Emergency bowel surgery in the elderly.
Emergency bowel surgery in the elderly.
复制标题
老年人的紧急肠道手术。
DOI：
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发表时间：
2003
期刊：
影响因子：
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通讯作者：
F. Coşkun
中科院分区：
文献类型：
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作者：
Bahadır Külah;Bariş Gülgez;M. Ozmen;M. Ozer;F. Coşkun
背景/目的
急诊肠道手术通常在急诊室进行，具有高发病率和死亡率风险，尤其是老年患者。本研究的目的是审查的介绍，管理和结果的肠急症在老年患者。
方法
本文回顾性分析了五年来248例65岁以上急诊肠道手术病人的临床资料。记录患者的年龄、性别、临床表现详情、既往病史、共存疾病的存在和外科手术类型，并分析其影响/任何不利结局。采用SPSS9.0forWindows统计软件对数据进行分析。小于0.05的p值被认为是显著的。
结果
平均年龄为72.5岁。有85例（34%）孤立性小肠急症（SBE）和153例（62%）孤立性大肠急症（LBE）。SBE中最常见的疾病是肠系膜缺血，67例（27%），其次是粘连，26例（10%）。恶性肠道疾病59例（24%）和乙状结肠扭转43例（17%）占LBE的大多数。百分之六十五（161）的患者出现梗阻，46（19%）例患者出现肠穿孔。恶性疾病、肠扭转和肠系膜缺血的切除率较高（分别为82%、78%和76%）。总体发病率和死亡率分别为42%（105）和28%（70）。
结论
急诊肠道手术对老年人的预后不佳。疾病的性质和程度、并存心肺疾病的存在、晚期入院和腹膜炎的存在显著影响老年肠急症患者的管理和结局。
BACKGROUND/AIMS
Emergency bowel operations are commonly performed in emergency units and carry high morbidity and mortality risk, particularly in elderly patients. The aim of the present study was to review the presentation, management and outcome of bowel emergencies in elderly patients.
METHODS
The records of 248 patients (91 females, 157 males) aged over 65 years, undergoing emergency bowel operation during a five-year period, were reviewed. Patient's age, sex, details of presentation, past medial history, presence of coexisting diseases, and type of surgical procedures were noted, and their effects/any unfavorable outcomes were all analyzed. Data were evaluated by using SPSS 9.0 for Windows statistical program. A p value less than 0.05 was accepted as significant.
RESULTS
Mean age was 72.5 years. There were 85 (34%) isolated small bowel emergencies (SBE) and 153 (62%) isolated large bowel emergencies (LBE). The most common disease in SBE was mesenteric ischemia in 67 (27%), followed by adhesions, 26 (10%). Malignant bowel disease in 59 (24%) and sigmoid volvulus in 43 (17%) accounted for the majority of LBE. Sixty-five percent (161) of patients presented with obstruction and 46 (19%) patients had bowel perforation. Malignant disease, volvulus and mesenteric ischemia carried high resection rates (82%, 78% and 76%, respectively). Overall morbidity and mortality rates were 42% (105) and 28% (70), respectively.
CONCLUSIONS
Emergency bowel operations have poor outcome in the elderly. Nature and extent of disease, presence of coexisting cardiopulmonary disease, late admission and presence of peritonitis significantly affect management and outcome of elderly patients with bowel emergencies.