直肠癌局部切除术后保留灌肠化疗的护理干预

目的 延长化疗药在直肠内保留的时间,提高化疗效果.方法 对288例次(对照组)直肠癌局部切除术后患者用氟尿嘧啶生理盐水作保留灌肠后排便快的原因进行回顾性分析,并针对其不同原因改进护理措施,对108例次(观察组)进行针对性护理干预.结果 观察组灌肠后药物保留时间显著长于对照组(P＜0.010.结论 直肠癌局部切除术后局部化疗排便快的原因是多方面的,针对性护理干预有助于延长氟尿嘧啶在直肠内的保留时间.     

晚期直肠癌局部热化疗护理体会

采用局部热化疗治疗难以切除的晚期直肠癌或直肠癌切除后阴道局部转移是近年来开展的一种新技术。我院从1987年4月～1990年3月,用该法治疗了7例晚期直肠癌病人,取得了一定效果,现将其操作及护理体会总结如下:     

灌肠后抬高臀部对药物保留时间的探讨

保留灌肠是慢性结肠炎常用的治疗方法之一。按常规灌肠后立即放平臀部 ,病人常有便意 ,并很快将灌入的药液排出 ,达不到应有的效果。因此 ,我们2 0 0 1年 6月至 2 0 0 2年 6月 ,对 4 6例慢性结肠炎病人采取在保留灌肠后继续抬高臀部 ,探讨药物在肠内保留的时间 ,报道如下。1　临床资料1 1　一般资料4 6例中 ,男 2 5例、女 2 1例 ,年龄 2 6～ 6 0岁 ,平均 4 1 0岁 ,随机分为Ａ、Ｂ两组各 2 3例 ,两组性别、年龄、病情、病程比较 ,差异无显著性意义 (均Ｐ >0 0 5 )。1 2　方法取 2 0 0ｍｌ中药煎剂 (39～ 4 1℃ ) ,2 2号肛管及常规灌肠用物。…     

保留灌肠肛管插入深度对药物保留时间的影响

保留灌肠是一项临床常见的护理技术操作，但其肛管插入深度在教科书及各种报道和临床操作中各有差异。为了探讨肛管插入深度对药物保留时间的影响，１９９８年１～６月我们对３０例病人分别采取不同插管深度进行保留灌肠，观察其药物保留的时间，报告如下。１资料与方法１...     

直肠癌术前术后化疗方法探讨

目的 探讨治疗直肠癌简单,安全有效的辅助化疗方法。方法 113例直肠癌患者随机分为试验组（T组）：术前5－Fu250-500mg,保留灌肠,每晚1次,共10d。术后1周,给予5Fu500mg/M^2,CF（甲酰四氢叶酸钙）30mg或300mg/M^2,静注,每日1次,共5d,以后每月1次,共5－6次;对照组（C组）;术前单用5-Fu 500mg/M^2,静注,每日1次,共5d,术后1周再用5-Fu500mg/M^2,静注,每日1次,共5d,以后每月1次,共5－6次。随访5-6年,完全随访率69．9％。结果 两组在3年生存率,术前血象改变无显著性差异,而5年生存率,术后复发率和术后感染率有显著性差异。结论 术前5－Fu保留灌肠和术后5－Fu/CF化疗可提高5年生存率和降低复发率。     

直肠癌保留肛门的切除术

直肠癌保留肛门的切除术徐伟，陈锡林我科于１９８６年至１９９３年对７９例中下段直肠癌病人施行切除术，保留其肛门，取得较满意的效果，现报告如下．临床资料本组男ｓｌ例，女２８例，年龄２５～６５岁，平均４５岁。肿瘤下线距肛缘５ｃｍ２９例，６～８ｃｍ５０例。肿...     

小儿保留灌肠的临床护理进展

综述小儿保留灌肠的临床护理进展，内容主要为肛管的改良、插入深度、灌肠液的选择及灌肠前后的体位安置等。以期对临床儿科护理工作起到促进和发展作用。     

小儿保留灌肠的临床护理进展

综述小儿保留灌肠的临床护理进展,内容主要为肛管的改良、插入深度、灌肠液的选择及灌肠前后的体位安置等.以期对临床儿科护理工作起到促进和发展作用.     

直肠癌局部切除术的国内外进展

直肠癌局部切除术是一种缩小手术范围,保留肛门括约肌的术式。随着纤维结肠镜在临床中的广泛应用,早期大肠癌的诊断率逐渐提高,直肠癌局部切除术也逐年增加[1]。该术式在现代直肠癌的治疗中有较重要的作用[2]。如果能够严格选择病例,部分直肠癌局部切除术也可以达到传统的根治手术目的[3,4],既能保留肛门功能、又能避免过度治疗(over treatment)[5]。现结合国内外文献,就直肠癌局部切除术国内外进展简述如下。     

直肠癌前切除术后局部复发原因分析

本文收集中山医科大学肿瘤医院1990～1994年行前切除术107例病例,分析复发因素,探讨复发原因,期待能找出预防措施,降低复发率,提高生存率。 临床资料 患者,男64例,女43例,年龄22～78岁,中位年龄55岁。肿瘤部位距肛门7cm内7例,7～9cm46例,≥9cm44例。术中见肿瘤位于腹膜返折以上72例,返折平面及以下35例。肿瘤组织学分级Ⅰ级35例,Ⅱ级61例,Ⅲ级11例。病理分期:Dukes A期34例,B期30例,C期30例,D期13例。行根治术91例,姑息术16例。手工吻合86例,吻合器吻合21例。     

直肠癌患者Miles术后骶前持续灌洗的护理

对44例直肠癌Miles术后患者行大剂量生理盐水(3 000 ml/24 h)骶前24 h持续灌洗5～7 d.结果 1例因会阴敷料持续渗湿中途停止骶前灌洗;2例出现骶前脓肿,行脓肿穿刺引流后出院;3例会阴切口感染,经积极换药后切口乙级愈合;38例灌洗顺利出院.提出保持引流管路通畅.观察灌洗液的颜色和性状,严格记录灌洗液出入量等是保障骶前持续灌洗的护理要点.     

Oncological Outcome After Local Excision of Rectal Carcinomas

Background  Local excision (LE) of T1 rectal cancer yields low recurrence rates. However, more frequent recurrences with unknown states of high-risk T1/T2 tumors are risk factors. The purpose of this study was to evaluate if, after LE, immediate reoperation is required, or awaiting salvage surgery is sufficient. Methods  150 T1 and 42 T2 tumors were treated by LE. Immediate reoperation was attempted for unfavorable pT1 (G3-4/L1/V1/R1/Rx/R ≤1 mm) and all pT2 tumors. Three groups were formed. Group A included low-risk pT1 tumors after complete (R0) LE; unfavorable pT1 and all T2 tumors were divided in groups B (immediate reoperation) and C (salvage surgery). Results  Groups A (n = 93) and B (n = 39) showed high tumor-free (TFS) and tumor-related survival (TRS) rates: group A 92% and 98%; group B 86% and 89%. In group C (n = 43), the TFS und TRS were significantly lower with 54% and 72%. Group A showed low recurrence rates and a wide range of International Union Against Cancer (UICC) stages. In group B, similarly low recurrence rates were found, but, in contrast, all recurrences were UICC IV. Group C had significantly higher recurrences rates and, in addition, two-thirds of these patients showed advanced UICC stages (III–IV). Conclusions  LE of low-risk T1 tumors represents an adequate therapy. Immediate reoperation after LE of pT1 tumors with unfavorable histological finding or pT2 tumors can avoid local recurrences. Thereafter, high TFS rates can be expected in these patients, but metastases cannot be prevented and adjuvant measures are necessary. Awaiting recurrences as in group C leads to bad oncological outcomes with high recurrences and low survival rates.     

低位直肠癌切除术后吻合口漏原因分析及护理

对低位直肠癌行全直肠系膜切除保肛术131例中发生吻合口漏17例进行回顾性分析.结果吻合口漏多发生于术后3～11 d.发生原因与术前肠道准备,术后吻合口张力等有关.提示术前良好的肠道准备至关重要;术后加强病情观察,能及时发现并预防吻合口漏;对吻合口漏的病人采取早期禁食、有效胃肠减压、补液抗炎、纠正水电解质失衡、有计划地肠外、肠内营养等治疗,可促进漏口愈合.     

Factors Associated with Local Recurrence After Neoadjuvant Chemoradiation with Total Mesorectal Excision for Rectal Cancer

Background  The purpose of the present study was to investigate risk factors associated with local recurrence in patients with locally advanced rectal cancer who received preoperative chemoradiotherapy in combination with total mesorectal excision (TME). Methods  Rectal cancer patients who were treated with neoadjuvant chemoradiation with TME were studied. We compared 26 patients who developed local recurrence with 119 recurrence-free patients during the follow-up period. Results  The median follow-up period was 52 months (range: 14–131 months). Based on the use of univariate and multivariate analyses, circumferential margin involvement (p = 0.02), the presence of lymphovascular or perineural invasion (p = 0.02), and positive nodal disease (p = 0.03) were contributing factors for local recurrence. The local recurrence rate was different between ypN(+) patients and ypN(–) patients with more than 12 nodes retrieved (p = 0.01). There was no difference in local recurrence rates between ypN(+) patients and ypN(–) patients with <12 nodes (p = 0.35) or between ypN(–) patients with <12 nodes or ≥12 nodes (p = 0.18). Conclusions  Patients with circumferential margin involvement, the presence of lymphovascular or perineural invasion, and positive nodal disease should be regarded as a high-risk group. We also determined that lymph node retrieval (<12 nodes) in patients with node-negative disease was a risk factor for local recurrence.     

Short-Term Outcomes After Robotic-Assisted Total Mesorectal Excision for Rectal Cancer

Background Laparoscopic total mesorectal excision for rectal cancer remains a difficult procedure with high conversion rates. We have sought to improve on some of the pitfalls of laparoscopy by using the DaVinci robotic system. Here we report our two-year experience with robotic-assisted laparoscopic surgery for primary rectal cancer. Methods A prospectively maintained database of all rectal cancer cases starting in November 2004 was created. A series of 39 consecutive unselected patients with primary rectal cancer was analyzed. Clinical and pathologic outcomes were reviewed retrospectively. Results 22 patients had low anterior, 11 intersphincteric and six abdominoperineal resections. Postoperative mortality and morbidity were % and 12.8%, respectively. The median operative time was 285 minutes (range 180–540 mins). The conversion rate was 2.6%. A total mesorectal excision with negative circumferential and distal margins was accomplished in all patients, and a median of 13 (range 7–28) lymph nodes was removed. The anastomotic leak rate was 12.1%. The median hospital stay was 4 days. There have been no local recurrences at a median follow-up of 13 months. Conclusions Robotic-assisted surgery for rectal cancer can be carried out safely and according to oncological principles. This approach shows promising short-term outcomes and may facilitate the adoption of minimally invasive rectal surgery.     

Local Excision After Preoperative Chemoradiation Results in an Equivalent Outcome to Total Mesorectal Excision in Selected Patients with T3 Rectal Cancer

Background  

We previously reported 26 patients who underwent preoperative chemoradiotherapy (CXRT) for T3 rectal cancer and were subsequently offered full-thickness local excision (LE) as an alternative to total mesorectal excision (TME). At nearly 4 years’ follow-up, no difference in outcome was observed. This study compares outcomes in a larger cohort of patients and reevaluates the original 26 patients after longer follow-up.