肠造瘘术后患儿造口及肛门同时扩肛效果观察

目的探讨肠造瘘术后造口及肛门同时扩肛的效果,促进患儿肠道功能恢复,减少Ⅱ期巨结肠根治术后并发症。方法将72例肠造瘘患儿随机分成观察组(40例)和对照组(32例),对照组在行Ⅱ期巨结肠根治术前,采用自行研制的有机玻璃扩肛器行造瘘口扩肛保守治疗,每日1次,每次15min,持续3个月。观察组行造瘘口扩肛的同时行肛门扩肛每日1次,每次30min。结果观察组患儿肛管蠕动频率、节律及幅度明显好于对照组;而对照组患儿肛管蠕动频率较慢,且幅度低浅,节律性较差。行Ⅱ期巨结肠根治术,术后均恢复良好,观察者肠梗阻及小肠结肠炎的发生率显著低于对照组(均P<0.05)。结论肠造口术后患儿行肠造口及肛门同时扩肛治疗有助于促进肠道蠕动功能恢复,使关瘘后上下肠段蠕动功能增强,有效防止术后肠梗阻及小肠结肠炎的发生。     

自制小儿肠造口护理保护装置用于造口护理

为解决小儿肠造瘘术后的家庭护理问题,设计了一种适应于各年龄段小儿使用的肠造口护理保护装置,有效地减少了术后造口旁疝、造口周围皮肤感染等并发症发生,保证了Ⅱ期肠还纳术的顺利进行。     

3例人工肛门造口回缩护理体会

２０００年来，笔者碰到３例永久性的人工肛门造口回缩患者，经精心护理，疗效良好。现报告如下：临床资料直肠癌切除人工永久性造口２例，回肓部癌切除I期手术腹壁造口１例。其中男性２例，女性１例；年龄６９～８１岁。３例均在手术后第２天见造口回缩。回缩后的造口由于肛门袋不能有效地阻止术后早期经造口排出的粪便向四周外溢，致使造口周围皮肤受污染发红破溃，患者感觉不适，而且可能致造口缘感染，甚至有可能形成窦道或造口周围脓肿。由于此类病人均为根治术，腹壁切口较大，紧挨着造口，往往会使外溢的粪便污染切口，导致切口感染…     

Miles手术可控人工肛门与腹壁造口功能对比

从 1990年起 ,我们自行设计并实施腹膜外腹壁肌层潜行可控性人工肛门41例 ,效果较满意 ,具有不带造口器具、不污染衣物、排便能控制、四季无臭味、生活能自理、隐蔽等功能。优于一般腹壁造口 ,现对比观察如下。1.临床资料 :因低位直肠癌做Ｍｉｌｅｓ手术 ,采用“鱼口状腹膜外腹壁肌肉潜行可控性人工肛门”术后 1年以上者 41例(男 31例 ,女 10例 ;年龄 31～ 84岁 ) ,与32例 (男 2 3例 ,女 9例 ;年龄 40～ 75岁 )按常规做腹壁造口者术后功能进行对比观察。2 .2种术式效果比较 :按最低生活要求制定 10项对比标准。结果 :可控性人工肛门均无粘膜…     

肠造口患者生活质量研究新进展

肠造口（Enterostomy）是通过外科手术,人为的把一段肠管从腹腔拉出,将开口翻转缝于腹壁切口,取代肛门或者膀胱功能,解决患者排便、排尿问题,因此也叫人工肛门,可分为结肠造口（Colostomy）和回肠造口（Ileostomy）,根据保留的时间又分为暂时性（temporary ostomy）与永久性（permanent ostomy）造口.     

变径齿轮状扩肛器及固定腹带的设计与应用

经腹会阴联合直肠癌根治术并行永久性结肠造口术是直肠癌患者常见的一种治疗方法,术后患者永久性排便改道,给生活造成极大痛苦,而常见的肠造口狭窄并发症更严重影响其生活质量。为预防肠造口狭窄,造口处拆线愈合后,通常采取手指扩肛措施,如用力不当,易引起出血、水肿、疼痛,甚至坏死等并发症。笔者于2009年8月设计制作变径齿轮状扩     

肠造口皮肤黏膜分离合并造口回缩的护理干预

目的 总结肠造口术后患者皮肤黏膜分离并造口回缩的护理经验.方法 行肠造口手术患者64例中,5例术后发生皮肤黏膜分离合并造口回缩,予以积极的全身治疗及心理护理,正确的伤口评估与处理以及营养和健康教育.结果 4例术后18～28 d伤口愈合出院;1例保守治疗效果不佳于术后14 d行造口重建,重建后14 d愈合出院.结论 术后需严密观察造口血运及周围皮肤状况,及时发现和早期处理患者皮肤黏膜分离及造口回缩等并发症,以利于提高患者生活质量.     

肠造口皮肤黏膜分离合并造口回缩的护理干预

目的总结肠造口术后患者皮肤黏膜分离并造口回缩的护理经验。方法行肠造口手术患者64例中,5例术后发生皮肤黏膜分离合并造口回缩,予以积极的全身治疗及心理护理,正确的伤口评估与处理以及营养和健康教育。结果 4例术后18～28d伤口愈合出院;1例保守治疗效果不佳于术后14d行造口重建,重建后14d愈合出院。结论术后需严密观察造口血运及周围皮肤状况,及时发现和早期处理患者皮肤黏膜分离及造口回缩等并发症,以利于提高患者生活质量。     

晚期直肠癌患者造口狭窄及造口周围皮炎的护理1例报告

肠造口术是外科最常施行的手术之一，往往是挽救、延续生命和改善生活质量的重要手段。肠造口术虽然看似简单，但如果术中处理不当或术后护理不当，将会出现多种并发症，增加病人的痛苦。同时造口及其周围皮肤并发症的发生将严重影响病人的生活质量，因此，及时处理好造口及造口周围皮肤并发症尤为重要。2004年3月我院造口门诊接诊了一位直肠癌晚期的乙状结肠造口严重狭窄及造口周围皮炎的患者。现将护理体会报告如下。     

肠造口病人的护理指导

对30例肠造口病人实施分阶段系统的造口护理指导. 结果术后7～15 d 27例病人能够自理造口;出院后调查,20例病人认为造口不会严重影响日常生活.     

Effects of the frequency of ostomy management reinforcement education on self-care knowledge,self-efficacy,and ability of stoma appliance change among Korean hospitalised ostomates

Patients who undergo stoma surgery experience difficulties in adapting physically and psychologically. The priority is to support them in learning self-care for successful rehabilitation and psychosocial adaption to a new life. In order to do this, it is important to provide ostomates with repetitive reinforcement education on self-care in a continuous and individual manner, not just to increase knowledge or perform related skills. This study aims to evaluate the effects of ostomy management reinforcement education (OMRE) in ostomates and to identify the optimal frequency of reinforcement education using an equivalent control group post-test design. Participants were 60 ostomates admitted to a university hospital after ostomy formation surgery, and they were randomly assigned to a control and two experimental groups of this study. The OMRE was given to the control group (n = 20), experimental group 1 (n = 20), and experimental group 2 (n = 20) once, twice, and three times, respectively. Participants' self-care knowledge, self-efficacy, and ability of stoma appliance change were evaluated before and after the OMRE. Major results of this study were as follows: the self-care knowledge score of post-test was higher than the pretest in the control, experimental 1, and experimental two groups (P < 0.001). The self-efficacy score of post-test was higher than the pretest in the control, experimental 1, and experimental 2 groups (P < 0.001). The self-care knowledge score according to the frequency of OMRE did not differ among the control, experimental 1, and experimental 2 groups (F = 1.921, P = 0.156). The self-efficacy score according to the frequency of OMRE was significantly different between the control and experimental groups (F = 8.616, P = 0.001), but there was no difference between the experimental 1 and experimental 2 groups (Scheffe's post-hoc analysis: a < b, c). The ability of stoma appliance change score according to the frequency of OMRE was significantly different between the control and experimental groups (F = 49.546, P < 0.001), but there was no difference between the experimental 1 and experimental 2 groups (Scheffe's post-hoc analysis: a < b, c). Results of this study suggested that the OMRE was effective for promoting hospitalised ostomates' self-care knowledge, self-efficacy, and ability of stoma appliance change, and two sessions of the OMRE was the most effective. Findings of this study may be useful in planning education programmes designed to improve self-care ability for hospitalised ostomates.     

Laparoscopic extraperitoneal colostomy in elective abdominoperineal resection for cancer: a single surgeon experience

Aim Parastomal herniation of end colostomies can be chronically debilitating for patients and a difficult problem to treat. To prevent parastomal hernia (PSH) formation an extraperitoneal colostomy (EPC) approach has been developed in open colorectal surgery and some studies have suggested a potential advantage to this approach. Here we describe our technique of laparoscopic extraperitoneal stoma formation and present our experience to date. Methods We performed a retrospective analysis of consecutive patients undergoing a laparoscopic abdominoperineal resection between March 1999 and March 2011. We performed the EPC technique as follows: under laparoscopic guidance, a smooth tip instrument was used to gently separate the peritoneum from the posterior aponeurotic plane to create an extraperitoneal tunnel running from the skin incision to the left flank of the abdominal cavity to join the previously dissected paracolic gutter. The colon was exteriorized and the position was checked to ensure the absence of torsion or kinking. Results Twenty‐two patients underwent a standard laparoscopic abdominoperineal resection with total mesorectal excision. Colostomy was constructed extraperitoneally (EPC) or transperitoneally (TPC) in 12 and 10 patients respectively. There were five complications requiring operative intervention: two stomal necrosis and one surgical site infection in the TPC group and two small bowel occlusions in the EPC group. Four patients from the TPC group developed PSH at 24, 36, 48 and 72 months respectively while there were no cases of PSH in the EPC group. Conclusion Extraperitoneal laparoscopic colostomy showed a potential reduction of PSH in our series of patients.     

肠造口患者及家属焦虑抑郁状况及对患者造口自护能力的影响

目的了解造口患者及家属围手术期及术后近期焦虑、抑郁的变化情况,探讨其可能的原因,以及焦虑抑郁对患者造口自我护理能力的影响。方法应用汉密顿焦虑及抑郁量表、造口适应量表和造口自我效能量表,对45组造口患者及家属围手术期(术前、术后3天)及术后1、3、6个月分别进行测量,对所得结果进行统计分析。结果造口患者及家属围手术期及术后近期焦虑与抑郁评分组内比较,差异有统计学意义(均P0.05);术后6个月家属焦虑、抑郁与患者自我效能及造口适应水平呈正相关(均P0.01)。结论造口患者家属的负性情绪影响患者对造口的适应水平及焦虑抑郁水平,医护人员应在术前早期对患者及家属提供支持和帮助,使其较好地控制焦虑、抑郁,并在术后持续关注患者生理、心理需求,提高患者造口适应能力,恢复身心健康。     

Patient satisfaction with stoma care and their expectations on mobile apps for supportive care

Aim

Self-efficacy in stoma care is essential, as it reduces morbidity and psychosocial problems. Mobile applications (apps) may optimise patients' self-efficacy. This article investigates patients' satisfaction with stoma care, their attitudes towards a supporting app aiming to promote self-efficacy and evaluate which functionalities are desired.

Method

A survey was sent to members of the two stoma-related patient associations in the Netherlands. Associations between patient characteristics, satisfaction concerning received stoma care, and willingness to use an app were evaluated.

Results

The survey was completed by 1868 patients. Overall satisfaction was scored as 6.6, with shortfalls reported in the preoperative information provision, stoma site selection, and postoperative care. Patients of older age, who were unaware of getting a stoma, had an ileostomy, a low quality of life or psychosocial problems, were less satisfied. An app was expected to be of added value by 59.4% of the patients having a stoma for less than three years, compared to the significantly lower 43.8% expectation rate of the remaining study population (p < 0.001). Moreover, patients with a high frequency of physical or psychosocial problems expressed higher levels of interest.

Conclusion

Patients were only moderately satisfied with their received stoma care. A supportive app is most likely beneficial for patients who had a stoma for less than three years, were in an acute situation, and/or have stoma-related problems. Most patients prefer information via internet or on paper, although apps may offer additional benefits. It is important to acknowledge digital literacy and to council patients appropriately about the benefits and help them to use apps.