New medical therapeutic options challenge the usual surgical management of Crohn’ s disease patients with intestinal perforation. Objectives-To determine factors predictive of surgery for perforation in Crohn’ s dis...New medical therapeutic options challenge the usual surgical management of Crohn’ s disease patients with intestinal perforation. Objectives-To determine factors predictive of surgery for perforation in Crohn’ s disease and define a group of patients that may benefit from non-surgical treatment. Methods-One hundred and sixty-two patients (69 males, 93 females, mean age 39) with perforated Crohn’ s disease (fistula, abscess, inflammatory mass) between January 1995 and September 2003 were studied retrospectively. Results-One hundred and fifty-one patients (93% ) underwent surgery: 70 had planned surgery and 81 had surgery for symptomatic deterioration. At two years, the cumulative probability of intestinal resection was 0.89 ≥ 0.03, and the cumulative probability of unplanned intestinal resection was 0.72 ≥ 0.05. Predictive factors of unplanned surgery were elevated platelet count (adjusted hazard ratio 3.15; 95% CI 2.21-4.50) and absence of fistula (adjusted hazard ratio 3.14; 95% CI 2.48-3.99). The rate of postoperative complications, the need for a stoma, and the length of bowel resection were not significantly different whether the surgery was planned or not. Conclusion-A significant proportion of patients with intestinal perforation complicating Crohn’ s disease, particularly those with a fistula, might benefit from non-surgical treatment.展开更多
AIM To present clinical characteristics, diagnosis and treatment strategies in elderly patients with biliary diseases. METHODS A total of 289 elderly patients with biliary diseases were enrolled in this study. The cli...AIM To present clinical characteristics, diagnosis and treatment strategies in elderly patients with biliary diseases. METHODS A total of 289 elderly patients with biliary diseases were enrolled in this study. The clinical data relating to these patients were collected in our hospital from June 2013 to May 2016. Patient age, disease type, coexisting diseases, laboratory examinations, surgical methods, postoperative complications and therapeutic outcomes were analyzed. RESULTS The average age of the 289 patients with biliary diseases was 73.9 +/- 8.5 years (range, 60-102 years). One hundred and thirty-one patients (45.3%) had one of 10 different biliary diseases, such as gallbladder stones, common bile duct stones, and cholangiocarcinoma. The remaining patients (54.7%) had two types of biliary diseases. One hundred and seventy-nine patients underwent 9 different surgical treatments, including pancreaticoduodenectomy, radical resection of hilar cholangiocarcinoma and laparoscopic cholecystectomy. Ten postoperative complications occurred with an incidence of 39.3% (68/173), and hypopotassemia showed the highest incidence (33.8%, 23/68). One hundred and sixteen patients underwent non-surgical treatments, including anti-infection, symptomatic and supportive treatments. The cure rate was 97.1% (168/173) in the surgical group and 87.1% (101/116) in the non-surgical group. The difference between these two groups was statistically significant (chi(2) = 17.227, P < 0.05). CONCLUSION Active treatment of coexisting diseases, management of indications and surgical opportunities, appropriate selection of surgical procedures, improvements in perioperative therapy, and timely management of postoperative complications are key factors in enhancing therapeutic efficacy in elderly patients with biliary diseases.展开更多
文摘New medical therapeutic options challenge the usual surgical management of Crohn’ s disease patients with intestinal perforation. Objectives-To determine factors predictive of surgery for perforation in Crohn’ s disease and define a group of patients that may benefit from non-surgical treatment. Methods-One hundred and sixty-two patients (69 males, 93 females, mean age 39) with perforated Crohn’ s disease (fistula, abscess, inflammatory mass) between January 1995 and September 2003 were studied retrospectively. Results-One hundred and fifty-one patients (93% ) underwent surgery: 70 had planned surgery and 81 had surgery for symptomatic deterioration. At two years, the cumulative probability of intestinal resection was 0.89 ≥ 0.03, and the cumulative probability of unplanned intestinal resection was 0.72 ≥ 0.05. Predictive factors of unplanned surgery were elevated platelet count (adjusted hazard ratio 3.15; 95% CI 2.21-4.50) and absence of fistula (adjusted hazard ratio 3.14; 95% CI 2.48-3.99). The rate of postoperative complications, the need for a stoma, and the length of bowel resection were not significantly different whether the surgery was planned or not. Conclusion-A significant proportion of patients with intestinal perforation complicating Crohn’ s disease, particularly those with a fistula, might benefit from non-surgical treatment.
基金Supported by the Science and Technology Project of State Grid Corporation of China,No.SGHB0000AJJS1400182
文摘AIM To present clinical characteristics, diagnosis and treatment strategies in elderly patients with biliary diseases. METHODS A total of 289 elderly patients with biliary diseases were enrolled in this study. The clinical data relating to these patients were collected in our hospital from June 2013 to May 2016. Patient age, disease type, coexisting diseases, laboratory examinations, surgical methods, postoperative complications and therapeutic outcomes were analyzed. RESULTS The average age of the 289 patients with biliary diseases was 73.9 +/- 8.5 years (range, 60-102 years). One hundred and thirty-one patients (45.3%) had one of 10 different biliary diseases, such as gallbladder stones, common bile duct stones, and cholangiocarcinoma. The remaining patients (54.7%) had two types of biliary diseases. One hundred and seventy-nine patients underwent 9 different surgical treatments, including pancreaticoduodenectomy, radical resection of hilar cholangiocarcinoma and laparoscopic cholecystectomy. Ten postoperative complications occurred with an incidence of 39.3% (68/173), and hypopotassemia showed the highest incidence (33.8%, 23/68). One hundred and sixteen patients underwent non-surgical treatments, including anti-infection, symptomatic and supportive treatments. The cure rate was 97.1% (168/173) in the surgical group and 87.1% (101/116) in the non-surgical group. The difference between these two groups was statistically significant (chi(2) = 17.227, P < 0.05). CONCLUSION Active treatment of coexisting diseases, management of indications and surgical opportunities, appropriate selection of surgical procedures, improvements in perioperative therapy, and timely management of postoperative complications are key factors in enhancing therapeutic efficacy in elderly patients with biliary diseases.
