopic explora-tion + tissue repair and 3 cases with laparoscopic exploration + closure of inner inguinal ring. The operation time, volume of intraoperative blood loss, time to postoperative first flatus, cases with short-term postoperative complications were 60 minutes (50 minutes,76 minutes), 20 mL(14 mL,30 mL), 2 days(1 day,2 days), 15 cases for patients undergoing open surgery, respectively. The above indicators were 56 minutes (47 minutes,77 minutes), 20 mL(10 mL,25 mL), 2 days(1 day,2 days), 21 cases for patients under-going laparoscopic surgery. There was no significant difference in the above indicators between the two groups ( Z=?0.88, ?1.37, ?1.56, χ2=0.07, P>0.05). Cases with intraoperative placement of mesh and duration of hospital stay were 18 cases and 5 days(3 days,8 days) for patients undergoing open surgery, versus 57 cases and 3 days(2 days,5 days) for patients undergoing laparoscopic surgery, showing significant differences between the two groups ( χ2=29.50, Z=?4.32, P<0.05). (2) Follow-up: of 236 patients, 192 were followed up for 2?60 months, with a median follow-up time of 19 months. Seven patients had recurrence of hernia after emergency operation, including 3 with high ligation of the hernia sac, 2 with Bassini surgery, 1 with Lichtenstein surgery, and 1 with laparoscopic exploration + closure of inner inguinal ring. One patient with late-onset mesh infection after Lichtenstein surgery was improved after mesh removal. No long-term complications such as hernia recurrence or late-onset mesh infection occurred to the 184 patients. Conclusions:Emergency inguinal hernia had different state of illness, manual reduction is suitable for partial patients with incarceration. Surgery is the first choice, and the surgical procedure needs to be individually selected.

Open Stent Grafting for Stanford Type A Acute Aortic Dissection Originating from an Aberrant Right Subclavian Artery / 日本心臓血管外科学会雑誌

<p>An aberrant right subclavian artery (ARSA) is a relatively rare congenital anomaly of arch branches, occurring in 0.5-2.0% of the population. Stanford type A acute aortic dissection involving an ARSA is rare, and is associated with difficult surgical planning in an emergency situation. We report a case of Stanford type A acute aortic dissection originating from an ARSA in a 50-year-old man. He was referred to our hospital with a chief complaint of chest and back pain. Contrast enhanced CT scan revealed type A aortic dissection involving an ARSA, with the entry located near the ARSA. Given the possible difficulty of performing distal anastomosis over the ARSA and ARSA reconstruction, total arch replacement was performed using the open stent-grafting technique. The postoperative course was uneventful, and a CT scan revealed a thrombosed false lumen and ARSA. The false lumen of the aorta next to the stent graft eventually disappeared at 1 year postoperatively. The open stent-grafting technique might be an effective alternative in the management of Stanford type A acute aortic dissection with ARSA.</p>

After placing stents undergoing elective surgery and emergency surgery in comparative study of obstructive colorectal cancer / 中国现代普通外科进展

Objective:To investigate the clinical value of two kinds of treatment methods of selective operation and emergency surgery after implantation of stents.Methods:Methods the clinical data of 90 patients with obstructive colorectal cancer were analyzed retrospectively.Temporary placement of metal stents in 30 cases,Elective surgical treatment (stent group);60 cases of emergency operation (emergency operation group).Comparing stent group and a emergency surgical resection and self-agreement,operation time,postoperative ventilation time,complications and hospitalization mortality indicators.Results:stent group one stage resection self-agreement (96.67％) were significantly higher than those of emergency surgery group(56.67％,P＜ 0.001).Postoperative complications(6.67％) stent group was obviously lower emergency surgical group(26.67％,P＜ 0 05).Support group hospitalization mortality compared with emergency surgery group,The difference was not statistically significant(P＞0.05).Support the operative time,postoperative ventilation time (156.13 ± 49.79) min and (3.60 ± 1.40) d,respectively,significantly lower than the emergency treatment (P＜ 0.05).Conclusion:Implant stents can rapidly and effectively alleviate symptoms of obstructive co orecta cancer After placing stents undergoing elective surgery compared with emergency surgery can increase the resection and self-agreement,reduce the complications and can be used as aeffect ve relieve obstructive colorectal cancer treatment.

Analysis and comparison of curative effects of elective operation and emergency operation in treating atlantoaxial vertebral segmental spinal canal space-occupying lesions / 重庆医学

Objective To compare and explore the curative effects of elective operation and emergency operation in treating atlantoaxial vertebral segmental spinal canal space-occupying lesions.Methods Thirty-two patients suffering from atlanto-axial vertebral segmental spinal canal space-occupying lesions treated in our hospital from May 2010 to April 2015 were selected and divided into the emergency operation group (group A,n =14) and elective operation group (group B,n =18).The emergency and elective operations were adopted respectively.Then the operation time,intraoperative blood loss,JOA score,ODI index,VAS score,postoperative imaging(MRI) and effect satisfaction degree were compared between the two groups.Results After treatment,the JOA score in the group A was (25.23±4.47) points,which was higher than (22.10±3.56) points in the group B,and the difference was statistically significant (t=3.67,P＜0.05).The ODI index and VAS score of the two groups all were decreased.The ODI index in the group A was (18.56±3.10) points,which in the group B was (21.56±4.37) points,and there was statistically significant difference between the two groups (t=3.76,P＜0.05).The VAS score in the group A was (1.89 ±-0.53)points,which in the group B was (3.16±0.89)points,the difference was statistically significant between the two groups (t=3.76,P＜0.05).Before surgery and at postoperative 1 month,the spinal cord function classification(Frankel grade) of the two groups had no statistically significant difference between the two groups(Z=-0.18,P=0.85＞0.05,Z=-0.52,P=0.60＞0.05).The operation time had no statistical difference between the group A and B[(120.23±9.02)min vs.(126.25±12.12)min,P＞0.05].The intraoperative bleeding volume had had no statistical difference between the group A and B [(211.26±12.25)mL vs.(220.43±17.58)mL,P＞ 0.05].After one month of treatment,the satisfaction degree in the group A was 92.56 ％,which was higher than 72.22％ in the group B,and the difference was statistically significant (Z=-2.13,P＜0.05).Conclusion Emergency operation in treating atlantoaxial segment spinal space occupying lesions can effectively improve the therapeutic effect,and has higher patients satisfaction after treatment.Therefore which is worth promoting and applying.

Comparative analysis on thoracoscopic surgery and conventional thoracotomy for emergency surgical treatment in multiple rib fracture complicating pulmonary laceration / 重庆医学

Objective To compare the effect of video‐assisted thoracoscopic(VAT) surgery and conventional thoracotomy in emergency treatment of multiple rib fracture complicating pulmonary laceration to provide the reference for clinical treatment .Meth‐ods Forty‐seven cases of multiple rib fracture complicating pulmonary laceration in our hospital from April 2013 to April 2014 were selected and divided into the VAT group(n=32) and thoracotomy group(n=15) according to the willingness of patients .The two groups performed the thoracoscopic and traditional thoracotomy titanium nickel alloy rib plate treatment respectively .The sur‐gery situation ,complications and changes of perioperative blood gas levels were compared between the two groups .Results The op‐eration time ,intraoperative bleeding volume ,ICU hospitalization time ,total hospitalization time and postoperative analgesic in the VAT group were lower than those in the thoracotomy group ,the differences were statistically significant (P0 .05) .The excellent rate in the VAT group was 90 .6% ,which was higher than 66 .7% in the thoracotomy group ,and the differ‐ence was statistically significant (P<0 .05) .Conclusion Thoracoscopic internal fixation for the treatment of multiple rib fractures complicating laceration has the advantages of minimal trauma ,convenient operation and high safety ,could effectively alleviate the patient′s sufferring ,improve the living quality ,and be a better way of treatment .

Practice of lean management in optimization of emergency operation process / 中华医院管理杂志

Lean management,when introduced to optimize emergency operations,may improve medical service.It has been proved in practice that ideas and methodology of lean management guarantee emergency services by ensuring safety and quality of emergency operation process.In addition,it minimizes costs and enhances the business and social efficiency of the hospital.

Brief Useful Comments on Laparoscopic Surgery in Acute Abdomen.

The use of laparoscopic surgery tends to become more and more popular, nowadays. It has also been extended in the management of acute abdominal disease as a diagnostic and as a therapeutic tool. However, its therapeutic use requires special experience and appropriate instrumentation, in addition to a reliable definite diagnosis. Based on randomized, controlled trials, it can be postulated that laparoscopic surgery in acute abdomen is feasible, safe and effective in acute cholecystitis, acute appendicitis and gastroduodenal ulcer perforation. There are still conflicting aspects in perforated diverticular disease and small bowel obstruction. In case of purulent peritonitis attention must be paid in order to avoid residual abscess formation and sepsis by thorough irrigation of the peritoneal cavity and on time antibiotic therapy. The proper indication for each case under the certain emergency circumstances is crucial.

Development and implement of a disaster plan in a laboratory animal care and use program / 中国比较医学杂志

As a vital component in an overall laboratory animal care and use program , development of a disaster plan plays a critical role for every research institution .Currently, most of domestic institutions would draw up an“emergency operation plan , EOP”, but ignoring a practicable “business continuity plan , BCP” in establishing a disaster plan.In this article, we will discusse about the definition of disaster , how to set up an EOP, and how to establish a thorough BCP , in order to show an integrated and professional disaster plan in laboratory animal care and use program .

A Case of Emergency Ascending Aorta Replacement for Paraplegia Caused by Stanford Type A Acute Aortic Dissection / 日本心臓血管外科学会雑誌

We report a rare case of type A acute aortic dissection with paraplegia which was cured immediately after an emergency operation. A 79-year-old woman was transferred to our institution with sudden back pain and paraplegia. Computed tomographic scans revealed a cardiac tamponade with an acute type A aortic dissection. She went into shock soon after arrival, and about 4 hours from onset we performed an emergency replacement of the ascending aorta. Three hours after the operation, her neurological deficit gradually resolved and could walk by postoperative day 3. This case suggests that early restoration of the blood flow to the spinal cord is mandatory to relieve paraplegia caused by type A aortic dissection.

Early Clinical Results of On-Pump Beating-Heart versus Off-Pump Coronary Artery Bypass Grafting in Patients with Acute Coronary Syndrome / 日本心臓血管外科学会雑誌

Emergency coronary artery bypass grafting (CABG) in patients with acute coronary syndrome (ACS) is still associated with high mortality and morbidity, and early outcome is poor compared with outcome in patients with stable angina. The purpose of this study was to examine the clinical results of on-pump beating heart CABG vs. off-pump coronary artery bypass (OPCAB) for ACS patients. From a total of 432 CABG patients, we retrospectively analyzed 72 (16.7%) patients who underwent emergency CABG between 2004 and 2008. Emergency CABG cases were divided into 2 operative groups : an on-pump beating-heart CABG group (on, <i>n</i>=31) and an OPCAB group (off, <i>n</i>=41). A preoperative history of acute myocardial infarction (AMI), detection of troponin T, preoperative creatine phosphokinase (CPK) value, low ejection fraction, presence of mitral regurgitation (MR) (>II) and cardiomegaly were markedly higher in the on group. There were no statistically significant differences in intraoperative factors. In-hospital mortality was 3.2% (1 patient) in the on group and 7.3% (3 patients) in the off group. Furthermore, statistically significant differences were found between the 2 groups in incidence of all-cause morbidity (on=71.0% : off=41.5%, <i>p</i>=0.01), respiratory failure (on=58.1% : off=29.3%, <i>p</i>=0.01), ICU stay (on=6.5±4.6 days : off=4.1±3.2 days, <i>p</i>=0.01), and necessary inotropic support (on=51.6% : off=17.1%, <i>p</i>=0.02). Multivariate regression analysis of preoperative and intraoperative factors was performed to identify independent factors for in-hospital mortality and morbidity. On multivariate analysis of preoperative factors, only the pre-CPK value reached statistical significance as an independent factor for in-hospital mortality and morbidity.

Blood Transfusion in Brain Surgery: A Comparison of Elective versus Emergency Operations / 대한수혈학회지

BACKGROUND: Blood transfusion is often performed to support successful brain surgery. In this study, we looked at two groups of surgery patients to analyze the transfusion requirements for patients undergoing brain surgery in our hospital. Group A patients received elective surgery, whereby blood products were prepared in advance, and Group B patients required emergency surgery which is often accompanied massive bleeding, and therefore adequate transfusion blood may not be available in advance. METHODS: During a one year period, patients who received brain surgery were classified as requiring either elective (Group A) or emergency (Group B) surgery. In each group, operation time and blood transfusion requirements were compared. RESULTS: Of the 35 total patients included in this study, 14 cases were Group A and 21 cases were group B. Average operation time was 4 hours and 13 minutes (253 minutes), and 2 hours and 50 minutes (170 minutes), respectively for Groups A and B. Red Blood Cell (RBC) transfusion was conducted in more than 90% of all patients. Average volume of RBC transfusion per operation was 2.5 units (Group A) and 3.1 units (Group B). Fresh frozen plasma (FFP) was transfused in 21% of Group A patients and in 38% of Group B patients. Platelet Concentrate (PC) was transfused in 19% of Group B patients, only. CONCLUSION: FFP and PC were more frequently transfused in patients who received emergency surgery than those who received elective surgery. Preparation of, not only RBC, but FFP and PC is required for emergency brain surgery. Therefore, efforts to retain adequate amounts of blood are needed to support emergency brain surgery.

Emergency Operative Treatment on Thoracolumbar Compression or Burst Fractures Using Pedicle Screw Instrument Through Posterior Approach and Indirect Reduction / 中国康复理论与实践

@#Objective To observe the clinical effect of emergency operative treatment on thoracolumbar compression or burst fractures using pedicle screw instrument through posterior approach and indirect reduction.Methods53 acute thoracolumbar compression or burst fractures cases injured within 4 days were accepted the emergency operation of indirect reduction, decompression and fixation using pedicle screw instrument through posterior approach. The mean percentage of traumatic vertebral body height, sagittal diameter of spinal canal, degrees of kyphosis and Frankel scoring of nerve function were evaluated before and after operation.ResultsAll cases received two weeks following-up, 47 cases had more than one-year following-up. The mean percentage of traumatic vertebral height restored from 42.28% (pre-operation) to 93.46% (post-operation); the mean degrees of kyphosis recovered from 26.44° (pre-operation) to 17.73° (post-operation); the mean percentage of sagittal diameter of spinal canal changed from 63.14% (pre-operation) to 78.55% (post-operation). All but cases with completely spinal cord injury got more than one grade nerve functional restoration. Neither later spinal cord injury nor back pain existed among the patients. Three cases emerged partial internal fixation device failure, but neither symptoms nor abnormality correction missed.ConclusionEmergency operation using pedicle screw instrument through posterior approach is a feasible and confirmatory choice in treatment of the acute thoracolumbar compression or burst fractures if the cases are selected properly.

Aspiration Pneumonia at Recovery Room in the Patient Emergency Pelviscopic Salpingectomy, without the Perceptive Sign of Gastric Regurgitation during Perioperative Periods: A case report / 대한마취과학회지

Aspiration pneumonia is considered to be a morbid complication of anesthesia, It was reported that several conditions are associated with an increased frequency of aspiration pneumonia, such as gastroenterological, neurological and, pulmonary diseases. The incidence is also higher in emergency situations than during elective surgery. We encountered aspiration pneumonia after emergency laparoscopic salpingectomy. The patient was 25 years old woman with no prior medical history but had fasted for only 5 h in the preoperative period. During the perioperative period, there were no signs of regurgitation of the gastric contents into the oral cavity. After surgery, the patient was transported to the recovery room in a fully awakened state. However, the patient became cyanotic without vomiting. After physiotherapy, a chest CT scan was performed, and she was diagnosed with aspiration pneumonia. She was admitted to intensive care. Ten days later, she was discharged in a healthy state.

The Comparision of Hemodynamic Responses to Orotracheal Intubation during Emergency Operation with the Proseal Laryngeal Mask Airway and Endotracheal Intubation / 医学研究杂志

Objective To compare the hemodynamic responses to orotracheal intubation during emergency operation with the proseal laryngeal mask airway and endotracheal Intubation.Methods Fifty six patients who were ASA GRADE Ⅰ-Ⅱ before onset undergoing orotracheal intubation were randomly dirideed into either without laryngoscope direct proseal laryngeal mask intubation(PLMA) group or direct laryngoscope endotracheal intubation(TT) group.SBP、DBP、HR and SpO2 were recorded before,durring and 5 minutes after intubation.Intubation time and first attempt insertion success rate were recordeddso.All patients were followed up postoperatively for adverse effects like sore throat or hoarseness.Results In intubation time、first attempt insertion success rate and adverse effects like sore throat or hoarseness,PLMA group was 96.43%,(19.7?5.7)s and 7.1%,TT group was 100%,(27.9?11.3)s and 39.29%.Intubation time was significantly shorter and adverse effects like sore throat or hoarseness were lower in the PLMA group than TT group(P

Prognostic Factors Associated with Surgical Mortality Conferred by Emergency Operation in Colorectal Cancer

PURPOSE: Compared with elective surgery, emergency surgery for colorectal cancer has been reported to be associated with high mortality, though little is known about the prognostic factors associated with surgical mortality. Above all, a distinction between patients with high and low mortalities might be helpful for perioperative management. The purpose of this study was to identify prognostic factors associated with surgical mortality due to an emergency operation. METHODS: Ninety-five cases of emergency surgery for colorectal cancer were performed from 1998 through 2005. The genders and the ages of the patients, the duration of symptoms, the APACHE score, the cancer location, the presence of perforation, the operative type, and the disease stage were determined as prognostic factors. The patients were examined retrospectively to establish any relationships between the prognostic factors and surgical mortality. RESULTS: In the univariate analysis, significantly higher surgical mortality rates were found in patients who were more than 75 years old, who had an APACHE II score above 10, and who had a perforation (P0.05). Multivariate analysis showed that age and APACHE II score were related to surgical mortality. The surgical mortality rate for colorectal cancer in an emergency situation was 8.4%. CONCLUSIONS: Prognostic factors of significance associated with surgical mortality due to an emergency operation were age (> or = 75) and APACHE II score (>10). Careful attention is needed for appropriate perioperative management of patients with these risk factors.

Emergency and sub-emergency cardiac operations on congenital heart defects in children / 重庆医科大学学报

Objective:To summarize and evaluate emergency and sub-emergency cardiac operations on congenital heart defects in children.Method:From January 2002 to April 2008,emergency and sub-emergency cardiac operations were performed on 172 children(105 males,67 females) with critical congenital heart defects.The age was 5 days～33 months(mean 10.2 ? 8.7 months),and the weight was 2.7 ~13.6 kg(mean 8.2 ? 4.8 kg).Thepreoperative situation included recurrent respiratory infection or congestive heart failure(113 cases),severe hypoxemia(62 cases) and other critical conditions(5 cases).Corrective operations were performed on 149 cases and palliative operations on 23 cases.Results:The early postoperative mortality was 8.7%(15/172).The duration of intubation was 5 hours～31 days(mean 3.1?4.9 days),and the ICU stay time was 2 ~31 days(mean 5.8 ? 2.5 days).Postoperative low cardiac output syndrome was observed in 19 cases,atelectasis in 12 cases,lung infection in 35 cases,worsened pulmonary hypertension in 5cases,and pleural effusion in 5 cases.There were 2 late deaths during follow-up period of 2~73 months.The postoperative cardiac function of the 155 survivals was restored to grade I~II(NYHA).Conclusion:Emergency and sub-emergency cardiac operations on critical congenital heart defects in children are necessary and feasible.Good results can be achieved with appropriate perioperative management and surgical technique.

A Clinical Analysis of Surgery in the Elderly Patients with Acute Abdomen

PURPOSE: In surgical treatment for the elderly patients with the acute abdomen, the high morbidity and mortality rate become a serious problem because of the difficulty of the initial diagnosis. This study, therefore, aims at analyzing the clinical presentation of the elderly patients with the acute abdomen in order to reduce the high mortality rate for the elderly patients. METHODS: This study included 114 elderly patients who underwent the emergency operation due to the acute abdomen from May 2000 to May 2002. The age of the elderly patients was over 65 years old. The clinical characteristics of these patients were investigated retrospectively in this study. RESULTS: The most two common diseases were the acute appendicitis(25.4%) and the acute cholecystitis (21.9%) for the elderly patients. Then comes the intestinal obstruction, the gastrointestinal cancer, the colonic diverticulitis, and the gastrointestinal vascular disease in that order. The accuracy of the initial diagnosis was 79%, but the correlation between the accuracy and age significantly decreased as the age of the elderly patients increased. The postoperative complication rate was 26.3%, and the most common cause of the complications was the postoperative infection. The postoperative mortality rate was 11.4%, and the common causes of the death were the sepsis(61.5%), the postoperative bleeding, the acute renal failure, and the cardiovascular disease in order of frequency. It was found that there was a significant correlation between the complication rate and old age(p=0.021). In addition, there was a significant correla- tion between the mortality rate and old age p=0.012). CONCLUSION: In this study, it was found that the acute appendicitis and the cholecystitis were the common diseases for the elderly patients with the acute abdomen. The accuracy of the initial diagnosis was 79%; however, it decreased with the aging process. For aged people, that caused the increase of the complication and the mortality rate. It thus appears that elderly patients with the acute abdomen should be treated carefully and systematically.

A Clinical Analysis of Surgery in the Elderly Patients with Acute Abdomen

PURPOSE: In surgical treatment for the elderly patients with the acute abdomen, the high morbidity and mortality rate become a serious problem because of the difficulty of the initial diagnosis. This study, therefore, aims at analyzing the clinical presentation of the elderly patients with the acute abdomen in order to reduce the high mortality rate for the elderly patients. METHODS: This study included 114 elderly patients who underwent the emergency operation due to the acute abdomen from May 2000 to May 2002. The age of the elderly patients was over 65 years old. The clinical characteristics of these patients were investigated retrospectively in this study. RESULTS: The most two common diseases were the acute appendicitis(25.4%) and the acute cholecystitis (21.9%) for the elderly patients. Then comes the intestinal obstruction, the gastrointestinal cancer, the colonic diverticulitis, and the gastrointestinal vascular disease in that order. The accuracy of the initial diagnosis was 79%, but the correlation between the accuracy and age significantly decreased as the age of the elderly patients increased. The postoperative complication rate was 26.3%, and the most common cause of the complications was the postoperative infection. The postoperative mortality rate was 11.4%, and the common causes of the death were the sepsis(61.5%), the postoperative bleeding, the acute renal failure, and the cardiovascular disease in order of frequency. It was found that there was a significant correlation between the complication rate and old age(p=0.021). In addition, there was a significant correla- tion between the mortality rate and old age p=0.012). CONCLUSION: In this study, it was found that the acute appendicitis and the cholecystitis were the common diseases for the elderly patients with the acute abdomen. The accuracy of the initial diagnosis was 79%; however, it decreased with the aging process. For aged people, that caused the increase of the complication and the mortality rate. It thus appears that elderly patients with the acute abdomen should be treated carefully and systematically.

Effect of endoscopic therapies for senile acute cholangitis of severe type / 临床外科杂志

Objective To investigate the clinical evaluation on endoscopic sequential therapy for senile ACST.Methods The 36 cases of senile ACST were collected and divided into two groups:emergency operation and endoscopic sequential therapy.The results of treatment were compared between two groups.Result Comparing with emergency operation, the mortality of endoscopic sequential therapy was reduced from 27.8%to 5.6%,the rate of complication from 61.1% to 16.6%,the periods of preoperative preparation was shorten from 12.6 hours to 7.5 hours,the periods of postoperative recovery from 6.5 days to 3.5 days,the intervals between two treatments from 43 days to 11 days,the periods of complete treatment from 45 days to 23 days.Conclusion Endoscopic sequential therapy was the ideal alternative for senile ACST,which is characterized by minimal injury,effectiveness and thoroughness.