Carrying out surgeries for senior citizens means that the surgical challenges are further escalated. And in such surgeries, there are always a lot of moving and comforting images being emerged!
Recently, the 96-year-old Granny Zhou (a pseudonym) and her family came to the colorectal and anal surgery ward of Wenzhou Central Hospital with a letter of thanks and a banner to express their gratitudefor Zhou Hong, director of the team, his mouth kept saying "Thank you doctor ......".
After detailed inquiry, Granny Zhou was hospitalized in the gastroenterology department of the hospital for hemafeciaand haematemesisat home, and after the bleeding symptoms were effectively controlled, endoscopy was arranged for her to further clarify the diagnosis, which showed irregular elevation of the rectal mucosa around the periphery of the rectum, ulceration on the surface and narrowing of the lumen, and combined with the pathology of the enteroscopy, the diagnosis of rectal cancer with incomplete intestinal obstruction was considered. The diagnosis was "rectal cancer with incomplete intestinal obstruction". The best treatment is surgery. However, Granny Zhou was already 96 years old, which was relatively contraindicated for surgical operations, and she had to face three major difficulties in her surgery:
1. Physiological degenerative changes in the function of various tissues and organs, their reserve function, compensatory capacity and stress capacity are significantly reduced, and the tolerance of surgery and anesthesia is poor.
2. Slow recovery after surgery, prone to infection and other complications.
3. Elderly patients have many basic diseases, such as hypertension, diabetes, etc. All of the above factors greatly increase the risk of surgery and anesthesia.
Granny Zhou's family faced a difficult time. After being introduced by a gastroenterologist, the family sought help from the team of Zhou Hong, Director of Colorectal and Anal Surgery.
Through a surgery for an elderly patient
Understand the multidisciplinary collaborative model
After a detailed preoperative evaluation by Dr. Yang Daqing, Deputy Chief Physician of Colorectal and Anal Surgery, it was found that Granny Zhou had degeneration and calcification of cardiac valves, mild pulmonary arterial hypertension with moderate tricuspid regurgitation, complete right bundle branch block, lumbar vertebrae compressive fracture, and severe mixed ventilatory diffusion dysfunction, which undoubtedly added many obstacles to the surgery. Yang Daqing immediately organized a multidisciplinary consultation in which physicians from the Department of Anesthesiology and Surgery, the Department of Intensive Care Medicine (ICU), the Department of Respiratory and Critical Care Medicine, the Department of Cardiovascular Medicine, and the Department of Spine Surgery conducted a preoperative evaluation on her.
After an intense and detailed discussion, they all agreed that Granny Zhou's cardiorespiratory function was poor, and it was difficult for her to tolerate prolonged general anesthesia, and that CO2 pneumoperitoneum for laparoscopic surgery would have adverse effects on the patient's cardiorespiratory function, hemodynamics, renal function and other aspects. Therefore, precise anesthesia, short rapid radical rectal cancer surgery and postoperative ICU support were the keys to this surgery.
Considering the fact that Granny Zhou suffered from anemerging lumbar compression fracture, in order to avoid the inability to get out of bed due to postoperative lumbar pain,spine attending surgeon Wu Zhuzhi arranged percutaneous puncture L4 vertebroplasty for her prior to radical rectal cancer surgery. Subsequently, after sufficient preoperative evaluation, nutritional support, and anesthesia preparation, Yang Daqing, Xia Jianfu, Li Wencai, Nurse Yang Mengshi of the Department of Anesthesiology and Surgery, and anesthesiologist Xu Shihao successfully performed radical rectal cancer surgery for Granny Zhou. The surgery took 2 hours in total, and the team of anesthesiologist Xu Shihao took good care of her throughout the operation. Her blood pressure was stable during the operation, and after the operation, the tracheal tube was successfully extubated from her and she was transferred to the ICU for supervision. After careful care by the team of Yang Daqing, deputy chief physician of Colorectal and Anal Surgery, Wu Jianhua, deputy chief physician of ICU, and the nurses of the 11th ward, Granny Zhou recovered well and was discharged from the hospital, which solved the dilemma of the elderly and her family at one fell swoop.
This is also by far the oldest patient on whom gastrointestinal tumor surgery has been performed under general anesthesiain Wenzhou Central Hospital. Yang Daqing said: "Although the risk of surgery for the elderly is relatively high, but it does not mean that it isn’t practicable to do so. With the progress of medicine, anesthesia becoming more and more safe and comfortable, and surgical methods are improving in the direction of being minimally invasive, etc. , as long as the risk is controlled, the appropriate surgical access and scope of surgery is selected, the physical condition is fully assessed before the operation, and a multidisciplinary teamwork model is used, age is no longer a contraindication to surgery."
Introduction to Specialists
Zhou Hong
Director of Colorectal and Anal Surgery Department, Wenzhou Central Hospital
Chief physician
Member of Colorectal Cancer Committee of Zhejiang Anti-Cancer Association
Member of Surgical Physicians Branch of Zhejiang Provincial Physicians Association
Member of Colorectal Disease Specialized Committee of Zhejiang Mathematical Medicine
Vice Chairman of Wenzhou Medical Association Anorectal Surgery Committee
Vice Director of Colorectal Disease Rehabilitation Committee of Wenzhou Rehabilitation Medicine Association
Vice Chairman of Colorectal Cancer Specialized Committee of Wenzhou Anti-Cancer Association
Member of Minimally Invasive Surgery Committee of Wenzhou Medical Association
Vice Chairman of Minimally Invasive Surgery Colorectal Group of Wenzhou Medical Association
Specialty: Specialize in colorectal tumor diagnosis and treatment, especially laparoscopic colorectal surgery
Outpatient Time: Wednesday morning (general clinic), Friday morning (special need clinic)
Yang Daqing
Associate Chief Physician
Master of Surgery
Member of Wenzhou Minimally Invasive Surgery Colorectal Group
Member of Anorectal and Intestinal Committee, Wenzhou Society of the Integration of Traditional and Western Medicine
Member of Anorectal Committee of Wenzhou Society of Traditional Chinese Medicine
Specialty: specialize in colorectal tumor surgery and comprehensive treatment, specialize in gastrointestinal tumor laparoscopic surgery and endoscopic minimally invasive surgery for colorectal tumors.
Outpatient Time: Thursday morning (general clinic), Sunday morning (special need clinic)
Introduction to the Department
Colorectal and Anal Surgery Department of Wenzhou Central Hospital is a key discipline hospital integrating clinic, scientific research and teaching, and is a regional colorectal disease diagnosis and treatment center and stomatologist training center, which undertakes the diagnosis and treatment of colorectal malignant tumors, all kinds of benign colorectal and perianal diseases and general surgical acute abdominal diseases in southern Zhejiang Province and northern Fujian Province. So far, the department has completed more than 2,000 cases of colorectal tumor surgeries, ranking the top in the whole city in terms of the number of surgeries and technical level.
Service characteristics: The department routinely carries out all kinds of traditional open and laparoscopic radical surgeries for colorectal cancers, and can skillfully carry out various ultra-low anus-preserving surgeries, such as intersphincteric resection (Lap ISR), rectal cancer resection with trans-anal anastomosis (Park operation), and trans-caecal rectal cancer resection (Kraske operation), and so on. Meanwhile, we have carried out unassisted trans-analnatureorificespecimenextraction(NOSES) and transanal endoscopie miorosurgery (TEM) for colorectal cancers, which can minimize the surgical trauma to patients as much as possible. For patients with terminal colorectal cancers, combined organ resectionsare also performed. In addition, the department has rich experience in the diagnosis and treatment of common diseases and acute abdomen in general surgery system, especially in the diagnosis and treatment of complex and huge tumors in pelvis, posterior peritoneal tumors, presacral tumors, rectovaginal fistula, appendicitis, digestive perforation and other diseases.
The department specializes in the treatment of benign perianal diseases by combining Chinese and Western medicine, and has unique experience in the treatment of internal hemorrhoids, external hemorrhoids, mixed hemorrhoids, anal fistula, perianal abscess, anal fissure, anal sinusitis, perianal necrotizing fasciitis, rectal prolapse, anterior proptosis of the rectum, inflammatory bowel disease, and constipation. The department carries out hemorrhoidal mucosal circumcision (PPH) and ultrasound Doppler-guided hemorrhoidal artery ligation with suspension surgery, which has the advantages of fewer postoperative complications, less pain and faster recovery.
The department specializes in comprehensive treatment of colorectal cancer, such as chemotherapy and targeted therapy, and actively carries out multidisciplinary discussion (MDT) of colorectal cancer to provide the most favorable therapeutic schedules for colorectal cancer patients. For chemotherapy patients, the department conducts IVAP surgery and daily maintenance to provide a safe, long-lasting, comfortable and convenient intravenous access for long-term chemotherapy of patients.
Talent construction: At present, there are 4 chief physicians, 4 deputy chief physicians, and 2 professional stomatologists in the talent team. There are 2 master's supervisors, 1 doctor, 2 doctoral students and 7 masters. In terms of scientific research, it has undertaken a number of provincial, ministerial, departmental and bureau-level scientific research projects, won the Zhejiang Provincial Medicine and Health Science and Technology Award, and published dozens of papers, including more than 20 SCI papers.
Writer: 11th Inpatient Ward, Hu Miaomiao Ye Rongjian
Reviewer: Li Dongmei
Editor: Liu Yue Chen Xiang
Executive Editor: Hu Xiangyue Qiu Yinghui Chen Huanxiao
(Note: The original writer owns the copyright of all the images and texts. In case of any infringements, please contact us in time.)
