膀胱全切原位M形回肠代膀胱的手术配合

对4例膀胱恶性肿瘤患者行膀胱全切原位M形回肠代膀胱术.手术均顺利完成,住院20～30 d康复出院.出院后随访2年,3例1年内能自主控制排尿,1例18个月能自主排尿.提出术前做好心理护理,掌握解剖结构及手术流程,严格保持术野的无菌状态,器械的传递做到轻、准、稳、快,与手术医生密切配合,可确保手术顺利进行.     

女性张力性尿失禁腹腔镜膀胱颈悬吊术患者的护理

对37例女性张力性尿失禁患者采用腹腔镜Batch氏膀胱颈悬吊术。结果手术顺利，35例正常排尿，2例留置导管进行膀胱功能训练后，7～10d症状缓解。随诊2～34个月，29例治愈，5例有效，3例无效，总有效率为91．9％。提出术前做好患者的心理护理及术前准备，术中、术后密切观察病情，保持会阴清洁，注意排尿情况，认真讲解术后复查时间及注意事项，有利于提高手术疗效，促进术后康复。     

Nursing care for elderly bladder cancer patients treated with orthotopic sigmoid colon neobladder after laparoscopic radical cystectomy

目的 探讨腹腔镜膀胱切除原位乙状结肠新膀胱老年患者的有效护理方法.方法 对33例行腹腔镜膀胱切除原位乙状结肠新膀胱手术老年患者进行术前和术后营养支持、心理护理、膀胱功能训练、新膀胱功能的观察与训练等护理.结果 33例术后平均住院30 d,19例可控制排尿,9例日间可控尿;随访3～20个月,均能控尿且能经尿道自主排尿.结论 腹腔镜膀胱切除原位乙状结肠新膀胱老年患者的护理中,术前营养评估、心理干预并提前进行膀胱功能训练,术后强调新膀胱储尿、排尿、控尿功能的观察与训练,加强老年患者的出院管理是促进患者康复的重要措施.     

膀胱全切原位M形回肠代膀胱的手术配合

对4例膀胱恶性肿瘤患者行膀胱全切原位M形回肠代膀胱术。手术均顺利完成，住院20～30d康复出院。出院后随访2年，3例1年内能自主控制排尿，1例18个月能自主排尿。提出术前做好心理护理．掌握解剖结构及手术流程，严格保持术野的无菌状态，器械的传递做到轻、准、稳、快，与手术医生密切配合，可确保手术顺利进行。     

腹腔镜下膀胱全切术治疗膀胱癌4例报告

目的:探讨腹腔镜下膀胱全切术治疗膀胱癌的可行性.方法:应用腹腔镜技术对4例膀胱癌患者进行膀胱全切术及原位回肠新膀胱手术.结果:4例患者膀胱根治均切除成功,手术时间220～270 min.腹腔镜下失血量400～500 ml.原位新膀胱手术时间200～270 min,输浓缩红细胞2个单位.术后3天恢复肠蠕动并拔除耻骨后引流管,4天开始进食.2周后拔除输尿管支架管.随访4～16个月,1例有排尿困难,1例轻微尿失禁,另2例排尿正常.4例均无复发.结论:腹腔镜膀胱全切术及原位回肠新膀胱手术创伤小,并发症少,出血少,有一定的优点,值得推广.     

经尿道前列腺电切术后护理

目的:探讨经尿道前列腺电切术后的护理.方法:重点做好术前心理护理及各项准备;术后膀胱冲洗与保持引流通畅;术后病情观察及并发症预防;给予出院指导.结果:本组术后当日膀胱冲洗液澄清,术后2～3天拔除三腔Fiocy尿管,患者自排尿4～5例,术后1～2周内有10例出现尿频,尿急,同为血尿,经对症处理后症状消失,只有1例术后第13天发生继发性出血,即重插之腔Fioey尿管,继续冲洗膀胱,消炎止血等,症状均消失,3周后痊愈出院,本组无死亡病例.结论:围手术期的护理点及护理经验能够保障手术成功和愈合良好.     

膀胱全切乙状结肠去带新膀胱术的术前护理及术后康复指导

目的探讨膀胱全切乙状结肠去带新膀胱术的术前护理及术后康复指导要点。方法收治10例浸润性膀胱癌患者,对患者进行充分的术前护理,配合膀胱全切乙状结肠去带新膀胱术围手术期的各项处理;术后早期对患者行新膀胱功能训练、饮食指引等康复指导,随访观察手术的疗效。结果所有手术均取得成功,术中无并发症发生。随访3～16个月,患者新膀胱功能良好,无尿道狭窄等明显并发症,所有患者白天可完全控制排尿。结论耐心细致的术前护理结合术后早期的新膀胱功能训练康复指导是保证手术疗效、减少并发症的重要因素之一。     

腹腔镜膀胱切除原位乙状结肠新膀胱术老年患者的护理

目的探讨腹腔镜膀胱切除原位乙状结肠新膀胱老年患者的有效护理方法。方法对33例行腹腔镜膀胱切除原位乙状结肠新膀胱手术老年患者进行术前和术后营养支持、心理护理、膀胱功能训练、新膀胱功能的观察与训练等护理。结果33例术后平均住院30d,19例可控制排尿,9例日间可控尿;随访3～20个月,均能控尿且能经尿道自主排尿。结论腹腔镜膀胱切除原位乙状结肠新膀胱老年患者的护理中,术前营养评估、心理干预并提前进行膀胱功能训练,术后强调新膀胱储尿、排尿、控尿功能的观察与训练,加强老年患者的出院管理是促进患者康复的重要措施。     

全麻腹部手术围手术期置放、拔除尿管的最佳时机的初步探讨

目的:探讨腹部手术围手术期留置尿管的理想时机.方法:纳入符合人选标准80例全麻下行腹部手术的病例,行术前麻醉后置放尿管,术后麻醉复苏前拔除尿管.术后观察尿潴留、膀胱刺激症状及术后1,3,7d尿中白细胞的改变.结果:80例术后患者75例均能自行排尿,仅5例再次置放尿管.术后第1天,发生膀胱刺激症状5例,与术前比较,有统计学意义(P＜0.01);术后第3,7天,发生膀胱刺激症状分别为2例和1例,与术前比较,无统计学意义(P＞0.05).术后第1,3,7天,尿中白细胞＞10/HP者分别为2,5,4例,与术前比较均无统计学意义(均P＞0.05).结论:全麻腹部手术,术前麻醉后置放尿管、术后麻醉复苏前拔除尿管,不会导致排尿困难,能减少膀胱刺激症状及尿路感染率.     

腹腔镜下全膀胱切除原位回肠新膀胱术(5例报告)

目的 探讨在基层医院采用腹腔镜下全膀胱切除原位回肠新膀胱术的临床应用.方法 浸润性膀胱癌患者5例,年龄60 ～ 65岁,男3例,女2例.采用OLYMPUS腹腔镜根治性切除膀胱后通过腹壁小切口形成回肠新膀胱,然后在腹腔镜下将新膀胱与尿道吻合.结果 5例患者手术均成功.手术平均时间8 h,出血量平均280 ml.术后2周拔除输尿管支架管,术后3周拔除导尿管.术后随访时间5 ～ 19个月,除1例女性患者外均能控制排尿,肾功能电解质大致在正常范围,未见肿瘤复发及远处转移.结论 腹腔镜下全膀胱切除原位回肠新膀胱术使传统的膀胱癌根治手术实现微创化,术中出血少,术后恢复快,在基层医院开展已成为可能.     

Evidence for the need for anaesthesia in the neonate

Neonates are both capable of experiencing pain and memory formation, albeit implicit memory. During surgical procedures, insufficient ablation of the stress response and possible implicit memory formation of intra-operative events might result in adverse early and long-term outcomes. Neonates deserve the same respect as adult patients. It is thus the responsibility of the anaesthetist to provide sufficient anaesthesia for neonates undergoing surgery. A critical approach in weighing the risks and benefits of exposing a neonate to anaesthesia is prudent, and truly elective surgery should be delayed.     

Operative technique for the oesophago-jejunostomy after gastrectomy for the cancer of the stomach

Author's described operative technique for the oesophagojejunostomy after gastrectomy for the cancer of the smonach. We are making antireflux termino-lateral oesophago-jejunostomy with antiperistaltic including proximal parts of the jejunum and distal parts of the duodenum, and with subcolic dextromesenterial propulsive latero-lateral duodeno-jejunostomy.     

Needs for special-care beds for the newborn in the Witwatersrand area

The requirements for different levels of neonatal care in the Witwatersrand area were estimated from a review of neonatal unit records of all infants born at Johannesburg Hospital during 1983 and 1984. When extrapolating these figures to the greater population of the Witwatersrand and referral areas, adjustments were made for the increased number of low-birth-weight and complicated deliveries at Johannesburg Hospital. Given the low-birth-weight rate of 8% for this population, it was calculated that 3.3 intermediate-care beds and 1.2 intensive-care beds were justified per 1,000 annual live births. A total of 25 beds for mechanical ventilation of neonates were required over this study period, approximately double the number available. Facilities for other population groups, who have higher rates for low birth weight, were even less adequate. For the country as a whole it is recognised that postneonatal mortality is a greater problem amenable to less costly intervention than neonatal mortality; nevertheless, existing facilities for neonatal care should be used more efficiently, and a co-ordinated regional service for all population groups in the area should be established.