乙状结肠膀胱扩大术治疗神经源性急迫性尿失禁的临床研究

目的探讨乙状结肠膀胱扩大术治疗顽固性神经源性急迫性尿失禁伴便秘的疗效。方法 16例患者经尿动力学检查为急迫性尿失禁,且术前均未发现肾积水和膀胱输尿管返流,行乙状结肠膀胱扩大术。结果术后随访3～24个月,均未见肾积水、膀胱输尿管返流和生化异常,便秘症状明显好转。所有患者能利用腹压辅助自行排尿及基本控尿,残余尿量10～40ml。结论乙状结肠膀胱扩大术治疗神经源性急迫性尿失禁能增加膀胱容量,降低膀胱压力,实现自主排尿;还能缓解便秘。     

学龄期儿童乙状结肠膀胱扩大手术的护理

目的探讨乙状结肠膀胱扩大术治疗儿童神经源性膀胱的护理方法。方法对9例神经源性膀胱患儿进行乙状结肠扩大术治疗并进行术前、术后和并发症的护理,评价治疗和护理效果。结果9例患儿术后全部治愈出院,均无后遗症。结论乙状结肠膀胱扩大术是一种治疗儿童神经源性膀胱的有效方法,充分的术前准备、严谨的术后护理和细致的健康教育是保证手术成功的重要环节,并直接影响本病的预后。     

脊髓病后神经源性膀胱患者肠道膀胱扩大术的护理

目的总结脊髓病后神经源性膀胱患者行乙状结肠膀胱扩大术围手术期护理。方法回顾性分析脊髓病后神经源性膀胱行乙状结肠膀胱扩大术31例患者的围手术期护理及术后随访资料。结果术后出现肠梗阻2例,短暂精神障碍1例,膀胱内真菌感染1例,均治愈。2例失访,余29例随访6个月～4年,恢复良好,能长期坚持间歇导尿。结论术前正确健康指导、肠道及膀胱准备,术后严密病情观察、胃肠减压及引流管道的护理,出院前间歇导尿的训练,出院后定期随访,是护理的关键内容,也是保证手术疗效的重要环节。     

乙状结肠膀胱扩大术治疗神经源性膀胱病人的围术期护理

神经源性膀胱常导致尿失禁、尿潴留、膀胱输尿管反流、肾积水、尿路感染,最终因肾衰竭而威胁病人生命。对于此种情况,保守治疗难以奏效。膀胱扩大术可达到增加膀胱容量、降低膀胱储尿期压力的目的。乙状结肠膀胱扩大术是治疗神经源性膀胱的有效方法之一,可大大提高病人生活质量。2007年12月-2008年5月,我们对4例行乙状结肠膀胱扩大术的神经源性膀胱病人进行护理,获得良好效果。现将护理体会报告如下。     

14例儿童神经源性膀胱行乙状结肠膀胱扩大术的围术期护理

目的：探讨乙状结肠膀胱扩大术治疗儿童神经源性膀胱的观察和围术期护理方法。方法回顾性分析2006年12月—2013年10月共14例乙状结肠膀胱扩大术治疗神经源性膀胱患儿的效果和护理对策。结果14例患儿术后给予抗炎、保护胃黏膜、补液等治疗，1例患儿因过早饮食引起肠梗阻，2例女患儿术后发生肾盂肾炎。14例患儿全部治愈出院，平均住院天数为16 d。结论乙状结肠膀胱扩大术是一种治疗儿童神经源性膀胱的有效的方法，充分的术前准备，严谨的术后护理和详尽的健康教育，是保证手术成功的重要环节。     

68例膀胱全切乙状结肠原位膀胱替代术患者的护理

总结了68例膀胱全切乙状结肠原位膀胱替代术患者的护理经验，主要包括术前心理护理、术前准备及手术后一般护理、引流管、饮食及并发症的护理。认为加强膀胱全切乙状结肠原位膀胱替代术患者的术前术后护理是患者顺利恢复的重要保证。     

乙状结肠膀胱扩大术治疗神经原性膀胱的围手术期护理

神经原性膀胱乙状结肠膀胱扩大术患者的围手术期护理主要包括:术前的心理护理、肠道准备、膀胱的准备;术后的包括胃肠减压及各管道的护理以及并发症的观察及护理;出院前训练患者熟练掌握间歇导尿的方法及导尿的注意事项;出院后定期随访并给予健康指导。     

乙状结肠膀胱扩大术治疗神经源性膀胱病人的围术期护理

神经源性膀胱常导致尿失禁、尿潴留、膀胱输尿管反流、肾积水、尿路感染,最终因肾衰竭而威胁病人生命.对于此种情况,保守治疗难以奏效.膀胱扩大术可达到增加膀胱容量、降低膀胱储尿期压力的目的[1].乙状结肠膀胱扩大术是治疗神经源性膀胱的有效方法之一,可大大提高病人生活质量.2007年12月-2008年5月,我们对4例行乙状结肠膀胱扩大术的神经源性膀胱病人进行护理,获得良好效果.现将护理体会报告如下.     

肠管代膀胱术后并发膀胱结石2例报告

有关肠管代替膀胱术后并发膀胱结石的专述不多。我院于1971年和1978年先后收治两例行乙状结肠代替及扩大膀胱术后并发膀胱巨大结石的患者。特提出报告并结合有关文献进行讨论。病例报告例1:患者男性,42岁,住院号71—5791。因行乙状结肠代膀胱术后7年,发现血尿伴肛门部坠胀感已有1月余,而于1971年9月12日入院。患者于1964年7月因患复发性多     

膀胱全切乙状结肠原位膀胱术临床护理体会

膀胱癌是泌尿系统中常见的恶性肿瘤,发病率高达成人恶性肿瘤的8％左右[1],膀胱全切加乙状结肠原位膀胱替代术是目前根治膀胱癌的首选治疗方式[2],选择乙状结肠作为新膀胱可避免以往由于大便改道或尿流改道需要长期带尿袋的痛苦,能够最大限度保留患者的生理排尿功能[3],大大提高患者的生活和生存质量,降低患者尿路感染的发生率[4].现总结15例行膀胱全切乙状结肠原位膀胱术患者临床护理措施如下.     

腹腔镜下膀胱全切除—全去带乙状结肠原位新膀胱围手术期的护理

目的总结腹腔镜下膀胱全切除—全去带乙状结肠原位新膀胱围手术期的护理要点。方法对6例膀胱癌病人实施腹腔镜下膀胱全切除—全去带乙状结肠原位新膀胱手术,并给予针对性的护理。结果术后病人均能经尿道自主控尿和排尿,无发生护理并发症。结论膀胱癌病人实施腹腔镜下膀胱全切除—全去带乙状结肠原位新膀胱手术效果好。强调术前应耐心、细致做好病人心理护理和健康教育工作,增强病人对手术治疗成功的信心;术前做好肠道准备减少病人术后发生感染;术后做好管道护理减少吻合口狭窄、泌尿系感染等并发症的发生,其是保证手术成功的重要措施。     

Roux-y乙状结肠新膀胱替代后肠黏膜组织学变化及对代谢的影响

背景:许多报道指出,尿流改道后会出现代谢紊乱和病理生理的变化,但是这些用肠道重建膀胱替代手术引起的代谢紊乱主要与肠管类型及长度相关.目的:观察Roux-y乙状结肠新膀胱替代后贮尿囊黏膜的变化及对代谢的影响.设计、时间及地点:回顾性病例分析,于2000-06/2008-11在解放军第一八四医院泌尿外科完成.对象:33例膀胱癌患者,男21例,女12例,平均年龄64岁.对照组为25例经胃肠镜活检无乙状结肠疾病史者.方法:采用根治性膀胱全切、利用肛门括约肌控尿的Roux-y乙状结肠新膀胱术进行手术治疗膀胱癌患者,分析新膀胱引流管拔管前后血电解质、肌酐和尿素的变化,并对其中13例患者的贮尿囊黏膜于术前、术后36个月取材作病理学检查.对照组为25例无乙状结肠疾病史者乙状结肠黏膜.检测项目包括肠黏膜厚度及腺体数目.主要观察指标:手术前、拔管前后电解质、肾功能和酸碱平衡、黏膜层厚度、腺体数目.结果:30例患者术后血电解质、肌酐和尿素均保持在正常范围,拔管前后电解质、肌酐和尿素的变化差异无显著性意义,3例患者表现有轻度的酸中毒.对照组手术前后结肠黏膜镜下改变不明显,基本保持了正常的组织结构.手术组术后黏膜层厚度变薄[(577.6±169.4),(412.5±114.7)μm,P＜0.05],肠腺排列疏松,间质稀少,单位腺体数目减少[(26.4±3.5),(15.2±2.7)个/HP,P＜0.05].术后新膀胱内的肠绒毛逐渐萎缩,肠上皮细胞未见增生及恶性改变.结论:Roux-y乙状结肠新膀胱替代后肠黏膜层厚度变薄,肠腺排列疏松,间质稀少,单位腺体数目减少,人体代谢无明显变化.     

Inguinoscrotal hernia containing the urinary bladder successfully repaired using laparoscopic transabdominal preperitoneal repair technique: A case report

We report herein a patient with an inguinoscrotal hernia containing the urinary bladder. The hernia was safely repaired using the laparoscopic transabdominal preperitoneal repair technique. A 76‐year‐old man was admitted to our hospital with abdominal pain, vomiting, and diarrhea. His scrotum was swollen to fist size. Abdominal CT showed herniation of the sigmoid colon and the bladder into the right inguinal region, and his abdominal pain was attributed to incarceration of the sigmoid colon; this was manually reduced. About 1 month later, we performed transabdominal preperitoneal repair. After the direct hernial orifice was identified, the bladder was noted to be sliding from the medial side of the hernia; this was reduced. Peeling on the medial side was carried out to the middle of the abdominal wall, and the myopectineal orifice was covered with mesh. The patient was discharged on postoperative day 1.     

Laparoscopic reduced port surgery for schwannoma of the sigmoid colon: A case report

A 74‐year‐old woman who developed schwannoma of the sigmoid colon was referred to our hospital for colonography to determine the cause of her stool occult blood. Colonoscopy revealed a submucosal tumor, which measured 3 cm in diameter, in the sigmoid colon. Endoscopic ultrasonography revealed a low echoic, homogeneous and demarcated submucosal tumor that continued into the fourth layer of the colonic wall. Gastrointestinal stromal, myogenic or neurogenic tumor was suspected, and thus, laparoscopic sigmoidectomy was carried out. We used two ports during the operation, a SILS Port in the umbilical region and a 12‐mm port in the right lower abdominal wall, and performed sigmoidectomy with D2 lymph node dissection. Histological findings revealed spindle‐like tumor cells with multiform nuclei. The tumor was diagnosed by immunostaining as benign schwannoma of the sigmoid colon. The conventional surgical treatment for schwannoma of the digestive tract is partial resection, but if preoperative diagnosis is unknown, radical resection with lymphadenectomy is acceptable for submucosal tumors in the digestive tract. In this case, laparoscopic reduced port surgery using only one or two ports may be more feasible and beneficial with regard to cosmesis and reduced postoperative pain than conventional laparoscopic colectomy.     

腹腔镜下膀胱切除-乙状结肠代膀胱术的护理

目的:探讨腹腔镜根治性膀胱切除-乙状结肠原位新膀胱术治疗浸润性膀胱癌的护理方法。方法:对18例浸润性膀胱癌患者在术前做好心理护理、术前宣教和肠道准备,术后严密观察病情、做好各引流管的护理和并发症的观察与处理,以及指导患者定时排尿和进行盆底肌的训练。结果:18例患者手术成功,患者恢复良好,术后5~7 d恢复饮食,2周后拔除盆腔引流管,3~4周拔除膀胱造瘘管,5~6周拔除导尿管及双侧输尿管支架管。患者拔除尿管后,经过对新建膀胱进行排尿功能训练,2周后可自控排尿,仅1例患者夜间偶有尿失禁。结论:腹腔镜根治性膀胱切除-乙状结肠原位新膀胱术治疗浸润性膀胱癌,配合围术期精心护理,可提高手术成功率,减少术后并发症,减轻患者痛苦,促进患者康复。     

Sigmoid volvulus after laparoscopic surgery for sigmoid colon cancer

We report the first case of sigmoid volvulus after laparoscopic surgery for sigmoid colon cancer. The patient is a 75‐year‐old man who presented with the sudden onset of severe abdominal pain. He had undergone laparoscopic sigmoidectomy for cancer 2 years before presentation. CT scan showed a distended sigmoid colon with a mesenteric twist, or “whirl sign.” Colonoscopy showed a mucosal spiral and luminal stenosis with dilated sigmoid colon distally and ischemic mucosa. The diagnosis of ischemic colonic necrosis due to sigmoid volvulus was established. Resection of the necrotic sigmoid colon was performed and a descending colon stoma was created. A long remnant sigmoid colon and chronic constipation may contribute to the development of sigmoid volvulus after laparoscopic sigmoidectomy. Prompt diagnosis is essential for adequate treatment, and colonoscopy aids in the diagnosis of ischemic changes in patients without definitive findings of a gangrenous colon.     

Rehabilitation care of patients with neurogenic bladder after spinal cord injury: A literature review

This article reviews the research progress of rehabilitation treatment and nursing care of patients with neurogenic bladder after spinal cord injury, in order to provide reference for the rehabilitation treatment and nursing care of patients. We reviewed recent medical literature on patients with neurogenic bladder, focusing on neurogenic bladder caused by spinal cord injury. We analyzed 30 recent of publications in patients with neurogenic bladder after spinal cord injury, in addition to reviewing and evaluating the commonly used rehabilitation nursing methods for neurogenic bladder. Psychological counseling is a vital aspect which cannot be neglected in the process of neurogenic bladder rehabilitation. Hitherto, the commonly used drug and surgical treatments may have negatively impacted the mental health of patients in varying degrees. However, in clinical practice, applying intermittent catheterization in patients who have neurogenic bladder with spinal cord injury may help improve patients’ life quality, mitigate psychological burden, and reduce negative emotions.