Neuman Mark D, Allen Steven, Schwarze Margaret L, Uy Joshua
*Department of Anesthesiology and Critical Care, Perelman School of Medicine at the University of Pennsylvania, Philadelphia †Leonard Davis Institute of Health Economics, Philadelphia, PA ‡Department of Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia §Division of Vascular Surgery, Department of Surgery, University of Wisconsin-Madison ¶Department of Medical History and Bioethics, University of Wisconsin-Madison; and ‖Department of Medicine, Division of Geriatric Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia.
Ann Surg. 2015 Apr;261(4):639-41. doi: 10.1097/SLA.0000000000000939.
An 85-year-old male nursing home resident who is frail but enjoys his current quality of life is admitted with an acute high-grade small bowel obstruction potentially due to adhesions from prior abdominal surgery. The patient has significant tenderness on abdominal exam with involuntary guarding and signs of pneumatosis on the CT scan that are concerning for bowel ischemia. After discussing potential options for management, including surgical intervention and palliative care, the patient and his family express a desire to proceed with surgery because there is a small chance that he could return to his preoperative quality of life. The surgeon believes that his problem is potentially reversible but worries that the patient is at high risk for complications, which could lead to a prolonged ICU stay and subsequent death. How should the possibility of surgical complications be introduced? What plans, if any, should be made at this point for how to deal with complications if one or more occur?
一名85岁的男性养老院居民，身体虚弱但享受着目前的生活质量，因急性高位小肠梗阻入院，可能是由于既往腹部手术的粘连所致。患者腹部检查有明显压痛，伴有不自主肌卫，CT扫描显示有肠壁积气迹象，提示肠缺血。在讨论了包括手术干预和姑息治疗在内的潜在治疗方案后，患者及其家属表示希望进行手术，因为他有小机会恢复到术前的生活质量。外科医生认为他的问题可能是可逆的，但担心患者发生并发症的风险很高，这可能导致在重症监护病房长时间住院并随后死亡。应如何告知手术并发症的可能性？如果发生一种或多种并发症，此时应制定哪些应对计划（如有）？
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