肠造口及其周围皮肤坏死1例的护理

本文报道1例乙状结肠造口黏膜及其周围皮肤坏死患者的护理。正确的评估肠造口及周围皮肤坏死情况,在加强心理护理的前提下,严密观察造口黏膜颜色,合理应用造口、伤口护理产品处理坏死的肠黏膜、造口周围创面,清除坏死组织,促进伤口愈合;保护造口周围皮肤,使造口袋粘贴牢靠,有效收集肠造口处排出的粪便。50天后造口黏膜及周围皮肤坏死完全愈合。     

膀胱癌膀胱全切术后尿路造口的护理体会

目的:探讨膀胱癌全切术后尿路造口患者手术前、术后护理、健康教育和术后尿路造口自我护理方法.方法:对11例患者术前着重于心理护理、饮食及肠道准备,术后重点加强引流管的护理,积极预防并发症,同时注意代膀胱功能的训练及尿路造口自我护理方法指导.结果:11例患者4周左右均痊愈出院,回肠造口恢复良好,尿路造口自我护理熟练.结论:充分的术前准备、精心的术后护理以及恢复期专科人健康教育指导是确保手术成功的关键.     

全膀胱切除术后回肠吻合口瘘的原因及处理

目的 探讨全膀胱切除并回肠膀胱术(Bricker术)后回肠吻合口瘘的发生原因及其治疗方法.方法 选取2001年1月至2020年12月间行全膀胱切除并Bricker术的244例患者的临床资料进行回顾性分析,并结合文献进行总结.结果 在244例患者中,术后发生回肠吻合口瘘7例(2.87％).1例因高龄、全身状况及营养状况差...     

膀胱全切回肠新膀胱术后病人的排尿功能锻炼

对9例膀胱癌病人行膀胱全切回肠新膀胱术.术后对病人实施有计划、有步骤、循序渐进的排尿功能锻炼.随访0.5～3.5年,结果病人排尿功能均接近正常.     

不同类型造口袋对造口周围皮肤影响的研究

目的研究一件式和两件式造口袋对肠造口患者造口周围皮肤的影响。方法采用方便采样的方法,选择2011～2012年在我科住院并行永久性肠造口术患者60例,分为使用一件式造口袋组和使用二件式造口袋组,每组30例。每位患者连续使用同一型号的造口袋3个月,观察造口周围皮肤的情况。结果使用二件式造口袋组患者造口周围皮肤损伤程度低于使用一件式造口袋组(P<0.05)。一件式造口袋较二件式造口袋粘贴时间长、更换造口袋耗时少、发生造口底版胶残留次数多(P<0.05);二者发生造口排泄物渗漏的次数比较差异无统计学意义(P>0.05)。结论两件式造口袋能减少造口周围皮肤损伤,改善造口周围皮肤状况,但其应用受到价格、操作方便性的限制。     

回肠造口的术前及术后护理

报告了对12例回肠造口的护理体会。在住院期间,了解患者术前对身体心像改变的接受度,向其讲解有关回肠造口的基本知识,术后对造口进行评估,制定相应的措施,做好心理、造口和饮食护理,提高生活质量。     

膀胱全切原位回肠新膀胱术后输尿管肠吻合口良性狭窄的处理

目的：探讨膀胱全切原位回肠新膀胱术后输尿管肠吻合口良性狭窄的处理方法。方法：我科自2003年1月～2012年6月采用膀胱全切原位回肠新膀胱术治疗395例膀胱癌患者。术后发生输尿管肠吻合口良性狭窄10例,采用输尿管镜扩张、内镜下逆行／经皮穿刺顺行球囊扩张、内镜下狭窄段内切开、开放输尿管膀胱再植术,并留置双J管3～6个月。结果：本组10例中,1例（1处）因导丝不能通过狭窄段而改行开放手术,术后随访36个月,肾积水明显改善。其余9例（11处）采用腔内技术处理,其中3例（4处）采用输尿管镜扩张,2例（3处）采用内镜下狭窄段内切开,4例（4处）采用内镜下逆行／经皮穿刺顺行球囊扩张。术后随访9～72个月（中位25个月）。5例（7处）肾积水明显改善,2例（2处）肾积水长期随访无加重,2例（2处,狭窄段长分别为1．2cm、1．5cm）再发狭窄,遂采用开放手术,分别随访16及24个月,肾积水改善。结论：腔内技术操作简单,创伤小,可作为输尿管肠吻合口良性狭窄的首选治疗方案。开放手术仍然是治疗输尿管肠吻合口狭窄的金标准。对于狭窄段〉1cm的患者,应首先考虑开放手术。     

2例根治性膀胱全切回肠膀胱术患者的围手术期护理

<正>膀胱癌居泌尿系肿瘤首位。膀胱全切适用于恶性程度高、浸润深、范围广的肿瘤。2006-09～2009-12我科共收治膀胱肿瘤15例,其中2例行膀胱全切回肠膀胱术,均获满意疗效,现将护理体会报告如下。     

1例高龄患者膀胱全切、输尿管皮肤造口、人工皮瓣乳头成形术的护理

膀胱癌是泌尿系统常见的恶性肿瘤,主要以手术治疗为主,配合放疗、免疫疗法及激光治疗等。肌层浸润性膀胱癌生物学行为高度恶性,治疗的主要方法是根治性膀胱切除加尿流改道术[1]。输尿管皮肤造口术是尿流改道的一种常用术式,对于一些需行膀胱全切除术的膀胱肿瘤患者,因为高龄且伴有心肺功能不全、预期寿命短、有远处转移,或全身情况不佳,不能耐受回肠膀胱术,可行膀胱全切、输尿管皮肤造口术[2]。目前单纯的双侧输尿管皮肤造口术较多,但单侧的     

膀胱癌患者行膀胱全切、回肠代膀胱术的围手术期护理

目的:探讨膀胱癌行膀胱全切、回肠代膀胱术的围手术期护理措施。方法:回顾性分析16例膀胱全切、回肠代膀胱术的临床资料。结果:本组患者均顺利的渡过了围手术期,术后无感染、吻合口瘘、尿瘘等并发症的发生。结论:术前充分的肠道准备及全身准备,是患者安全渡过手术、提高手术质量的重要保证,术后加强护理,可有效预防术后并发症的发生,是患者疾病康复的重要护理措施。     

Quality of care in bladder cancer: trends in urinary diversion following radical cystectomy

Objective  Quality-of-care indicators have not yet been defined for patients with bladder cancer. Nonetheless, certain aspects of bladder cancer care can be evaluated to quantify the quality of care delivered. We sought to determine trends in continent urinary diversion to evaluate the adoption of this more optimal reconstruction. Methods  Subjects who underwent radical cystectomy for a primary diagnosis of bladder cancer were identified from the Healthcare Cost and Utilization Project Nationwide Inpatient Sample. We identified covariates independently associated with utilization of continent urinary diversion after radical cystectomy using multivariate logistic regression modeling. We then examined trends in diversion type based on patient and hospital characteristics and examined the impact of hospital volume on use of continent reconstruction. Results  Our weighted sample included 5,075 subjects (14.3%) who underwent continent urinary diversion and 30,295 subjects (85.7%) who underwent an ileal conduit. Independent correlates of continent diversion included younger age, male gender, having private insurance, and undergoing surgery at an urban teaching hospital. Hospitals performing continent diversions on more than 40% of their cystectomies had a yearly cystectomy volume of 0.8 surgeries. Subjects treated at high-volume hospitals trended toward lower rates of comorbid conditions. Conclusions  We identified substantial disparities in continent diversion which, based on yearly trends, are unlikely to improve in the near future. Continent reconstructions are not the exclusive domain of high-volume cystectomy centers. Yet efforts to increase rates of this complex reconstruction must concentrate on technique dissemination and better definition of the quality-of-life detriments incurred by cystectomy patients.     

Indiana可控膀胱成形术39例疗效观察

为了客观评价Ｉｎｄｉａｎａ可控膀胱成形术的手术疗效，对１９９１年１月～１９９６年７月３９例膀胱癌全切Ｉｎｄｉａｎａ可控膀胱成形术患者进行疗效观察。３９例中，回结肠膀胱成形术２２例，盲结肠自身折回缝合成形术１７例。术后１年，导尿间隔４～５小时，每次尿量５００ｍｌ，最大容量达８００ｍｌ，４００～５００ｍｌ时膀胱内压平均低于０．７８ｋＰａ（８ｃｍＨ２Ｏ）；随时间延长膀胱容量扩大，内压降低、稳定；全组病例均获得满意的低压大容量；防输尿管返流和尿失禁措施可靠；肾功正常，无代谢紊乱，并发症少。结果表明，该术式疗效满意，值得临床采用。     

1例直肠癌根治联合放化疗粒子植入术后并发症的护理

对1例直肠癌患者行直肠癌根治术联合放射性125I粒子和氟尿嘧啶缓释化疗粒子植入,术后发生化疗粒子脱出、会阴部伤口感染、低钾血症。严密观察会阴部伤口及引流情况,发现脱出的化疗粒子,立即通知和协助医生去除,加强心理护理及会阴部伤口换药,注重放射防护等。结果患者并发症好转出院,经返院化疗及继续强化伤口对症处理,伤口愈合。提出术后严密观察伤口情况、一旦发现化疗粒子脱出即刻正确处理,有利于促进患者伤口愈合。     

Robot-assisted radical cystectomy and urinary diversion

Radical cystectomy remains the standard for muscle-invasive, organ-confined urothelial carcinoma of the bladder. With the emergence of minimally invasive approaches for the treatment of urologic cancers, technologic advances using laparoscopy have led to the development of robotic assistance to increase the feasibility of performing this formidable operation. In this article, we describe the procedure of robotic-assisted laparoscopic radical cystectomy with urinary diversion and review the pertinent literature.     

Complications and late sequelae following radical cystectomy and supravesicle urinary diversion

Until recently radical cystectomy combined with urinary diversion was only justified by most urologists as a therapeutic measure for the management of bladder cancer, when other forms of treatment failed controlling the disease. This attitude was mainly based on a high morbidity and mortality rate of up to 20% of the cases. Improved selection of the patients, progress in improving preoperatively the physical conditions of the patients, intra- and post-operative intensive care and improvement of the surgical technique have contributed considerably to reduce the risks of this procedure. Effective preparation of the small and large bowel, early anticoagulation and digitalis medication as well as an efficient antibiotic treatment starting intraoperatively, and optimal parenteral hyperalimentation are of particular importance. Adjuvant preoperative radiation therapy and a simultaneously performed pelvic lymph node dissection do not contribute to an increased morbidity or mortality rate. Taking into account all available preventive measures, the mortality rate of about 20% 20 years ago has been reduced to about 1-5% at present.     

Urinary tract infections following radical cystectomy and urinary diversion: a review of 1133 patients

Objective

To investigate the incidence and microbiology of urinary tract infection (UTI) within 90 days following radical cystectomy (RC) and urinary diversion.

Methods

We reviewed 1133 patients who underwent RC for bladder cancer at our institution between 2003 and 2013; 815 patients (72%) underwent orthotopic diversion, 274 (24%) ileal conduit, and 44 (4%) continent cutaneous diversion. 90-day postoperative UTI incidence, culture results, antibiotic sensitivity/resistance and treatment were recorded through retrospective review. Fisher’s exact test, Kruskal–Wallis test, and multivariable analysis were performed.

Results

A total of 151 urinary tract infections were recorded in 123 patients (11%) during the first 90 days postoperatively. 21/123 (17%) had multiple infections and 25 (20%) had urosepsis in this time span. Gram-negative rods were the most common etiology (54% of positive cultures). 52% of UTI episodes led to readmission. There was no significant difference in UTI rate, etiologic microbiology (Gram-negative rods, Gram-positive cocci, fungi), or antibiotic sensitivity and resistance patterns between diversion groups. Resistance to quinolones was evident in 87.5% of Gram-positive and 35% of Gram-negative bacteria. In multivariable analysis, Charlson Comorbidity Index > 2 was associated with higher 90-day UTI rate (OR = 1.8, 95% CI 1.1–2.9, p = 0.05) and Candida UTI (OR 5.6, 95% CI 1.6–26.5, p = 0.04).

Conclusions

UTI is a common complication and cause of readmission following radical cystectomy and urinary diversion. These infections are commonly caused by Gram-negative rods. High comorbidity index is an independent risk factor for postoperative UTI, but diversion type is not.

     

Retroperitoneal hernia following radical cystectomy: case report

Retroperitoneal hernias are rare. When they occur, they most often occur in naturally occurring fossas, such as with paraduodenal hernias. Due to the anatomy of the ureterovesicular system, patients with prior urological operations may be more likely to develop retroperitoneal hernias. We report the case of a 76-year-old male who had undergone a radical cystectomy with ileal loop conduit for bladder cancer, who presented with recurrent episodes of nausea and vomiting. Upon exploratory laparotomy, he was found to have a retroperitoneal hernia. The patient underwent resection of the strangulated loop of small bowel, and recovered without complications. In our patient, ureteral dissection from his prior procedure had created a defect in the peritoneum posterior to the sigmoid mesocolon, which allowed for herniation and subsequent strangulation of a portion of small bowel. Retroperitoneal hernias may represent an under-diagnosed etiology of intestinal obstruction in post-operative urological patients. Knowledge of anatomy is crucial in patients with previous abdominal operations, and prior operative notes should be reviewed, including non general surgical operations such as urological and gynecological procedures. The surgeon must remain vigilant in such cases of small bowel obstruction, as delayed intervention may lead to bowel compromise.