Stupin V A, Bel'kov A V, Smirnova G O, Narezkin D V, Siluianov S V, Kan V I
Russian State Medical University, Faculty of Gastric Surgery No. 1, Moscow.
Eksp Klin Gastroenterol. 2002(4):72-8, 133.
In 78% of cases the ulcerative disease in elderly age proceeds with complications and presents a serious surgical problem. The specificity of elderly patients is the combination of several pathologies, on background of which the ulcerative disease proceeds. The level of an expressiveness of accompanying pathology influences on the prognosis of disease course and on the choice of medical tactics. Therefore for objectivization of state heaviness of the patient group mark systems of an estimation MODS and APACHE III are used. The interventions in gastroduodenal bleedings for the patients of elderly age should be differentiated and depended on a risk degree of bleeding relapse and adequate estimation of MODS heaviness. In 55.4% of the elderly patients the ulcerative perforation occur without antecedent history. Therefore indications to sewing of ulcers, including little-invasive interventions, should be extended in this group of the patients. The size of radical surgical interventions in absence of manifestation of the polyorganic insufficiency for the elderly patients should be the same, as for the younger patients.
在78%的病例中，老年溃疡性疾病会伴有并发症，是一个严重的外科问题。老年患者的特殊性在于多种病理状况并存，溃疡性疾病在此背景下发生。伴随病理状况的严重程度会影响病程预后和医疗策略的选择。因此，为客观评估患者群体的病情严重程度，采用了多器官功能障碍综合征（MODS）和急性生理与慢性健康状况评分系统Ⅲ（APACHE III）。针对老年患者的胃十二指肠出血干预措施应有所区别，取决于出血复发的风险程度以及对MODS严重程度的充分评估。在55.4%的老年患者中，溃疡性穿孔无前驱病史。因此，对于这组患者，包括微创干预在内的溃疡缝合指征应放宽。在无多器官功能不全表现的情况下，老年患者的根治性手术干预规模应与年轻患者相同。
