互联网＋健康宣教在肠造口患者中的应用

目的探讨互联网＋健康宣教在肠造口患者中的应用效果。 方法选取2017年1月至8月在国家癌症中心/国家肿瘤临床医学研究中心/中国医学科学院北京协和医学院肿瘤医院结直肠外科住院的270例肠造口患者,按照宣教的时间顺序分为观察组和对照组。对照组采用常规围手术期护理模式。观察组在对照组的基础上增加互联网＋的模式,通过公众号的互动、云课堂、门诊病历互联网反馈等形式进行健康宣教,比较两组患者在出院后造口并发症的发生率及护理宣教满意度情况。 结果观察组患者在出院后1个月造口周围粪水性皮炎（χ²=5.391,P=0.02）、皮肤黏膜分离（χ²=4.014,P=0.045）均低于对照组,观察组出院3个月造口周围粪水性皮炎（χ²=5.137,P=0.023）及造口回缩的发生率（χ²=4.060,P=0.044）均低于对照组。统计观察组患者在出院后第3个月的患者满意度,其中宣教途径及方式（χ²=5.40,P=0.02）、问题反馈及时效性（χ²=5.065,P=0.024）优于对照组,差异均有统计学意义（P<0.05）。 结论互联网＋健康宣教在肠造口患者的应用中能明显降低患者早期造口并发症的发生率,提升了患者的生活质量,增加了患者对护理宣教的满意度,值得借鉴和推广。     

出院计划在直肠癌肠造口患者中的应用效果

背景直肠癌是常见的消化系统恶性肿瘤,手术是治疗的主要方式,术后肠造口影响患者的躯体结构、生活方式、心理调试、社会适应性.探索提高直肠癌肠造口患者造口适应性和生活质量的方法有助于患者顺利回归家庭与社会.目的探讨出院计划服务对直肠癌肠造口患者造口适应性、生活质量与造口并发症的影响.方法采用便利抽样法选择2016-10/2018-03在广西壮族自治区人民医院治疗的直肠癌肠造口患者100例为研究对象.采用随机数字表将其分为对照组与观察组,每组50例.对照组采用常规护理及电话随访,观察组在常规护理的基础上实施出院计划模式进行延续性护理,两组病人干预时间均为6 mo.比较两组患者的造口适应性、生活质量、造口并发症发生率等指标.结果出院3 mo和6 mo,观察组造口适应性明显高于对照组,差异均有统计学意义(t=2.136和6.713, P0.05);观察组总体生活质量高于对照组,差异均有统计学意义(t=22.52和24.87, P0.05); 6 mo内,观察组造口并发症发生率低于对照组,差异有统计学意义(χ~2=15.072, P 0.05).结论出院计划模式应用于直肠癌肠造口患者的延续护理中,能提高患者了造口适应性及生活质量,降低造口并发症发生率,值得进一步推广应用.     

一针法预防性回肠造口在直肠癌低位前切除手术中的应用

目的探讨一针法回肠造口方法在直肠癌低位前切除手术中的技术优势。 方法前瞻性分析2016年1月至2019年1月河南省肿瘤医院普外科连续80例行直肠癌低位前切除并预防性回肠造口手术的患者,按随机表法分为一针法回肠造口组（观察组）和传统方法造口组（对照组）,对比两组造口手术操作时间、造口皮肤黏膜分离、粪水性皮炎、造口旁疝、造口脱垂、造口回缩等相关造口并发症指标的发生率。 结果两组患者的基线资料比较差异无统计学意义（均P>0.05）,观察组手术操作时间短于对照组［（2.1±0.9）min vs.（15.2±4.6）min］（t=-17.510,P<0.05）,造口皮肤黏膜分离、粪水性皮炎、造口回缩等发生率与传统方法组比较差异均有统计学意义（观察组造口皮肤黏膜分离患者1例,对照组15例;观察组粪水性皮炎患者3例,对照组32例;观察组造口回缩患者0例,对照组8例）（χ²=15.313,42.717,8.889;P均<0.05）,在造口旁疝、造口脱垂两方面差异无统计学意义（观察组造口旁疝患者2例,对照组6例;观察组造口脱垂患者2例,对照组3例）（χ²=2.222,0.213;P均>0.05）。 结论一针法回肠造口在直肠癌低位前切除术中较传统方法更具操作优势,而且可减少相关造口并发症的发生。     

电灼疗法联合盐酸氨酮戊酸光动力疗法治疗尖锐湿疣疗效观察

目的探讨电灼疗法联合光动力疗法治疗尖锐湿疣的临床效果。方法将120例尖锐湿疣患者随机分为治疗组和对照组各60例。两组均先行电灼疗法治疗;去除疣体后治疗组再行盐酸氨酮戊酸光动力疗法治疗,每周1次,共3次。疗程结束后3个月判定疗效。结果治疗组及对照组总有效率分别为88.33%、58.33%,P〈0.01（χ2=3.917）。结论光动力疗法联合电灼疗法治疗尖锐湿疣效果确切,疗效优于单一疗法。     

腹膜外隧道式结肠造口的观察及护理对策

目的观察腹膜外隧道式结肠造口手术与常规的腹膜内造口术后患者在肠道功能恢复方面及肠造口并发症方面的差异,并探讨护理方法。 方法将205例腹会阴联合切除术患者,按造口手术方式分为两组：治疗组隧道式结肠造口,对照组常规的腹膜内造口。观察两组患者围手术期至术后一年肠道功能恢复情况、结肠造口并发症以及排便情况。 结果围手术期两组患者肠梗阻发生率、结肠造口并发症的发生率差异无统计学意义（P>0.05）。术后患者腹胀症状明显、排便时间延长,治疗组高于对照组,差异有统计学意义（P<0.05）。术后一年内自我护理造口的能力和肠梗阻的发生率两组患者差异无统计学意义（P>0.05）;两组患者在术后形成规律排便习惯方面差异有统计学意义（χ²=6.616,P=0.010）。术后一年内肠造口凹陷、狭窄的发生率两组患者差异无统计学意义（P>0.05）;肠造口旁疝、肠造口脱垂的发生率：治疗组明显低于对照组,差异有统计学意义（均P<0.05）。 结论腹膜外隧道式结肠造口患者术后近期肠道功能恢复时间长于腹膜内造口患者且腹胀症状明显。护士要加强饮食、活动指导,促进肠道功能恢复;术后远期更易形成规律的排便习惯,造口旁疝、造口脱垂的发生率明显低于腹膜内造口患者,因此对于腹膜内结肠造口患者的护理指导内容可根据其优势进行优化调整。     

低位直肠癌保肛手术中回肠襻式造口与改良自闭式造口的对比研究

目的探讨低位直肠癌保肛手术中应用改良自闭式造口的安全性和有效性,比较采用改良自闭式造口与回肠襻式造口两种造口方式的临床疗效。 方法回顾性分析苏北人民医院胃肠外科2016年9月~2018年8月期间60例行低位直肠癌保肛手术患者的临床资料,根据预防性造口实施方式的不同分为：改良自闭式造口组25例,回肠襻式造口组35例。分析指标包括：一般资料及病理资料、术中及术后恢复情况、术后并发症及随访情况。 结果两组患者均未发生吻合口漏,改良自闭式造口组患者术后总住院时间为（8.68±0.95）天,回肠襻式造口组患者术后总住院时间为（14.46±1.20）天,两组比较差异具有统计学意义（t=13.00,P<0.01）,包括行一期造口及二期还纳手术的时间。改良自闭式造口组患者在院总花费为（59 284.52±5 712.63）元,回肠襻式造口组为（75 128.77±10 238.05）元,两组比较差异具有统计学意义（t=6.99,P<0.01）。 结论相比回肠末端襻式造口,改良自闭式造口住院时间少、住院费用低,避免了造口旁疝及造口脱垂等造口相关并发症的出现,是低位直肠癌保肛术中可供选择的预造口方式。     

硫酸镁辅助治疗毛细支气管炎75例临床疗效观察

目的观察硫酸镁对毛细支气管炎的疗效。方法150例患者毛细支气管炎随机分成对照组（n=75）和治疗组（n=75）。两组均常规给予抗生素、全身用激素、局部雾化吸人、吸氧等综合治疗，治疗组采用硫酸镁静脉滴注，对照组用氨茶碱静脉滴注。分别观察两组的疗效。结果治疗组的治愈率明显高于对照组（P〈0．01），且不良反应少。结论：硫酸镁辅助治疗毛细支气管炎安全有效。     

健康教育在糖尿病患者门诊护理中的应用

目的分析研究健康教育在糖尿病患者门诊护理中的应用。方法选取该院在2016年7月—2017年7月接受门诊护理的糖尿病患者102例,随机平分为两组,每组51例,一组观察组和另一组对照组,对照组的糖尿病患者给与常规的门诊护理,而观察组的51例糖尿病患者给与门诊健康教育护理,10周后对比分析两组对的应用效果以及护理效果。结果观察组患者满意程度明显高于对照组,满意度分别为90.20%与64.71%,通过对两组数据分析比较,差异有统计学意义(P=0.001);护理干预前两组患者的空腹血糖值以及糖化血糖蛋白值没有明显差异,护理后对照组的各项血糖值均高于观察组。结论门诊护理中应用健康教育在糖尿病患者中能够有效的调节患者的血糖,控制血糖在一定水平,避免病情加重,提高了治疗疗效,值得临床推广。     

自我肯定理论在老年结直肠癌患者造口护理中的应用观察

目的 探究自我肯定理论在老年结直肠癌患者造口护理中的应用效果,以及对患者并发症、造口周围皮肤健康程度、自我效能和生活质量的影响.方法 选择于2019年12月-2020年12月复旦大学附属华山医院收治的老年结直肠癌造口患者76例,采用随机数表法分为观察组(n=39)和对照组(n=37).对照组患者采用常规护理,观察组患者...     

伤口造口护理组在护理品质管理中的应用分析

目的对伤口造口护理组在护理品质管理中的应用进行分析。方法随机抽取2014年11月~2015年11月之间148例我院伤口造口患者,根据随机数字表法,分为观察组和对照组各74例,对观察组患者予以伤口造口护理,对照组予以常规护理,观察并对比两组患者的护理满意度。结果观察组护理满意度达到100.00%,高于对照组82.43%,具有统计学意义(P0.05)。结论对伤口造口患者采用伤口造口护理方式,能够有效提高患者及家属的护理满意度,具有临床推广价值。     

Wound management in an era of increasing bacterial antibiotic resistance: A role for topical silver treatment

Background: Antibiotic-resistant bacteria represent an increasing concern in wound infections. Wound colonization with these organisms normally results in aggressive management of the wound complicated by a greatly limited choice of therapeutic antibiotics. Silver and other noble metals are recognized as potential allies in combating these organisms in wounds. Methods: Three types of topical silver applications were tested to determine their bactericidal efficacies against clinical isolates of antibiotic-resistant organisms. The silver-based applications represent 3 methods of applying silver to wounds: as a liquid (silver nitrate), incorporated in a cream (silver sulfadiazine) and as a dressing coating (silver-coated dressings). The reduction in the viable bacterial population recovered from test articles after exposure to silver provided a comparative measure of the bactericidal efficacies of these silver applications. Results: All of the products demonstrated an ability to reduce the number of viable bacteria. However, the methods varied in their efficacy against antibiotic-resistant bacteria, with the silver-coated dressing being the most efficacious and silver nitrate the least efficacious. Conclusions: Silver was demonstrated to be effective at killing the antibiotic-resistant strains tested. The silver-coated dressing was particularly rapid at killing the tested bacteria and was effective against a broader range of bacteria. Silver may be a useful prophylactic or therapeutic agent for the prevention of wound colonization by organisms that impede healing, including antibiotic-resistant bacteria. (AJIC Am J Infect Control 1998;26:572-7)     

三种手术方法治疗乳糜尿的疗效比较

用３种手术方法治疗丝虫性乳糜尿１７０例，总有效率为８７％。大剂量硝酸银肾盂灌注法有效率为８３．２％，腹股沟淋巴结大隐静脉吻合术有效率为８８．６０％，两法疗效无差异（Ｐ＞０．１）。肾蒂周围淋巴管结扎术有效率为１００％，但副作用较多。认为腹股沟淋巴结大隐静脉吻合术为外科治疗乳糜尿的选择方法。     

内镜下高频电刀治疗气管-支气管结核的初步临床观察

目的评价高频电刀治疗支气管结核的临床疗效和安全性。方法支气管结核13例，全身常规抗结核治疗及雾化治疗的同时，加用内镜下高频电刀治疗，观察治疗效果。结果8例溃疡型／或增殖型患者支气管内干酪样坏死物和肉芽组织被清除。2例管壁可见散在的小瘢痕。X线胸片显示10例患者肺结核病灶有明显吸收，无1例出现病灶增多或播散。3例肺不张患者肺复张。高频电刀治疗前后病人的心率和血氧饱和度无明显变化。结论高频电刀治疗支气管结核效果好，对正常组织损伤小，创面恢复快，并发症少，值得推广。     

Endoscopic hemostasis for hemorrhagic gastroduodenal ulcer. Meta-analysis of randomized clinical trials]

To demonstrate the advantages of various endoscopic hemostatic methods (laser photocoagulation, electrocautery, injection therapy) for bleeding gastroduodenal ulcer in patients at high risk for continued or recurrent bleeding, a critical review of published randomized clinical trials was made with meta-analytic methods. Only the 15 clinical trials dealing either with patients with visible non bleeding vessels or spurting arterial bleeding were included. Regarding visible non bleeding vessels, the meta-analysis of five trials on electrocautery and two trials on sclerotherapy showed a significant reduction in rebleeding rates in the treatment group compared with untreated controls. The odds ratios were 4 (95 percent confidence levels (CL): 2.4-6.9) (P less than 0.001) and 6.8 (95 percent CL: 2.7-17.2) (P less than 0.001), respectively. As well, the meta-analysis of four trials on electrocautery and the two trials on sclerotherapy showed a significant reduction in the number of emergency surgical operations in the treated groups a compared with the untreated groups. The odds ratios were 5.5 (95 percent confidence levels (CL): 2.7-11.3) (P less than 0.001) and 6.1 (95 percent CL: 2.1-17.8) (P less than 0.001), respectively. Meta-analysis did not show any advantage for laser, electrocautery, or sclerotherapy in terms of mortality. Indirect meta-analysis did not reveal any difference between electrocautery and sclerotherapy. Regarding spurting arterial bleeding, meta-analysis of the two YAG laser trials, the two Argon laser trials, and the two electrocautery trials showed a significant reduction of rebleeding or continued bleeding in the treatment groups as compared with the control groups.(ABSTRACT TRUNCATED AT 250 WORDS)     

Stomal varices: a rare cause of stomal hemorrhage. A report of three cases

Stomal varices secondary to portal hypertension are a rare but potentially fatal cause of hemorrhage. Management, determined by the site of the bleeding, centers on preventing additional bleeds and may include providing local pressure, applying silver nitrate, injection sclerotherapy, suture ligation of the bleeding point, and/or the placement of transjugular intrahepatic portosystemic shunts and refashioning the stoma. Two patients (60- and 69-year-old women) had panproctocolectomy for inflammatory bowel disease and presented at the authors' hospital with bleeding from the ileostomy 1 and 19 years, respectively, following the creation of their stomas. A third patient (a 72-year-old man) bled from an end colostomy following an abdominoperineal resection for Duke's C rectal adenocarcinoma performed 3 years previous. All three patients had recurrent admissions for stomal bleeding and stomal varices secondary to portal hypertension and were initially treated with local measures (pressure, silver nitrate, and suture ligation). Two had undergone revision of their stomas prior to current treatment. One patient responded to local treatment but later died due to liver failure, one stopped bleeding after transjugular portosystemic shunt placement, and one died from metastatic cancer. Clinicians should maintain a high index of suspicion of stomal varices in patients with underlying liver disease who present with recurrent stomal bleeds and provide appropriate treatment to stop active bleeding and reduce portal venous pressure.     

内镜电凝加PPI治疗岛型及舌型SSBE疗效观察

目的观察内镜下高频电凝加PPI治疗岛型及舌型SSBE的近中期疗效及安全性。方法经内镜及病理检查确诊的岛型及舌型SSBE病例39例,随机及自愿结合分组。23例治疗组患者在内镜下对岛型及舌型SSBE病灶施行高频电凝治疗,同时口服雷贝拉唑,20mg,bid,疗程4周。16例对照组患者则单纯予雷贝拉唑口服,20mg,bid,持续抑酸治疗。分别于治疗后第3个月、6个月、12个月、18个月及24个月行胃镜随访,对照原内镜图片,观察各组岛型及舌型SSBE病灶的变化,并在原病灶处取活组织检查其病理改变。对治疗组中复查内镜未达显效者,再次行镜下电凝治疗并予雷贝拉唑口服,20mg,bid,疗程4周。结果治疗组随访病例平均显效率87.6%,总有效率100%;未出现出血、穿孔及食管狭窄等并发症。对照组平均显效率6.6%,平均总有效率26.5%,平均无效率73.5%。结论经内镜下高频电凝加PPI治疗岛型及舌型SSBE安全,近期疗效明显。     

Electrocautery vs non-electrocautery dilation catheters in endoscopic ultrasonography-guided pancreatic fluid collection drainage

AIM: To investigate the safety and utility of an electrocautery dilation catheter for endoscopic ultrasonography(EUS)-guided pancreatic fluid collection drainage.METHODS: A single-center, exploratory, retrospective study was conducted between August 2010 and August 2014. This study was approved by the Medical Ethics Committee of our institution. Informed, written consent was obtained from each patient prior to the procedure. The subjects included 28 consecutive patients who underwent EUS-guided transmural drainage(EUS-TD) for symptomatic pancreatic and peripancreatic fluid collections(PFCs) by fine needle aspiration using a 19-gauge needle. These patients were retrospectively divided into two groups based on the use of an electrocautery dilation catheter as a fistula dilation device; 15 patients were treated with an electrocautery dilation catheter(electrocautery group), and 13 patients were treated with a non-electrocautery dilation catheter(non-electrocautery group). We evaluated the technical and clinical successes and the adverse events associated with EUS-TD for the treatment of PFCs between the two groups.RESULTS: There were no significant differences in age, sex, type, location and diameter of PFCs between the groups. Thirteen patients(87%) in the electrocauterygroup and 10 patients(77%) in the non-electrocautery group presented with infected PFCs. The technical success rates of EUS-TD for the treatment of PFCs were 100%(15/15) and 100%(13/13) for the electrocautery and the non-electrocautery groups, respectively. The clinical success rates of EUS-TD for the treatment of PFCs were 67%(10/15) and 69%(9/13) for the electrocautery and the non-electrocautery groups, respectively(P = 0.794). The procedure time of EUS-TD for the treatment of PFCs in the electrocautery group was significantly shorter than that of the non-electrocautery group(mean ± SD: 30 ± 12 min vs 52 ± 20 min, P 0.001). Adverse events associated with EUS-TD for the treatment of PFCs occurred in 0 patients and 1 patient for the electrocautery and the non-electrocautery groups, respectively(P = 0.942).CONCLUSION: EUS-TD using an electrocautery dilation catheter as a fistula dilation device for the treatment of symptomatic PFCs appears safe and contributes to a shorter procedure time.     

Effective Management of Posthemorrhoidectomy Secondary Hemorrhage Using Rectal Irrigation

PURPOSE: How to manage posthemorrhoidectomy secondary hemorrhage, a rare but serious complication, effectively remains controversial. This study evaluated the effectiveness of using rectal irrigation as an initial treatment for posthemorrhoidectomy secondary hemorrhage. METHODS: Among 4,880 patients on whom elective closed hemorrhoidectomy for symptomatic hemorrhoidal disease was performed, 45 (0.9 percent) developed posthemorrhoidectomy secondary hemorrhage. The 45 patients were divided into two groups based on the initial treatment in the stoma therapy room (n = 25) or in the operating room (n = 20). Patients in the stoma therapy room group were treated with rectal irrigation, whereas those in the operating room group were examined under anesthesia and the bleeding point (if any) was under-run using a suture. The two groups were then compared with respect to the cost-effectiveness of treatment, rehospitalization stay, and satisfaction with treatment. RESULTS: The two groups (stoma therapy room vs. operating room groups) were comparable with respect to the mean age of patients (44 vs. 38 years), interval of hemorrhage (9.4 vs. 7.8 days), and estimated amount of blood loss (560 vs. 520 ml). Bleeding effectively stopped in 22 (88 percent) patients in the stoma therapy room group but only in 12 (60 percent) patients in the operating room group (P = 0.010). The rehospitalization stay was three days in the stoma therapy room and 4.9 days in the operating room group (P = 0.016). In addition, the stoma therapy room group had a greater satisfaction rate than the operating room group did (80 vs. 10 percent, P < 0.001). Moreover, the average cost of treatment in the operating room group was six-fold higher than that in the stoma therapy room group. CONCLUSIONS: Our data suggest that rectal irrigation is an effective initial treatment for posthemorrhoidectomy secondary hemorrhage and offers a high rate of patient satisfaction with a reduced hospital cost.     

High frequency diathermy--a new method in the treatment of malignant and benign stenosis of the airways

High-frequency electrocautery is a relatively new method in the treatment of malignant or benign airway stenoses. We report on the results of 58 sessions in 41 patients (malignant condition n = 30, benign n = 11) within a three-year period. Various instruments were available for coagulation (blunt probe, knives of 4, 5 and 7 mm length, forceps and wire snare). 53/58 sessions were performed under general anaesthesia, energy was limited to 40 W with unlimited duration of pulses. The knives were the most frequently used devices, preferably with a length of 5 mm, which enabled us to either cut the tumour or scar tissue precisely slice by slice or to resect by direct coagulation. The use of the blunt probes and forceps was frequently rendered more difficult by detritus covering the instrument during coagulation. Polypes were easily resected with the wire snare, but this kind of tumour was found in four patients only. Major (> 100 ml) bleeding occurred in two patients. Obstructing fibrinous membranes were never seen after electrocautery. In conclusion, high-frequency electrocautery is an effective and safe method for endobronchial resection and can be considered a good alternative to the laser as the classical method for endobronchial resection.     

OVARIAN ELECTROCAUTERY VERSUS HUMAN MENOPAUSAL GONADOTROPHINS AND PURE FOLLICLE STIMULATING HORMONE THERAPY IN THE TREATMENT OF PATIENTS WITH POLYCYSTIC OVARIAN DISEASE

Eighty-eight clomiphene citrate-resistant infertile patients with oligomeno-rrhoea or amenorrhoea attributable to polycystic ovarian disease were divided at random into three groups. Twenty-nine patients were treated with ovarian electrocautery, 30 with human menopausal gonadotropins (hMG) and 29 with pure follicle stimulating hormone (FSH). Successful ovulation was induced in 71-4, 70-6 and 66-7% of the cycles in the groups respectively. Ten patients conceived after electrocautery and pure FSH therapy while 15 conceived after hMG medication (chi-squared = 1 -6464, P = 0–439). The six-cycle cumulative pregnancy rate in the three consecutive groups was 521, 55-4 and 38-3%. Four further pregnancies were achieved after treating 10 patients in the electrocautery group with clomiphene citrate (100 mg/day for 5 days) for 25 cycles. The rate of pregnancy wastage in the corresponding groups was 21-4, 53-3 and 40% (chi-squared = 3–127, P = 0–2039). Ovarian electrocautery is equally effective as hMG and pure FSH in the treatment of PCO patients resistant to clomiphene citrate therapy.