Оптимизиране на резултатите при хирургичното лечение на гериатрични пациенти с колоректален карцином
DOI :
https://doi.org/10.67572/dvy1sb73Ключови думи :
гериатрична хирургия, колоректална хирургияАбстракт
УВОД: В последните десетилетия нараства тенденцията към увеличаване на продължителността на живота. Същевременно нараства броят на пациентите с колоректален карцином, което определя и по–големия брой такива болни, които се нуждаят от хирургично лечение. Възрастта е съществен рисков фактор за развитието на КРК, но напредналата възраст сама по себе си е важен рисков фактор за следоперативния морбидитет и леталитет.
ЦЕЛ: Поставихме си за цел да анализираме оперираните пациенти с колоректален карцином на възраст над 75 г. в клиниката по хирургия на „МБАЛ Света Анна“ София, като сравним резултатите при планово и спешно интервенираните пациенти.
МАТЕРИАЛ И МЕТОД: Извършихме ретроспективно нерандомизирано проучване на оперираните пациенти в гериатрична възраст за 3-годишен период (2022-2024г.). Анализирахме демографските данни, нозологичните единици, ко-морбидитета, полифармацията, оперативните техники, болничния престой, следоперативните усложнения и леталитета.
РЕЗУЛТАТИ: Пациентите, оперирани по повод колоректален карцином за дадения период, са 132-ма, от които 68 мъже и 64 жени. Планова оперативна интервенция е извършена при 98 болни, докато по спешност са интервенирани 34 пациенти. Почти 50% от тях са в деветата декада. Относителният дял на ко- морбидитета е висок- над 90%. Болничният престой варира от 1 до 31 дни, като е значително по-висок при спешните оперативни интервенции. Леталитетът при планово оперираните е 10,2%, докато при оперираните по спешност достига 50%.
ОБСЪЖДАНЕ И ЗАКЛЮЧЕНИЕ: Ключови фактори в оптимизирането на оперативното лечение при гериатрични пациенти с КРК са акуратното и навременно откриване на лечима патология, цялостната гериатрична оценка и необходимата предоперативна подготовка с оптимизиране на физиологичния статус, ко-морбидитета и специфични гериатрични синдроми, подходящият избор на анестезиологични и хирургични техники, адекватните следоперативните грижи и рехабилитацията. Подобряването на изхода от лечението се постига чрез мултидисциплинарен подход. Елективната хирургия редуцира значително рисковете от усложнения, морбидитета и леталитета, които са характерни за интервенциите по спешност.
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