直肠癌根治术中纱布填塞压迫止血治疗骶前静脉出血的护理

骶前静脉出血是直肠癌根治术术中最危险的并发症,严重时可危及患者生命。2000年12月~2010年12月,我院直肠癌根治术中共发生骶前静脉出血5例,均采用纱布填塞压迫止血,均痊愈出院。现将护理方法报告如下。     

低位骶前畸胎瘤切除术并发骶前大出血(附1例报告)

在对1例低位骶前畸胎瘤患者实施肿瘤切除术中并发骶前大出血,经结扎双侧髂内动脉、阻断腹主动脉、缝扎、图钉按压、双极电凝等处理,均未能止血,改用骶前留置纱布垫填塞压迫后止血。认为妇科手术中并发骶前大出血系由骶前静脉丛或骶椎椎体静脉损伤所致,止血困难,纱布垫填塞压迫效果较好。     

直肠癌术中骶前静脉丛大出血9例分析

目的探讨直肠癌根治术中骶前大出血的预防和处理方法。方法回顾性分析1991～2003年发生的9例骶前大出血的临床资料。结果9例骶前大出血中8例止血成功，1例死亡，出血量500-6000m1。结论熟悉盆腔解剖结构，并按解剖层次正确操作，是预防出血的关键。发生大出血时可用纱布压迫或止血钉止血。     

骶管阻滞术治疗腰椎间盘突出症的护理干预

目的探讨骶管阻滞术治疗腰椎间盘突出症的护理干预。方法对81例采取骶管阻滞术治疗腰椎间盘突出症的患者,介绍本病的治疗方法,做好基础护理及治疗前、后的护理,要及时安慰患者,消除思想顾虑与恐惧心理,使患者积极主动配合治疗。患者康复出院时,做好健康教育。结果经过骶管阻滞治疗术及护理干预的81例腰椎间盘突出症患者,其中治愈58例,好转16例,无效7例。结论腰椎间盘突出症是临床疼痛科的常见病、多发病,不仅严重影响了患者的生活质量,而且给患者带来极大的心身痛苦。通过治疗及有效的护理干预,既缓减了临床症状,提高了疗效,也缩短了病程,降低了复发率,极大地提高了患者的生活质量。     

前列腺原发胃肠道外间质瘤2例报告并文献复习

目的 探讨前列腺胃肠道外间质瘤（EGISTs）的临床特点、影像表现、诊断及治疗.方法 收治前列腺EGISTs患者2例,报告其中1例的临床资料,并进行文献复习.结果 患者因排便困难半年、排尿困难2个月入院,直肠指诊发现直肠前壁黏膜下有一质韧肿物,考虑为直肠肿物.前列腺B超及MRI检查均考虑肿物可能来源于前列腺,术前直肠肿物穿刺活检病理诊断为间叶源性肿瘤.骶前肿物探查术后病理结果提示为梭形细胞肿瘤,诊断为恶性EGISTs,考虑肿物来源于前列腺;免疫组化检查CDⅢ、CD34均阳性.术后辅助伊马替尼治疗,随访3年6个月无复发.结论 前列腺EGISTs以手术治疗为主,确诊需依靠病理及免疫组化检查,转移和不能手术治疗者可行药物辅助靶向治疗.     

接受日间乳腺肿物的糖尿病患者心理护理体会

目的研究分析接受日间乳腺肿物治疗的糖尿病患者心理护理体会。方法随机抽取2017年4月—2018年4月至该院接受治疗的乳腺肿物合并糖尿病带管出院患者59例作回顾性分析,所有患者在入院后接受乳腺肿物切除手术,对患者心理特征予以有效分析,把握其术前、术中、术后心理特性,实施针对性心理护理干预措施。并比较患者心理护理前后焦虑(SAS)、抑郁(SDS)情绪改善情况。结果经组间比较显示护理后患者焦虑、抑郁评分均明显优于护理前(P0.05)。且心理护理后54例患者心理压力及不良情绪得到有效消除,均以良好的心理顺利完成手术治疗,占比91.53%;其中5例患者因过度紧张、恐惧等,抗拒手术手术治疗,后续经护理人员及其家属安抚,手术顺利进行,术后正常出院,占比8.47%。结论将心理护理干预措施应用于接受日间治疗的乳腺肿物合并糖尿病患者围术期期间效果显著,可有效提升患者手术耐受及依从性,缓解心理压力与不良情绪,保障手术效果,促进患者身心健康,可大规模应用于临床中。     

86例囊性脊柱裂围术期护理

198 5年 10月以来 ,我院收治 86例囊性脊柱裂患儿。单纯脊膜膨出 52例 ,脊髓脊膜膨出 34例。行囊壁切除并修补术 ,效果满意。术后发生刀口感染 2例 ,慢性脑积水 1例 ,脑脊液漏 3例 ,死亡 1例。现将围术期护理体会总结如下。围术期护理 :1术前护理 :a.预防感染 :由于肿物皮肤随年龄增大而逐渐变薄 ,或仅为一层透明的薄膜 ,极易破溃感染。因此 ,要避免肿物与床铺或粗糙衣物直接接触 ,可穿柔软内衣或在床上加棉垫 ,并尽量侧卧或俯卧。对皮肤已破溃者 ,外敷湿润的无菌生理盐水纱布 ,每 2～ 4 h更换 1次 ,应用抗生素。b.术前 7天对患儿进行俯卧位…     

综合护理干预对心脏外科老年患者术后认知功能障碍的影响

目的总结老年患者心脏外科手术后并发认知功能障碍的类型及预防护理经验。方法对2011年1月至2012年12月在我科心脏手术后出现认知功能障碍的13例老年患者的临床资料进行回顾性分析。结果兴奋型7,抑郁型4例,混合型2例。经综合治疗与护理后,全部老年患者认知功能障碍症状消失,治愈出院。结论做好术前预防术后护理有助于降低和治疗术后老年患者认知障碍,有助于术后康复。     

StanfordA型主动脉夹层患者术后神经系统损伤的护理

目的探讨Stanford A型主动脉夹层患者术后神经系统损伤的护理经验。方法对24例Stanford A型主动脉夹层患者进行术后病情观察和护理。护理重点是血压监测、神经系统护理、安全护理、呼吸道护理和重症监护病房环境管理。结果 1例因多器官功能损害,感染性休克,心搏骤停死亡;4例自动出院;脑出血1例;脑梗死3例;失语2例;偏瘫4例;苏醒延迟2例;未苏醒2例;术后出现精神症状(定向障碍,认识障碍,幻觉和错觉,焦虑,多疑,被害妄想,拒绝治疗,胡言乱语)13例。术后护理效果理想。结论 Stanford A型主动脉夹层患者术后采取有效的护理措施,严格控制动脉收缩压、加强神经系统的监护、做好呼吸道的管理和护理安全管理,能预防护理不良事件发生,促进患者的康复。     

剖宫产术中宫腔填塞纱布止血的手术配合及护理

1997～ 2 0 0 1年 ,我院对 3 0例剖宫产术中出血患者行宫腔填塞纱布止血 ,效果良好 ,现将手术配合及护理体会介绍如下。临床资料 :3 0例患者年龄 2 3～ 3 2岁 ,平均 2 7岁 ;初次怀孕 2 2例 ,第二次怀孕 8例 ,均为初产妇 ;剖宫产术中出血量为80 0～ 2 0 0 0 ml,平均 140 0 ml,应用大剂量缩宫素、止血药效果不满意改行宫腔填塞纱布 (自制 )止血。治疗方法 :填塞纱布条均为消毒绷带 ,两侧毛边包裹在里 ,折叠为四层。应用时用卵圆钳夹住纱布一端 ,沿宫底自左向右填塞至宫腔上半部 ,不留死腔 ;取另一端自宫颈管穿至阴道 ,然后继续填塞纱布条至子…     

Primary presacral adenocarcinoma

A rare case of a patient who presented with a presacral tumor is described. The tumor, after complete resection, was shown to be a primary adenocarcinoma. After potential sources such as gastrointestinal, pancreas, or prostate were eliminated, the diagnosis of primary presacral adenocarcinoma was made. Possible origins of this unusual tumor are discussed.     

Carcinoid tumor: An extremely unusual presacral lesion

PURPOSE: Use of endorectal ultrasonography in preoperative evaluation of a presacral lesion is demonstrated. METHOD: The natural history, presentation, evaluation, and treatment of presacral lesions in adult patients are presented. The case of a female patient with a presacral carcinoid tumor is presented and discussed. RESULTS: The patient underwent preoperative evaluation including physical examination, hematologic studies, proctosigmoidoscopy, magnetic resonance imaging, computed tomographic scanning, and endorectal ultrasonography. Ultrasonography proved to be extremely valuable in differentiating tumor compression from tumor invasion of the rectal wall. The patient underwent en bloc excision of the lesion, surrounding tissue, and coccyx. Pathologic diagnosis was carcinoid tumor, possibly replacing a presacral lymph node. Postoperative complete gastrointestinal tract work-up and urinary 5-hydroxyindoleacetic acid analysis along with preoperative imaging revealed no evidence of synchronous lesions or additional metastases. CONCLUSIONS: Presacral lesions are extremely rare entities. The role of endorectal ultrasonography has not been clearly defined. This case demonstrates the value of this simple and safe imaging procedure in detecting bowel wall compression vs.invasion, greatly assisting in planning an operative approach.     

原发性心脏恶性肿瘤的诊断与外科治疗经验

目的总结原发性心脏恶性肿瘤的诊断和外科治疗经验。方法2003年1月至2007年12月手术治疗4例原发性心脏恶性肿瘤,其中男1例,女3例,年龄26~43岁,平均35岁,本组除1例右心房肿瘤广泛侵犯右房室环及心包仅做活检外,其余3例均在全麻低温体外循环辅助下行肿瘤切除术,根据肿瘤的部位及侵润程度,完整切除2例,姑息切除1例,同期行室间隔修补、肺动脉成形1例,二尖瓣置换1例,三尖瓣成形1例。结果全组无围术期死亡。单纯探查活检术的患者2个月后死于心力衰竭;1例右心室梭形细胞肉瘤术后辅助放、化疗,术后18个月肿瘤复发死于右心衰竭;1例左心房恶性间皮瘤手术后3个月死于双肺广泛转移;1例左心房梭形细胞肉瘤术后随访5个月无肿瘤复发。结论原发心脏恶性肿瘤预后欠佳,早期诊断,及时手术治疗辅以综合治疗可望改善预后。     

Primary retrorectal adenocarcinoma: report of a case

Primary adenocarcinomas of the retrorectal (presacral) space are uncommon and usually arise from cystic lesions developing from remnants of the embryological postanal gut (tail gut cysts) containing mucous-secreting epithelium. A singular case of a patient who presented with a retrorectal mass is described. A 70-year-old previously healthy man had a four-month history of perianal pain during defecation. Preoperative colonoscopy showed external compression of the lower rectum with normal mucosa; pelvic computed tomography demonstrated a 5.5×4.5 cm² retrorectal oval mass, originating from the posterior lower rectal wall, containing cystic components and some small calcifications. The tumor, after complete resection via transanal approach, was shown to be a very rare case of primary adenocarcinoma of the presacral space. The patient had an uneventful postoperative course and he is free from disease 4 years after surgery. Clinicopathological features and surgical treatment of this unusual tumor are discussed. Received: 29 January 2002 / Accepted: 20 November 2002 Correspondence to M. Solazzo     

Solid-pseudopapillary tumor of the pancreatic tail

We report a case of the rare solid-pseudopapillary tumor of the pancreas. In contrast to other pancreatic tumors, the solid-pseudopapillary tumor has a favorable prognosis. The 60-year-old female patient we report on here was treated by left pancreatic resection combined with splenectomy for a non-metastasizing tumor of the pancreas. A solid-pseudopapillary tumor was found on histology. The patient had no signs of metastases at present. Since a microscopically invasive tumor growth is assumed, oncologically curative resection should be preferred vs the less radical enucleation. The rare solid-pseudopapillary tumor of the pancreas has a good prognosis after successful oncological resection.     

Laparoscopic partial nephrectomy: the effect of preoperative tumor embolization

The purpose of this study was to describe our initial experience with preoperative tumor embolization for laparoscopic partial nephrectomy. Between September 2003 and August 2004, six patients with solid hypervascular renal tumors were treated with a combination of preoperative tumor embolization and laparoscopic partial nephrectomy. Ethanol (100%) was used to preoperatively embolize all major vessels supplying the tumor. The laparoscopic partial nephrectomy procedure was performed without clamping the renal vessels. The mean tumor size was 2.9 cm (range, 2.0-4.0 cm). Mean estimated blood loss was 177mL (range, 40-410 mL). Mean laparoscopy time was 243 minutes (range, 160-290 minutes). Histopathology demonstrated an infected cyst in one patient and a pT1 renal cell carcinoma in five patients, including a specimen with a positive tumor margin. After a mean follow-up period of 30 months (range, 25-36 months), neither residual tumor nor recurrent tumor was identified by imaging studies in any of the six patients. Our initial experience suggests that preoperative embolization for the treatment of hypervascular renal tumors might reduce blood loss during subsequent laparoscopic partial nephrectomy, especially in procedures in which the renal vessels are not clamped. Preoperative tumor embolization may also help prevent the disastrous effect of incomplete tumor resection. A longer follow-up will be necessary to confirm efficacy.     

Controlling a Presacral Hemorrhage by Using a Saline Bag: Report of a Case

The incidence of presacral bleeding during rectal mobilization is low, but the bleeding may be massive and even fatal, therefore, effective hemostasis is critical. We report our successful use of a saline bag tamponade in a patient with a life-threatening presacral hemorrhage after an abdominoperineal resection of an anal carcinoma.     

Hepatic and retroperitoneal tumor resection for late metastases of a Wilms' tumor in an adult patient--a case report.

Hepatic metastases after a Wilms' tumor in adult patients are seen extremely rarely. A 21 year-old male patient developed liver metastases 13 years after resection of a primary left extrarenal Wilms' tumor. In this case, without any other metastases, extended right curative hepatic lobectomy was performed. The patient was re-admitted 4 months after the hepatic lobectomy for a resection of a new Wilms' tumor metastatic mass in the area of the pancreatic tail. The patient received adjuvant high dose systemic chemotherapy with ordinary bone marrow cell rescue after the 2nd operation. He is alive and well with no signs of new metastases 18 months after surgery and adjuvant chemotherapy.     

An unusual case of fatty liver in a patient with desmoid tumor

A desmoid tumor, also known as aggressive fibromatosis, is a rare benign neoplasm that arises from fascial or musculoaponeurotic tissues. It can occur in any anatomical location, most commonly the abdominal wall, shoulder girdle and retroperitoneum. The typical clinical presentation is a painless mass with a slow and progressive invasion of contiguous structures. It is associated with a high local recurrence rate after resection. Many issues regarding the optimal treatment of desmoid tumors remain controversial. Aggressive surgical resection with a wide margin (2-3 cm) remains the gold standard treatment with regard to preserving quality of life. Radiotherapy alone has been shown to be effective for the control of unresectable or recurrent lesions. Desmoid tumors tend to be locally infiltrative, therefore, the fields must be generous to prevent marginal recurrence. The radiation dose appropriate for treating desmoid tumors remains controversial. We present a 25-year-old Caucasian man with local recurrence of a desmoid tumor after repeated surgical resection, treated with radiotherapy. The patient achieved complete tumor regression at 4 mo after radiotherapy, and he is clinically free of disease at 12 mo after the end of treatment, with an acceptable quality of life. The patient developed short bowel syndrome as a complication of second surgical resection. Consequently, radiotherapy might have worsened an already present malabsorption and so led to steatohepatitis.     

Malignant insulinoma presenting a non-functioning metastatic liver tumor 14 years after resection of the primary tumor

A 58-year-old woman who had undergone resection of insulinoma 14 year earlier visited our clinic complaining of abdominal discomfort. Computerized tomographic scan showed multiple liver tumors, and a diagnosis of metastatic tumor of malignant islet cell tumor was confirmed histologically. No oversecretion of hormones or hypoglycemic episode was observed on readmission. Thus, the insulinoma seemed to have transformed to a clinically non-functioning tumor. The patient was treated with transcatheter arterial embolization, resulting in clinical improvement with marked reduction in tumor size. Features of interest in this case included; (1) transformation to non-functioning metastatic liver tumor 14 years after resection of insulinoma, (2) the usefulness of transcatheter arterial embolization for multiple metastatic tumor of malignant islet cell tumor. (Received Oct. 6, 1997; accepted Apr. 24, 1998)