Objective To investigate the clinical effect of non inflatable endoscope assisted lateral cervical lymph node dissection in elderly patients with thyroid cancer. Methods The clinical data of 61 patients with lateral cervical lymphadenectomy assisted by non inflatable endoscope from January 2016 to December 2020 were retrospectively summarized. There were 48 females and 13 males with an average age of (71±6.5) years (range, 65–82 years). The operative time, intraoperative blood loss, cases of accessory nerve injury, cases of phrenic nerve injury, total number of lateral neck dissection lymph nodes, postoperative lymphatic leakage, postoperative drainage volume and hospital stay were counted. Neck ultrasonography and thyroglobulin levels were measured during follow-up to assess recurrence. Results All patients successfully completed the non inflatable endoscopic assisted lateral cervical lymph node dissection, the operative time was 51–117 min, the average was (92±22.1) min, the intraoperative blood loss was about 80–150 mL, the average was (120±17.1) mL, the postoperative drainage was 190–670 mL, the average was (332±167.1) mL, the postoperative hospital stay was 5–13 d, the average was (9±2.3) d, the total number of lymph nodes was 11–23, the average was (16±4.7). There were 11 cases of hypoparathyroidism, 5 cases of temporary recurrent laryngeal nerve injury, 3 cases of accessory nerve injury and no case of phrenic nerve injury. One patient had local redness and swelling after removing the drainage tube. Lymphatic leakage occurred in 3 cases. There was no recurrence during the follow-up period. Conclusion Non inflatable endoscope assisted lateral neck lymph node dissection provides technical support for elderly patients with thyroid cancer, and the effect is exact, and the short and medium-term follow-up results are satisfactory.
Objective To investigate the effects of different ventilation modes on postoperative pulmonary complications in elderly patients undergoing abdominal surgery. Methods The patients who underwent upper abdominal surgery under general anesthesia in Chengdu Office Hospital of the People’s Government of Tibet Autonomous Region between February 2020 and February 2021 were selected. Patients were randomly divided into volume controlled ventilation (VCV) group, pressure controlled ventilation (PCV) group, and pressure controlled ventilation-volume guarantee (PCV-VG) group according to the random number table method. All the three groups adopted the internationally recognized lung protective ventilation strategy. The transcutaneous arterial oxygen saturation and respiratory mechanics indicators of three different time periods, as well as pulmonary symptoms and signs and laboratory imaging examinations 7 days after surgery were recorded. The incidence of postoperative pulmonary complications in the three groups of patients were evaluated using the Melbourne Group Scale Version 2. Results A total of 120 patients were included, with 40 in each group. There was no statistically significant difference in the general situation of the three groups of patients (P>0.05). The platform pressure and compliance of three different time periods all changed over time (P<0.05). There were statistically significant differences in the occurrence of pulmonary complications and hospital stay among the three groups 7 days after surgery (P<0.05). Conclusion Under the internationally recognized lung protective ventilation strategy, PCV-VG mode can significantly reduce the incidence of pulmonary complications 7 days after abdominal surgery, shorten the length of hospital stay, and improve the quality of life in elderly patients.
ObjectiveTo evaluate the effect of early preoperative mobilization on the rehabilitation of the elderly patients with hip fractures after operation.MethodsThe clinical data of 16 elderly patients with hip fractures between February 2017 and April 2018 who met the selection criteria was retrospectively analyzed. There were 8 males and 8 females, with an average age of 80.3 years (range, 69-90 years). There were 8 cases of intertrochanteric fracture and 8 cases of femoral neck fracture. The preoperative American Society of Anesthesiologists (ASA) scored 2.94±0.43. There were 3 cases of cardiovascular and cerebrovascular diseases, 6 cases of essential hypertension, 5 cases of respiratory diseases, 3 cases of diabetes, and 2 cases of other system diseases. The time from injury to admission was 4 hours to 14 days with an average of 39.5 hours. On the day of admission or on the first day after admission, the patient started to exercise on the floor underwent analgesia treatment. And the patients were treated with closed reduction (9 cases) or artificial hip arthroplasty (7 cases). The time from admission to operation was 4 to 25 days, with an average of 7.4 days. At the time of admission, after the first ground movement before operation, on the second day after operation, and at last follow-up, the Barthel Index was used to assess the patients’ self-care ability, and Barthel effectiveness (BE) was calculated. The complications were observed and recorded during follow-up.ResultsAll 16 patients underwent operation successfully. The hospital stay was 8 to 24 days, with an average of 14.1 days. All patients were followed up 2.5-16.0 months with an average of 6.5 months. One patient developed postoperative pulmonary infection; the remaining patients had no surgical-related complications. No patient died during the follow-up. The Barthel Index scored 30.63±5.56 at admission, 53.13±9.50 after the first ground movement before operation, 60.63±6.09 on the second day after operation, and 96.25±4.84 at last follow-up. There were significant differences in Barthel Index scores between different time points (P<0.05). The BE was 0.23±0.06 after the first ground movement before operation, 0.30±0.04 on the second day after operation, and 0.66±0.06 at last follow-up. There were significant differences in BE between different time points (P<0.05).ConclusionFor elderly patients with hip fractures who have long waiting time before operation, early preoperative mobilization has a positive impact on patients’ activities of daily living.
Objective To conclude the research progress of unicompartmental knee arthroplasty (UKA) in the treatment of elderly patients with knee osteoarthritis (KOA). Methods The literature on UKA at home and abroad in recent years was reviewed to summarize the clinical characteristics of elderly patients with KOA, perioperative management (including evaluating indications preoperatively, intraoperative prosthesis selection, postoperative complication management, etc). Results Through reasonable preoperative evaluation, prosthesis selection, and advanced perioperative management, for elderly patients with KOA who meet the indications, UKA can be considered. Compared with total knee arthroplasty, the incidence of postoperative complications in elderly patients undergoing UKA is lower, joint awareness is reduced, functional improvement and satisfaction are higher. Meanwhile, choosing appropriate prostheses and fixation methods can lead to a good survival rate. ConclusionUKA can provide a safe and effective treatment option for elderly patients with KOA within a certain range of indications.
Objective To investigate the expression and clinical significance of T lymphocyte subsets, natural killer (NK) cells and CD19+ B cells in the elderly with primary immune thrombocytopenia (ITP) before and after treatment. Methods The elderly ITP patients diagnosed and treated in the Songjiang Hospital Affiliated to Shanghai Jiaotong University School of Medicine (preparatory stage) between January 2014 and June 2019 were retrospectively selected as the observation group. The healthy elderly in the same period were selected as the control group. According to the treatment, the observation group was divided into effective group and ineffective group. The expression levels of T lymphocyte subsets (CD3+, CD4+, CD8+ and CD4+/CD8+), NK cells and CD19+ B cells were observed and analyzed. Results A total of 75 subjects were included, including 35 in the observation group and 40 in the control group. The total effective rate was 85.71% (30/35). Before treatment, the expression levels of T lymphocyte subsets (CD3+, CD4+ and CD4+/CD8+) in the observation group were lower than those in the control group (P<0.05). There was no significant difference in other indexes between the two groups (P>0.05). After treatment, except for CD8+, the expression levels of T lymphocyte subsets (CD3+, CD4+ and CD4+/CD8+) in the observation group were higher than those before treatment (P<0.05). The expression levels of NK cells and CD19+ B cells were lower than those before treatment (P<0.05). The expression levels of T lymphocyte subsets (CD3+, CD4+ and CD4+/CD8+) in the effective group were higher than those before treatment (P<0.05), while the expression level of CD19+ B cells was lower than that before treatment (P<0.05). There was no significant difference in other indexes before and after treatment (P>0.05). There was no significant difference in the expression levels of T lymphocyte subsets (CD3+, CD4+, CD8+ and CD4+/CD8+), NK cells and CD19+ B cells in the ineffective group before and after treatment (P>0.05). Conclusions T lymphocyte subsets are abnormal in elderly ITP patients. The immune abnormality of T lymphocyte may be one of the reasons for elderly patients with ITP. With the improvement of therapeutic effect, immune cell subsets have also been improved.
Objective To compare the effectiveness of internal fixation, hemiarthroplasty, and total hip arthroplasty in the treatment of displaced femoral neck fractures in elderly patients so as to provide the evidence for the selection of therapeutic methods. Methods Between May 2005 and April 2008, 108 elderly patients with displaced femoral neck fractures were treated by internal fixation with compression screw (IF group, n=31), hemiarthroplasty (HA group, n=37), and total hiparthroplasty (THA group, n=40). In IF group, there were 8 males and 23 females with an average age of 73 years (range, 65-80 years); fractures were caused by tumbl ing (25 cases) and traffic accident (6 cases), including 17 cases of Garden type III and 14 cases of Garden type IV; and the time from injury to operation ranged from 8 hours to 13 days with an average of 4.2 days. In HA group, there were 10 males and 27 females with an average age of 74 years (range, 65-80 years); fractures were caused by tumbl ing (29 cases) and traffic accident (8 cases), including 21 cases of Garden type III and 16 cases of Garden type IV; and the time from injury to operation ranged from 1 to 14 days with an average of 4.4 days. In THA group, there were 11 males and 29 females with an average age of 73 years (range, 66-80 years); fractures were caused by tumbl ing (32 cases) and traffic accident (8 cases), including 23 cases of Garden type III and 17 cases of Garden type IV; and the time from injury to operation ranged from 2 to 14 days with an average of 5.6 days. There was no significant difference in general data among 3 groups (P gt; 0.05). Results There were significant differences in operation time and blood loss among 3 groups (P lt; 0.05), and IF group was less than other 2 groups. All patients were followed up 1 year and 4 months to 2 years and 3 months with an average of 1 year and 8 months. In IF group, HA group, and THA group, the rates of early postoperative compl ications were 19.4% (6/31), 8.1% (3/37), and 7.5% (3/40), respectively; the rates of late postoperative compl ications were 29.0% (9/31), 13.5% (5/37), and 7.5% (3/40), respectively; and the reoperation rates were 29.0% (9/31), 10.8% (4/37), and 5.0% (2/40), respectively. The rates of the early postoperative compl ication, late postoperative compl ication, and reoperation rate were significantly higher in IF group than in HA group and THA group (P lt; 0.05), but there was no significant difference between HA group and THA group (P gt; 0.05). The mortal ity rates were 16.1% (5/31), 13.5% (5/37), and 15.0% (6/40) in IF group, HA group, and THA group, respectively; showing no significant difference (P gt; 0.05). According to Harris hip score, the excellent and good rates were 65.4% (17/26), 81.3% (26/32), and 85.3% (29/34) in IF group, HA group, and THA group, respectively; showing significant differences among 3 groups (P lt; 0.05). Conclusion According to patient’s age, l ife expectancy, and general conditions, THA is a reasonable choice for the patients aged 65-80 years with displaced femoral neck fracture.
Objective To evaluate the preliminary efficacy and safety of XELOX combined with trastuzumab in the transformation therapy of human epidermal growth factor receptor 2 (HER2) positive elderly patients with advanced gastric cancer. Methods The clinical and surgical data of 21 patients with HER2 positive elderly patients with advanced gastric cancer who were treated with XELOX combined with trastuzumab in our Hospital from February 2019 to February 2021 were retrospectively analyzed, and the remission of patients after conversion therapy and the relevant indicators during and after surgery were observed. Results After the conversion therapy, there were 2 cases (9.5%) of complete remission, 13 cases (61.9%) of partial remission, and 6 cases (28.6%) of stable disease, the remission rate of the conversion therapy was 71.4% (15/21). After conversion treatment, 21 patients underwent laparoscopic exploration, of which 20 patients (95.2%) underwent R0 resection, simple exploration 1 case. In all 21 cases, the operative time was 124–185 min, with a median of 152 min. The intraoperative blood loss was 100–210 mL, with a median of 120 mL. The number of lymph nodes cleared was 12–54, with a median of 32. The duration of indwelling gastrointestinal decompression was 51–134 h, with a median of 102 h. The recovery time of gastrointestinal function was 70–98 h, with a median of 78 h. The drainage time in the abdominal operation area was 4–9 days, with a median of 6 days. Postoperative hospital stay was 7–13 days, with a median of 8 days. There were 2 cases of Grade IIIA complications (1 case of incomplete intestinal obstruction and 1 case of pulmonary infection) and 2 cases of Grade II complications (1 case of incision fat liquefaction and 1 case of jugular catheter infection) after operation. All patients were followed up for 3–36 months, with a median of 16.8 months. The median progression-free survival time was 12.4 months and the median overall survival time was 20.5 months. Conclusion For HER2 positive elderly patients with advanced gastric cancer, XELOX combined with trastuzumab transformation therapy is effective and safe.
ObjectiveTo evaluate the safety and efficacy of mitral valve surgery and cryoablation in elderly patients with mitral valve disease and persistent or long-term persistent atrial fibrillation.MethodsFrom May 2014 to July 2018, 144 patients with mitral valve diseases combined with persistent or long-term persistent atrial fibrillation in the Department of Cardiothoracic Surgery, General Hospital of Northern Theater Command were selected. Among them, there were 69 patients in a non-elderly group (<60 years) including 18 males and 51 females aged 52.07±5.56 years, and 75 patients in an elderly group (≥60 years) including 32 males and 43 females aged 65.23±4.29 years. A propensity-score matching (PSM) study was conducted to eliminate confounding factors. Both groups underwent mitral valve surgery and cryoablation at the same time. A 2-year follow-up was conducted after discharge from the hospital, and the perioperative and postoperative efficacy indexes were compared between the two groups.ResultsAfter PSM analysis, there were 56 patients in each group. The sinus rhythm conversion rate of the two groups at each follow-up time point was above 85%, and the cardiac function was graded asⅠorⅡ, which was significantly improved compared with that before the surgery, but there was no statistical difference between the two groups (P>0.05). Among the perioperative indicators of the two groups, the elderly group had more coronary artery bypass graft surgeries and longer postoperative ICU stay time compared with the non-elderly group (P<0.05), and the differences in other indicators were not statistically different (P>0.05).ConclusionThe mitral valve surgery and cryoablation in elderly patients with mitral valve diseases combined with persistent or long-term persistent atrial fibrillation are safe, and the short-term outcome is satisfactory.
ObjectiveTo summarize the various treatment methods for reducing jaundice in the elderly patients with malignant obstructive jaundice (MOJ), and provide reference for the treatment of elderly MOJ.MethodUsing “malignant obstructive jaundice” as the Chinese keyword and the English keyword, a computer search of the literatures on the treatment of elderly MOJ patients was conducted and reviewed.ResultsThe treatment methods of reducing jaundice in elderly MOJ included radical surgery, cholangiojejunostomy, endoscopic ultrasound-guided biliary drainage, endoscopic biliary stent implantation, percutaneous transhepatic biliary drainage and stent implantation. Radical surgery was the most effective, but it was traumatic and had many complications for elderly patients. Cholangiojejunostomy was effective and suitable for elderly patients who cannot tolerate major surgery. Endoscopic ultrasound-guided biliary drainage was less traumatic to elderly patients, but technical difficulty. Endoscopic biliary stent implantation was currently the first-line choice for the treatment of elderly patients with advanced MOJ. Percutaneous transhepatic biliary drainage and stent implantation were suitable for elderly and frail patients with high obstruction.ConclusionThe treatment of elderly MOJ needs to be individualized and regionalized, and appropriate treatment methods should be selected according to the patient’s condition and the medical level of the medical center.
ObjectiveTo explore the predictive value of the modified frailty index-11 (mFI-11) for postoperative complications in elderly lung cancer patients undergoing robot-assisted lobectomy. MethodsRetrospective collection of clinical data from lung cancer patients aged ≥65 years who underwent robot-assisted lobectomy at the Department of Thoracic Surgery, Gansu Provincial Hospital, from January 2022 to June 2025. Based on the optimal grouping threshold of 0.27 in previous studies for the mFI-11 score, patients were divided into a frail and a non-frail group. Postoperative complications of the two groups were analyzed, and multivariate logistic regression was used to assess the relationship between mFI-11 and postoperative complications. The receiver operating characteristic (ROC) curve was drawn to evaluate the predictive efficiency of mFI-11 for postoperative complications. ResultsA total of 161 patients were included, with 77 males and 84 females, and an average age of (68.48±2.90) years. Among them, 103 (64.0%) patients were in the non-frail group and 58 (36%) in the frail group. Differences between the two groups in terms of independent functional status, hypertension requiring drug control, history of type 2 diabetes, history of chronic obstructive pulmonary disease, American Society of Anesthesiologists classification, and tumor staging were all statistically significant (P<0.05). The length of postoperative hospital stay in the frail group was longer than that in the non-frail group [5.50 (5.00, 8.25) d vs. 5.00 (4.00, 5.00) d, P<0.001]. The incidence rates of general respiratory diseases (25.9% vs. 8.7%), hypoproteinemia (15.5% vs. 4.9%), arrhythmia (12.1% vs. 1.9%), bronchopleural fistula (5.2% vs. 0.0%), transfer to ICU for severe complications (10.3% vs. 1.0%), and readmission within 30 days after discharge (12.1% vs. 1.9%) were all higher in the frail group compared to the non-frail group (P<0.05). Multivariate logistic regression analysis found that mFI-11 had a better predictive efficiency for postoperative complications: general respiratory diseases [area under the curve (AUC)=0.759], hypoproteinemia (AUC=0.723), arrhythmia (AUC=0.795), transfer to ICU for severe complications (AUC=0.713), and readmission within 30 days after discharge (AUC=0.702). ConclusionmFI-11 can effectively predict postoperative complications in elderly lung cancer patients undergoing robot-assisted lobectomy and can serve as an objective indicator for identifying high-risk elderly lung cancer patients.