Evaluation of sexual dysfunction in the female following rectal resection and intestinal stoma

Problems of sexual dysfunction were surveyed by questionnaire mailed to women who had undergone rectal resection and ostomy surgery over a ten-year period. Completed questionnaires were returned by 30 respondents, 19 to 54 years of age, who indicated both physical and psychological problems. Many of the problems were solved by the patients themselves, but the way can be made easier with the help of an understanding surgeon and knowledgeable stoma therapist who can create a climate in which the patient may feel, at ease asking for guidance concerning sexual matters. Read at the meeting of the American Society of Colon and Rectal Surgeons, Hollywood, Florida, May 11 to May 16, 1980.     

Reliability and validity of the Functional Assessment of Cancer Therapy-Colorectal (FACT-C) quality of life instrument

Background: This paper describes the development of the Functional Assessment of Cancer Therapy-Colorectal (FACT-C) – a questionnaire assessing quality of life concerns pertinent to colorectal cancer patients. This self-report instrument combines specific concerns related to colorectal cancer with concerns that are common to all cancer patients as assessed with the FACT-General (FACT-G). Method: Three separate and distinct validation samples were used with different ethnic and stage of disease compositions. Results: Results suggest that the FACT-C is a reliable and valid measure in both its English and Spanish language versions. Specifically, the FACT-C evidenced good internal consistency reliability and concurrent validity, as well as an ability to distinguish between groups based on functional status and extent of disease. The FACT-C was also found to be sensitive to changes in functional status. Colorectal cancer-specific items form the Colorectal Cancer Subscale (CCS) which was found to have adequate convergent and divergent validity. Internal consistency was adequate in most samples. In addition, the CCS was able to distinguish among groups that differed in functional status and was sensitive to change in functional status. Conclusion: It is recommended that the entire FACT-C (rather than simply the CCS) be used when studying patients with colorectal cancer in order to provide a comprehensive assessment of quality of life. Recommendations are offered concerning the appropriate use of these measures in clinical research and directions for future research with colorectal cancer patients.     

深静脉置管在特重型颅脑损伤后的应用

目的：通过外周静脉穿刺与深静脉置管在特重型颅脑损伤中的应用比较，探讨如何减少患者静脉炎、疼痛及渗漏，从而提高患者日常生活自理能力及生活质量。方：72例特重型颅脑损伤患者分为两组，30例外周静脉穿刺为A组，42例深静脉置管为B组，记录静脉炎、疼痛、渗漏及主要并发症发生情况。结果：A组静脉炎率40％，B组静脉炎率2.4％；A组疼痛率46％，B组疼痛率7％；A组渗漏发生率53％，B组渗漏发生率2.4％；A组肿胀发生率23％，B组肿胀发生率4.8％。结论：在特重型颅脑损伤中，选用深静脉置管效果明显优于外周静脉穿刺，值得临床推广。     

结肠造口还纳术51例临床分析

目的 探讨造口还纳术的手术时机及技巧。方法 对１９８３－１９９９年４月５１例结肠造口还纳术病例进行了回顾性分析。结果 单纯袢式造口还纳术２８例，结肠或直肠吻合术２３例，手术时间１－５．５小时，平均２．１小时，并发症发生率为１１．９％，结论造口还纳术手术时机应个体化，术前准备充分，合理选择术式是降低病死率的关键。     

Enterostomy closure site hernias: a clinical and ultrasonographic evaluation

BACKGROUND: Parastomal hernia with a reported incidence of up to 50% is a major problem after ostomy formation. Hernias at the closure site may be a problem after the closure of the enterostomy. In this study, in addition to physical examination, we used ultrasonography (USG) in order to find the true incidence of ostomy closure site and laparotomy incisional hernias. METHODS: We examined patients with closed enterostomy sites by both physical examination and USG for the detection of hernias. Risk factors for hernia formation, such as age, gender, body mass index (BMI), ostomy type, and surgical site infections, were determined. RESULTS: The evaluation of 31 patients with ostomies resulted in a 32% incidence of closed ostomy site hernias when patient medical history, physical examination, and ultrasonographic examination were used together. With physical examination and USG, incisional hernias at the laparotomy incision were found in 58% of cases. USG was able to detect hernias which were not clinically evident at the ostomy closure site and the laparotomy wound. BMI, age, gender, ostomy type, and surgical site infection did not have a significant effect on hernia formation. CONCLUSION: Ostomy closure site and laparotomy incisional hernias are important clinical problems with a high incidence after ostomies are closed. Closure of the enterostomy site should be regarded as a hernia repair rather than a simple fascial closure. USG is a valuable clinical tool in combination with physical examination for the detection of minor defects.     

Morbidity of Ostomy Takedown

Purpose Creation of a temporary ostomy is a surgical tool to divert stool from a more distal area of concern (anastomosis, inflammation, etc). To provide a true benefit, the morbidity/mortality from the ostomy takedown itself should be minimal. The aim of our study was therefore to evaluate our own experience and determine the complications and mortality of stoma closure in relation to the type and location of the respective ostomy. Methods Patients undergoing an elective takedown of a temporary ostomy at our teaching institution between January 1999 and July 2005 were included in our analysis, and the medical records were retrospectively reviewed. Excluded were only patients with relevant chart deficiencies and nonelective stoma revisions/takedowns. Data collected included general demographics; the type and location of the stoma; the operative technique; and the type, timing, and impact of complications. Perioperative morbidity was defined as complications occurring within 30 days from the operation. Results 156 patients (median age 45 years, range 18–85) were included in the analysis: 31 loop and 59 end colostomy reversals and 56 loop and 10 end ileostomy takedowns. Mean follow-up was 6 months. The overall mortality rate was low (0.65%, 1/156 patients). However, the morbidity rate was 36.5% (57 patients), with 6 (3.8%) systemic complications and 51 (32.7%) local complications. Minor would infection (34 patients, 21.8%) and postoperative ileus (9 patients, 5.7%) were the most common surgery-related complications, but they generally resolved with conservative management. Anastomotic leak and formation/persistence of an enterocutaneous fistula (6 patients, 3.8%) were the most serious local complications and required reintervention in all of the patients. Closure of a loop colostomy accounted for half and Hartmann reversals for one third of these complications, as opposed to ileostomy takedowns, which accounted for only one sixth (1.8% absolute risk). Conclusion Takedown of a temporary ostomy has a low mortality but a nonnegligible morbidity. The stoma location (large vs. small bowel) has a higher impact than the type of stoma construction (end vs. loop) on the incidence and severity of complications.     

造口患者电话咨询256例次数据分析

目的通过电话咨询及时解决造口患者出院后的问题;了解出院后的需求,逐步完善现有的专科健康教育内容;探讨开展造口患者电话咨询的意义。方法记录有统计学意义的电话咨询资料256例次,将数据进行分类整理和分析。结果61-80岁造口患者电话咨询所占比例较高(64.5%);造口术后1年内的患者电话咨询比例较高(85.0%)。咨询内容中造口用品信息、造口周围皮肤问题和排泄物渗漏分别为32.8%、30.1%、24.6%。通过电话能直接解决问题的有201例次,占78.5%。结论开展造口患者出院后电话咨询有助于了解造口患者的各项需求,及时解决大部分患者的问题,改善他们的生活质量,对完善健康教育内容和开展延伸服务有指导意义。     

护理干预对膀胱肿瘤手术行泌尿造口患者生活质量的影响

目的探讨护理干预对膀胱肿瘤手术行泌尿造口患者生活质量的影响。方法采用癌症患者生活质量核心量表（EORTC QLQ-C30）对29例膀胱肿瘤手术行泌尿造口患者生活质量进行调查,针对原因进行护理干预。结果进行护理干预后,患者的生活质量评分显著提高。结论护理干预可以明显提高膀胱肿瘤手术后泌尿造口患者生活质量。     

同伴教育在结直肠癌造口患者中的实施现状综述

<正>结直肠癌是最常见的癌症之一[1]。中国结直肠癌发病率迅速上升,1998年至2007年,全国肿瘤登记地区结直肠癌发病率为每10万人口24.91,标化发病率为每10万人口17.67[2]。50%~60%的结直肠癌患者需要进行永久性肠造口术[3]。肠造口术对于结直肠癌患者而言虽然效果明确,但严重影响了患者的生活方式、社会交往和性生活,降低了患者的生活质量和自我效能感。同伴教育作为一种新兴的教育     

经皮肾穿刺造瘘术在梗阻性肾功能衰竭诊治中的应用研究

目的探讨B超引导下经皮肾穿刺造瘘术在梗阻性肾功能衰竭诊治中的应用价值。方法对19例梗阻性肾功能衰竭患者在B超引导下行经皮肾穿刺造瘘术,经造瘘管注入造影剂了解梗阻原因,同时引流肾积水,病情稳定后手术解除梗阻。结果17例患者经造影明确梗阻原因及部位,2例患者造影后未能明确梗阻原因,但明确了梗阻部位,经引流后19例Bun、UN,Cr均有下降,15例手术解除梗阻后恢复好。结论经皮肾穿刺造瘘在梗阻性肾袁病人诊治中,既可经造瘘管造影提高诊断符合率,又可使尿流改路,暂时解除梗阻,为手术解除梗阻病因争取了时机,且操作简单,经济实惠,值得推广。