延续性护理对结直肠癌化疗患者自我感受负担及服药依从性的影响

目的探讨延续性护理干预对结直肠癌化疗患者自我感受负担及服药依从性的影响。方法选取2016年3月至2018年3月我院收治的结直肠癌化疗患者112例,随机分成对照组和观察组,每组56例。对照组患者给予化疗常规护理干预,观察组患者在接受化疗常规护理干预的基础上给予延续性护理干预。比较两组患者的自我感受负担量表(SPBS)、生活质量量表(QLQ-CCC)、焦虑自评量表(SAS)、抑郁自评量表(SDS)评分。结果干预1年后,观察组患者的SPBS评分显著低于对照组,QLQ-CCC评分显著高于对照组;观察组患者用药依从率(94.64%)显著高于对照组(82.14%);观察组患者的SAS、SDS评分均显著低于对照组,差异有统计学意义(P0.05)。结论延续性护理干预可有效改善结直肠癌化疗患者的自我感受负担,提高服药依从性,缓解患者焦虑、抑郁等不良情绪,提高生活质量,有利于患者改善预后。     

护理干预对直肠癌合并糖尿病手术患者预后的影响分析

目的探究护理干预对直肠癌合并糖尿病手术患者预后的效果,为临床提供指导。方法以2015年6月—2017年6月该院收治的56例直肠癌合并糖尿病手术患者作为观察对象,随机将56例患者分为常规组(28例,应用常规护理干预)、循证组(28例,应用循证护理干预)。研究对比循证组和常规组患者的满意度评分、生活质量评分、心理健康评分及并发症发生率。结果循证组患者护理后满意度评分(89.78±6.67)分、生活质量评分(81.59±4.77)分相比常规组明显更高,且心理健康评分(19.14±2.22)分较常规组明显更低(P0.05);循证组患者并发症发生率(7.14%)相比常规组(28.57%)明显更低(P0.05)。结论对直肠癌合并糖尿病手术患者实施循证护理切实可行,对患者预后具有较积极的作用。     

老年癌性结直肠梗阻患者行肠造瘘的临床价值

目的探讨老年晚期结直肠癌合并癌性梗阻患者行肠造瘘的临床价值。方法回顾性分析我院2006年6月至2011年6月5年间收治的82例老年癌性结肠梗阻患者的临床资料。结果造瘘组在营养状况、(再)手术率、生存时间、生活质量、满意度调查等方面均优于单纯最佳支持治疗组,2组比较差异有统计学意义(P<0.05)。结论为老年癌性结肠梗阻而无法耐受肿瘤切除手术的患者施行肠造瘘术,是一种简便、安全、有效的治疗手段。     

循证护理在妊娠合并心脏病患者中的作用观察

目的探究循证护理应用在妊娠合并心脏病患者中的作用。方法选取我院2012年3月-2014年7月期间收治的110妊娠合并心脏病患者,按照抽签法将其分为观察组以及对照组,每组患者为55例,予以对照组患者常规护理手段,观察组患者在常规护理的基础上增加循证护理,对两组患者的生活质量以及并发症进行对比。结果两组患者通过护理,其观察组患者的生活质量明显高于对照组患者的生活质量,并且对照组患者的并发症发生明显大于观察组患者,两组之间经对比,存在显著差异,具有统计学意义(P0.05)。结论对妊娠合并心脏病患者进行循证护理能够提升其总体护理质量,可以改善患者的心功能,加强护理人员解决问题的能力,具有临床应用价值。     

晚期多原发结直肠癌多学科治疗一例报道

近年来,结直肠癌的发病率显著上升,随着多学科共同参与的多学科团队（multidisciplinary team,MDT）模式的建立,结直肠癌患者特别是晚期结直肠癌患者的生存时间得到明显延长,生活质量得到有效改善。此例晚期多原发结直肠癌患者带瘤生存已达7年,在多学科协作模式下进行的综合治疗使患者病情得到较好控制,生活质量保持较高水平。本文就此例患者诊疗过程中的一些经验和体会与大家一起来分享。     

直肠癌合并糖尿病应用综合护理对血糖的影响和患者恢复速度评价

目的探讨对直肠癌合并糖尿病患者实行综合护理对其血糖以及恢复速度的影响。方法将2017年6月—2018年6月期间该院收治的60例直肠癌合并糖尿病患者分为两组进行研究,就常规护理(对照组,n=30)与综合护理(观察组,n=30)对血压、血糖水平、生活质量评分以及并发症发生率展开对比。结果观察组患者的血压水平以及血糖水平、相关并发症相对于对照组较低,生活质量评分明显优于对照组,差异有统计学意义(P0.05)。结论对直肠癌合并糖尿病患者实行综合护理效果较好,可有效降低其血压以及血糖水平,提高生活质量,降低并发症发生率,具有较高的临床应用价值。     

自膨式金属支架治疗结直肠恶性梗阻30例临床体会

晚期结直肠癌造成的梗阻,手术治疗风险大、效果差.支架置入术是解决部分晚期结直肠癌造成的梗阻的有效手段,与传统外科开放手术相比,具有痛苦小、安全、简便、住院时间短、恢复快、重复性强、能维持正常生理排泄通道的特点,易被医患双方接受.可对失去外科手术机会的晚期肿瘤患者及放弃手术治疗的患者提供姑息性解除结肠梗阻的治疗机会,对于改善患者生活质量和生存率具有积极的意义.     

结直肠癌永久性肠造口伴高血压患者接受适应性领导理论护理干预的效果

目的 探讨结直肠癌永久性肠造口伴高血压患者中应用基于适应性领导理论的护理干预效果,评价其应用价值。方法 按照本研究制定目标,选取医院在2020年6月至2022年6月内收治的结直肠癌伴高血压永久性肠造口患者,共计88例,用随机数字表法分为两组,各44例,对照组实施科室常规护理干预,观察组实施基于适应性领导理论的护理干预,对比护理效果。结果 不同护理干预实施后,观察组干预后3个月患者自我护理能力、生活质量以及防御能力均显著提高（P<0.05）,同时干预后1月、3月、6月时间段下血压控制情况均优于对照组（P<0.05）。结论 针对结直肠癌伴高血压永久性肠造口患者,应用基于适应性领导理论护理干预效果好,值得临床应用。     

结直肠癌合并肠梗阻的外科治疗-附78例报告

结、直肠癌合并肠梗阻是常见的外科急腹症，成年人中约53．3％的急性机械性肠梗阻是腹内肿瘤引起，其中84％为结直肠癌。由于结肠梗阻多为闭襻性梗阻，结肠内含有大量细菌，且患者多有高龄、围手术期并发症多、难处理、预后差。对大肠癌引起的急性肠梗阻的手术方式选择尚有争议。本文对我院1990年-2001年78例结直肠癌合并梗阻的临床资料进行回顾性分析，现报告如下。     

系统化护理干预对结直肠癌合并2型糖尿病患者术后切口愈合的影响

目的 分析系统化护理干预对结直肠癌合并2型糖尿病患者术后切口愈合的影响。方法 选取2022年1月—2023年5月山东省青岛市黄岛区区立医院外科收治的100例结直肠癌合并2型糖尿病患者为研究对象,按照入组时间顺序不同,分为对照组（常规糖尿病护理）和观察组（系统化糖尿病护理）,各50例。比较两组护理效果。结果 观察组血糖低于对照组,差异有统计学意义（P<0.05）。观察组切口愈合质量优良率高于对照组,差异有统计学意义（P<0.05）。结论 针对接受手术的结直肠癌合并2型糖尿病患者,予以系统化糖尿病护理,可提高切口愈合质量,并合理控制血糖水平。     

结直肠癌支架置入术后并发症危险因素及预防

结直肠癌患者常伴结肠梗阻症状,急诊手术多因无法行肠道准备及患者一般情况较差,死亡率及术后并发症的发病率较高。支架置入治疗可以作为手术的桥梁治疗,同时也可作为晚期转移性结直肠癌患者的姑息治疗手段,与手术治疗比较,支架置入治疗的死亡率及术后并发症发生率均较低,且可避免瘘口形成,患者住院时间短、术后恢复快。但支架置入常伴穿孔、支架移位、再梗阻等并发症,严重时危及患者生命。本文对支架置入术后相关并发症相关的危险因素及预防措施作一概述。     

Long-term release of a malignant ileal obstruction by placement of a colorectal self-expandable metal stent

An 84-year-old man underwent the Hartmann procedure with an R1 resection for advanced rectal cancer. One year after surgery, the patient presented with abdominal pain and vomiting. Abdominal radiography and computed tomography revealed an expanding small bowel and ileal obstruction caused by invasion of local, recurrent rectal cancer. In order to release the ileal obstruction, a colorectal self-expandable metal stent was placed via a through-the-scope technique using a colonoscope inserted through a stoma in the transverse colon. After stent placement, the patient’s clinical symptoms and signs improved and the symptoms of obstruction did not recur. No major complications associated with the placement of the stent were observed during the 7-month follow-up period. Thus, self-expandable metal stents are a safe and effective palliative treatment for malignant gastroduodenal or colorectal obstructions, and as a bridge to surgery. However, endoscopic placement of these stents in cases of malignant small bowel obstruction is not yet feasible because of the limitations of endoscopic access and the stent delivery system. To our knowledge, this is the first report of malignant ileal obstruction treated with a colorectal self-expandable metal stent using a colonoscope. This case indicates that colorectal self-expandable metal stents can be effectively and safely used to treat malignant ileal obstructions.     

优质护理在食管癌患者根治性放疗中的应用对提升患者满意度的价值分析

目的评价食管癌患者根治性放疗中优质护理的应用效果及对患者护理满意度的影响。方法选择本院2018年1月至2019年3月收治的接受根治性放疗的80例食管癌患者,通过信封法随机分为常规护理组和优质护理组各40例。常规护理组进行常规护理,优质护理组进行优质护理。对比两组患者经护理后的生活质量评分变化和护理满意度情况。结果两组患者护理前生活质量各项评分对比无明显差异(P>0.05);优质护理组患者护理后生活质量各项评分比常规护理组显著增高(P<0.05);优质护理组患者护理后护理满意度评分比常规护理组患者显著增高(P<0.05)。结论食管癌患者根治性放疗中应用优质护理可提高患者的术后生活质量与护理满意度。     

Frühe palliative Führung

Despite advances in chemotherapy treatment, the prognosis for patients with advanced lung cancer still remains serious accompanied by devastating effects on physical well-being, psychological health and psychosocial care. Although chemotherapy is accepted as an effective treatment, the high prevalence of disease-specific symptoms, depressed mood and aggressive end-of-life care highlight the need for palliative care to minimise symptom distress and promote quality of life. In this context, a randomised palliative intervention trial performed by Temel et al. in Boston, USA (N Engl J Med 2010) was remarkable comparing standard oncological chemotherapy alone with an early palliative concept integrated into standard chemotherapy in patients with newly diagnosed metastatic non-small cell lung cancer (NSCLC). The results show that those patients receiving additional palliative care had a better quality of life and less depressive symptoms than did patients assigned to the standard therapy alone. In addition, median survival of patients in the palliative care group was significantly prolonged for 2.7?months compared to standard therapy alone. Data support the incorporation of early palliative care into the therapeutic concept for metastatic NSCLC.     

Management of malignant colonic obstruction

Opinion statement Malignant large bowel obstruction remains a clinical entity that is commonly encountered despite our advances in screening for colorectal cancer. Patients with malignant large bowel obstruction usually have advanced colorectal cancer and are often poor operative candidates, yet these patients are in need of treatment and colonic decompression. Surgical therapies are available and can offer good outcomes in selected patients. Patients who have curative or palliative surgeries planned should routinely undergo preoperative endoscopic decompression. Available options for decompression include the placement of colonic decompression tubes, ablative methods such as the use of lasers, argon plasma coagulators, and the use of self-expanding metal stents. The author favors the use of self-expanding metal stents, as these devices provide rapid colonic decompression, create a wide luminal diameter, and are applicable in patients requiring preoperative decompression and bowel preparation as well as in patients undergoing palliative therapy only. Patients who go on to surgery can have the stent and tumor removed en bloc at the time of the procedure, whereas patients who are only candidates for palliation can have the stents left in place as permanent decompressive devices with minimal morbidity and mortality.     

Covered metal stents for management of inoperable malignant colorectal strictures

BACKGROUND: Metal stents have been reported as an effective alternative to surgery for the palliation of patients with colorectal neoplastic obstruction. Because most of the published series describe the use of uncovered stents, the purpose of our study was to prospectively evaluate the effectiveness, feasibility, safety, and outcome of covered stents for the palliative treatment of malignant colorectal strictures. METHODS: Sixteen patients with advanced distal colorectal cancer underwent placement of 10 and 12 cm long, 23 mm diameter covered stents under fluoroscopic and endoscopic control. Clinical and endoscopic follow-up was scheduled at 3- to 6-week intervals. RESULTS: Stent insertion was successful in 15 of 16 patients (93%). Perforation occurred in one patient during stent placement requiring colostomy. Relief of bowel obstruction was documented in all successfully treated patients. The median follow-up was 21 weeks (range 1 to 46). No recurrence of obstruction was observed during the follow-up period. Stent migration occurred in 2 patients, 7 and 21 days after stent placement. CONCLUSIONS: Covered stents may provide safe and effective palliation of patients with malignant rectosigmoid strictures. Prolonged luminal patency and sealing of fistulous tracts are potential advantages of covered versus uncovered stents in the palliative treatment of colorectal malignancies. ?     

Role of secondary surgery in relapsed ovarian cancer

In recurrent ovarian cancer secondary surgery may be an important opportunity to improve survival and quality of life. In order to give a general overview of the available evidence, we discuss published data on the role of secondary surgery in relapsing ovarian cancer. The median survival after secondary surgery has been reported ranging from 16 to 29 months, and seems to be longer in subjects with optimal debulked disease. However, as with front-line debulking, it is difficult to establish whether the secondary debulking itself has a therapeutic, or even a lasting palliative effect, or whether the patients in whom the procedure is successful are those who have more indolent disease. Any benefit of treatment must be compared with potential morbidity. Post-operative complications are reported in about 25--30% of cases, with a potential impact on hospital stay. During the natural course of the disease, most patients with ovarian cancer develop intestinal obstruction, without impairment of other vital organs or pain. Reported series have suggested that palliative surgery for bowel obstruction is generally feasible in most patients. Some prognostic factors have been suggested to identify patients likely to benefit most from palliative surgery: young age seemed to be associated with longer survival after successful surgery for bowel obstruction, though this finding was not statistically significant. The site of obstruction does not seem to be related to survival after surgery.     

Palliative radiation therapy for advanced gastrointestinal cancer

Patients with locally advanced disease can have significant local symptoms. The most common symptoms from local extension are pain, bleeding (hematemesis, melena) and obstruction (dysphagia, vomiting). These can cause a significant impact on a patient's quality of life. Radiation therapy is used to control these symptoms with modern 3-dimensional conformal techniques or brachytherapy. The aim of this study was therefore to review the outcome of palliative radiation therapy in patients with symptomatic locally advanced or recurrent gastrointestinal cancer.     

Self-expanding metallic stent in the treatment of colonic obstruction caused by advanced malignancies

INTRODUCTION: The treatment of malignant obstruction of the left colon or rectum usually requires emergency surgery on poor-risk patients, and the creation of a stoma is usually inevitable. With the use of self-expanding metallic stents, the prompt relief of large-bowel obstruction without surgery has become possible. This report describes our results in the use of self-expanding metallic stents in the treatment of left-sided colonic obstruction resulting from advanced malignancies. METHODS: From November 1997 to March 1999, insertion of self-expanding metallic stents was attempted in 24 patients with acute left-sided colonic obstruction caused by primary or recurrent malignancies. All the procedures were performed by colorectal surgeons. The guidewire was inserted through the channel of the endoscope, and its position was confirmed with fluoroscopy. Uncovered Wallstent® esophageal endoprostheses were used in all except the first case. The insertion and deployment of the stents were under both endoscopic and fluoroscopic guidance. RESULTS: There were 24 patients (15 males) with a mean age of 63.6 (range, 36–98) years. Thirteen patients had primary colorectal cancer and 11 had recurrent cancers (colorectal cancer, 5; gastric cancer, 5; other, 1). In the treatment of primary colorectal cancer, seven procedures were palliative, and no subsequent surgery was planned because of extensive liver metastasis or poor medical risk. The other six patients underwent elective resection after mechanical bowel preparation. There was no mortality related to the procedure. Stenting was successful in the relief of obstruction in 23 patients. Perforation of the colon occurred in one patient, and an emergency Hartmann's operation was performed. Migration of the stents occurred in three patients. Only 3 of the 18 patients in the palliation group required the subsequent creation of stomas. CONCLUSION: The use of the self-expanding metallic stents can achieve rapid and effective nonsurgical means to relieve left-sided colonic obstruction. It provides good palliation for unresectable advanced tumors that cause colonic obstruction. It may also have a role in the temporary relief of obstruction so that subsequent colonic resection can be performed under elective conditions.Poster presentation at The American Society of Colon and Rectal Surgeons' 100th Anniversary and Tripartite Meeting, Washington, D.C., May 1 to 6, 1999.     

The patient-driven payment model: A missed opportunity for patient-centered cancer care

Hospitalized older patients with advanced cancer who were discharged to a skilled nursing facility (SNF) for rehabilitation are unlikely to receive future cancer treatment, have high 30-day readmission rates, and high mortality yet minimal hospice use. The Medicare SNF benefit was designed to be a bridge and provide short-term nursing and rehabilitation care for patients after a hospitalization. However, advanced cancer patients churn through the health system cycling between the hospital, post-acute care facilities, and home in the last months of life. This article explores the potential impact of the patient-driven payment model, a new SNF reimbursement model introduced by the Center for Medicare and Medicaid Services in 2019, on the experience of older cancer patients. Previously, SNF reimbursement was based on the hours of rehabilitative therapy provided to patients, unintentionally incentivizing SNFs to provide more therapy resulting in long lengths of stay and increased Medicare expenditure. The new patient-driven payment model bases reimbursement on patient clinical characteristics and resources utilized during their SNF stay. We discuss the impact this payment model might have on cancer patients in the SNF setting and highlight the importance of access to palliative care for this population. We discuss challenges policymakers face in creating palliative care guidelines and developing palliative care delivery models in SNFs. We highlight the policy gaps that remain in creating a system that achieves high-quality SNF care and conclude by offering suggestions that might better incorporate a patient's illness trajectory, prognosis, and goals of care.