自闭保护性造口在梗阻性结直肠癌急诊手术中的应用

目的 探讨术中结肠灌洗联合末端回肠自闭插管保护性造口术在左半结直肠癌合并急性梗阻患者手术中的应用价值.方法 左半结直肠癌合并急性梗阻并行手术治疗患者80例,分为插管组（行末端回肠自闭插管保护性造口术）35例,Hartmann组45例.观察插管组术后肠道自动开放成功率,比较2组患者术后造口相关并发症、肠瘘,造口周围皮炎、早期炎症指标及营养状况等.结果 插管组术后肠腔自动开放成功率100％ 插管组造口相关并发症明显少于Hartmann组（P〈0.05）;肠瘘、肠梗阻、早期炎症指标等比较,差异无统计学意义（P〉0.05）;早期营养指标比较,术后第7天,插管组明显优于Hartmann组（P〈0.05）.结论 针对左半结直肠癌合并急性梗阻需要手术治疗的患者,术中结肠灌洗联合末端回肠自闭插管保护性造口术是安全可靠的.与传统Hartmann术比较,不但能避免二次造口回纳术,且能降低术后并发症,改善早期营养状况.     

和爽在结肠代食管病人术前的应用和效果观察

[目的]探讨和爽（复方聚乙二醇电解质散）和传统灌肠方法在食管癌结肠代食管病人术前肠道准备的效果差异。[方法]将40例食管癌结肠代食管病人术前肠道准备随机分成两组,和爽组20例,传统灌肠法组20例。对比观察其肠道清洁度、不良反应与术后并发症率的相关性。[结果]口服和爽组肠道清洁满意度优于传统灌肠组（P〈0．05）,腹胀腹痛、肛门不适感不良反应和吻合口瘘的发生率在两组中有统计学意义（P〈O．05）。[结论]和爽用于肠道准备清洁效果优于传统灌法且并发症少,简便有效,护理方便,病人易于接受。     

一种肠造口灌肠器的设计与应用

正肠造口无括约肌,排便、排气无法控制,如果患者造口远端肠管需行CT或肠镜检查,就要行肠道准备~([1])。传统的肠道准备是通过口服泻药或清洁灌肠来完成,但自造口顺行结肠灌洗法是造口肠道准备的理想方式~([2-3])。肠灌洗常常是一次灌入800~1 000 ml的灌肠液,使用普通灌肠器时由于肠造口无括约肌,而且造口的远端一般开口都比较小,且方向没有规律,灌肠过程中灌肠液极     

结肠造口患者用气囊导尿管行清洁灌肠的应用体会

结肠造口患者清洁灌肠的常用方法是从结肠造口将灌肠液灌入肠道,但如何将灌肠液完全灌入肠道,不从造口处反流是一大难题。我们根据结肠造口的生理特点及气囊导尿管结构原理,2004年2月~2005年1月对6例结肠造口患者进行清洁灌肠的肠道准备,取得满意效果,现介绍如下。1临床资料1·1一般资料本组6例,男5例,女1例;年龄21~58岁,平均32·5岁。均为结肠造口患者,其中乙状结肠癌术后行暂时性结肠造口4个月4例,直肠癌M iles术后永久性单腔造口、结肠刀刺伤和坠落伤后结肠造口各1例。1·2方法1·2·1物品准备:灌洗液为400~500 m l生理盐水或0·1%~0·2…     

预防性双腔造口远端肠道清洁灌肠的护理体会

总结了45例预防性双腔造口远端肠道清洁灌肠的护理体会,主要包括清洁灌肠的体位,用物选择及装置,护患的配合,灌洗方法及注意事项。认为患者取坐位,用点滴输液法连接一次性胃管从造口远端开口灌入液体进行清洁灌肠安全有效。     

等渗性全肠灌洗液在肠造口还纳术前肠道清洁中的应用研究

[目的]寻求一种对肠造口还纳病人方便实用的肠道清洁方法。[方法]将57例拟行肠造口还纳手术的病人随机分为观察组（27例）和对照组（30例），分别采用口服复方聚乙二醇4000溶液及清洁灌肠的方法进行肠道准备。比较两组清洁效果及病人主观不适程度。[结果]观察组清洁效果高于对照组（P〈0.05）；病人主观不适程度观察纽低于对照组（P〈0．01）。[结论]口服复方聚乙二醇4000溶液对行造口还纳手术的病人术前肠道准备的效果优于清洁灌肠。     

经皮内窥镜辅助下盲肠造口顺行结肠灌洗技术护理

1990年MNone首先报道阑尾造瘘结肠顺行灌洗（MACE）用于慢传输性便秘、直肠排空障碍的患者及先天性肛门直肠畸形术后大便失禁者，与逆行灌肠相比较，顺行灌肠有明显的优越性，如疗效显著，并发症少等。Heriot在2002年提出经内镜结肠皮下造口顺行性灌洗技术，使得手术变得更加简单、创伤更小。本中心采用经皮内窥镜辅助下盲肠造口后行顺行结肠灌洗，取得良好临床效果。现将相关护理报告如下。     

球囊灌注器用于结肠造口灌肠效果的研究

目的探讨球囊灌注器应用于结肠造口患者灌肠的效果。方法便利抽样法选择湖北医药学院附属太和医院胃肠外科结肠造口患者80例,按随机数字表法随机分为观察组和对照组各40例。对照组采用传统结肠灌洗方法,使用灌肠筒进行灌洗,通过调节器控制;观察组采用球囊灌注器,每次灌洗器内吸入灌洗液25~30ml,肛管与灌洗器角度为120°,利用封闭液体以上气体的压强,将液体通过肛管快速注入肠腔进行结肠灌洗。比较两组患者的结肠结肠灌洗时间、肠腔清洁程度、患者满意度以及被服污染情况。结果观察组结肠灌洗时间、肠腔清洁程度、患者满意度以及被服污染情况与对照组相比,差异均有统计学意义(均P0.01)。结论球囊灌注器应用于结肠造口灌肠可有效缩短灌洗时间,提高灌洗效率及患者满意度,可在临床推广应用。     

保留左结肠动脉的腹腔镜直肠癌前切除术的临床疗效

目的：比较保留左结肠动脉的腹腔镜直肠癌前切除术的临床疗效。方法回顾性分析77例行腹腔镜直肠癌前切除术患者的临床资料,比较术中保留左结肠动脉（26例）和不保留左结肠动脉（51例）患者的手术时间、术中出血量、术后通气时间、肠系膜根部淋巴结清扫数以及预防性造口和吻合口瘘发生情况。结果77例患者均顺利完成手术,无中转病例。两组肠系膜根部淋巴结清扫数、手术时间、术中出血量、术后通气时间差异无统计学意义（P ＞0．05）,保留组患者未行预防性造口,不保留组8例行末端回肠造口,保留组术后无吻合口瘘,不保留组术后发生 1例吻合口瘘。结论腹腔镜直肠癌前切除术中保留左结肠动脉安全可行,减少了预防性造口,且未增加吻合口瘘的发生。     

改良型灌肠装置应用于结肠造口患者肠道准备中的效果观察

目的提高结肠造口患者清洁灌肠的效果,提升患者满意度。方法将80例结肠造口患者分为对照组与观察组各40例,对照组采用传统清洁灌肠方法,观察组采用改良型灌肠装置,比较两组灌肠次数、操作时间、灌肠效果及患者满意度。结果观察组灌肠效果显著优于对照组,灌肠次数、操作时间均少于对照组、且满意度由67.5%提升至87.5%,差异有统计学意义(P0.05)。结论使用改良型灌肠装置灌肠法操作简单,减少了护士操作时间及灌肠次数,灌洗过程中无粪水逆流现象,提高了肠道清洁效果及患者满意度。     

改良清洁灌肠法在直肠癌患者术前肠道准备中的应用效果分析

目的探讨改良清洁灌肠法在直肠癌患者术前肠道准备中的应用效果。方法选取2006年1月-2008年12月在本院特诊外科住院行手术治疗的直肠癌患者50例,分为观察组28例及对照组22例。观察组采用改良清洁灌肠法行术前肠道准备,对照组采用传统清洁灌肠法行术前肠道准备。记录并比较两组患者灌肠相关指标。结果两组患者在每次灌入液体量、灌肠次数、灌肠液保留时间及自觉症状方面的差异存在统计学意义（均P〈0．05）。与对照组比较,观察组患者每次灌入液体量较多,保留时间长,而灌肠次数减少,自觉症状减轻。结论改良清洁灌肠法在直肠癌患者术前肠道准备中的应用效果优于传统清洁灌肠法。     

Feasibility of umbilical loop ileostomy in overweight and obese patients with rectal cancer during laparoscopic surgery: Preliminary results

We examined the feasibility of umbilical diverting ileostomy for overweight and obese patients with rectal cancer undergoing laparoscopic surgery. Four patients who were overweight or obese (BMI > 27 kg/m²) were initially scheduled for the creation of a conventional loop ileostomy. Intraoperatively, however, this was considered too complicated because of thick subcutaneous fat, bulky mesentery, or both. Instead, patients received a diverting ileostomy with the placement of an umbilical stoma. All patients had protruding umbilical ileostomies. No severe stoma‐related complications were encountered. One patient had minor skin dehiscence, and another had paralytic ileus but resumed oral intake after a short time. Performing a temporary loop ileostomy at the umbilicus was safe and feasible in this small group of overweight and obese patients. This stoma placement may avoid the problems inherent to conventional loop ileostomy in obese subjects.     

Comparison of three colon cleansing methods: evaluation of a randomized clinical trial with 300 ambulatory patients

In a prospective randomized clinical trial, three colon cleansing methods for colonoscopy were compared with regard to a) side effects, b) patient acceptance, c) residual liquid and stool during colonoscopy, and d) quality of the examination. The patients were randomly assigned to one of the following three groups for colon preparation: Group 1 (n = 100) 4 liters of Golytely, group 2 (n = 102) 2 liters of Golytely combined with Cascara-Salax, and group 3 (n = 98) X-Prep (a Senna preparation) combined with an enema. X-Prep (group 3) caused significantly more abdominal cramps than 4 liters of Golytely (group 1) or 2 liters of Golytely with Cascara-Salax (group 2) (p less than 0.001). Vomiting was most frequent in group 1 (p less than 0.05 vs. group 3). The patients therefore preferred X-Prep to 4 liters of Golytely (p less than 0.01). The cleanest colon was obtained with 4 liters of Golytely, while 2 liters of Golytely with Cascara-Salax was least efficacious. The quality of the examination was equal in groups 1 and 3, and clearly better than in group 2 (p less than 0.01). We thus conclude that while 4 liters of Golytely and X-Prep plus enema have equivalent cleansing efficacy for colonoscopy, patients judged X-Prep to be less unpleasant.     

改进右半结肠癌患者术前清洁灌肠方法的研究

目的改进清洁灌肠方法,提高右半结肠癌患者术前清洁灌肠的效果和效率,改善患者主观感受,减少不良反应。方法采用单盲法将120例右半结肠癌患者随机分成两组,每组60例。对照组采用传统清洁灌肠方法,实验组采用改进方法,评价灌肠效果(术中肠道清洁度),记录灌肠效率(灌肠所用时间、术中肠壁水肿、灌肠总次数)及患者主观感受与不良反应(腹部疼痛、心慌气短、睡眠障碍、肛门坠迫感)。结果与对照组比较,实验组肠道清洁度明显提高(χ2=6.249,P<0.05),灌肠所用时间减少(χ2=9.405,P<0.01),术中肠壁水肿减轻(χ2=11.737,P<0.01),灌肠总次数减少(χ2=9.859,P<0.01);在患者主观感受与不良反应方面,腹部胀痛无明显差异(χ2=2.188,P>0.05),心慌气短、睡眠障碍和肛门坠迫感减轻(χ2=6.567,6.182,8.895,P均<0.05)。结论改进后的清洁灌肠方法效果较好,适用于右半结肠癌患者的术前肠道准备。     

复方聚乙二醇电解质散在妇科手术病人术前肠道准备中的应用

[目的]观察复方聚乙二醇电解质散在妇科手术病人术前肠道准备中的应用效果,探讨其护理措施。[方法]将150例妇科择期手术病人随机分为两组,观察组78例应用复方聚乙二醇电解质散进行术前肠道清洁准备,对照组72例口服硫酸镁及常规灌肠。比较两组病人肠道清洁度、肠道清洁过程中不良反应发生情况。[结果]观察组病人肠道清洁度优于对照组(P<0.05);观察组病人肠道清洁过程中发生不良反应为8.9 7%,对照组为19.44%,观察组明显少于对照组(P<0.05)。[结论]复方聚乙二醇电解质散用于妇科手术病人术前肠道清洁效果优于口服硫酸镁及常规灌肠,且不良反应少。     

Fecal tagging: MR colonography without colonic cleansing

Colorectal cancer, mostly arising (>90%) from preexisting adenomatous polyps, continues to be the second leading cause of cancer death. Magnetic resonance colonography (MRC) permits accurate detection of colonic polyps with a diameter larger than 10 mm. Because residual colonic stool cannot be differentiated from polyps, MRC requires a clean colon. However, the rigors associated with colonic cleansing considerably reduce patient acceptance. The need for colonic cleansing could be eliminated, if stool were to acquire a signal intensity different from polyps and identical to the enema used to fill and distend the colon. In principle, there are two approaches to this concept of fecal tagging: dark polyps surrounded by bright stool and a bright enema, and bright polyps surrounded by dark stool and a dark enema. The first approach has been evaluated with some success. Gadolinium (Gd)-DOTA was administered as an oral contrast agent with meals preceding MRC based on the administration of a Gd-based enema. The high cost of Gd-based contrast has limited the clinical utility of this technique. In the second approach patients are provided with barium as an oral fecal tagging agent to render stool dark, and barium for the enema is used to distend the colon during MRC. The colonic wall and polyps arising from it can be made visible after intravenous administration of Gd-based extracellular contrast. This method provides sufficient contrast between the darkened colonic lumen and the brightly enhanced colonic wall to permit virtual endoscopic rendering. Preliminary results showed an exact correlation with findings of conventional endoscopy and surgery. Fecal tagging obviates bowel cleansing and therefore should enhance patient acceptance for MR colonoscopy. Barium as the tagging agent is promising because it is inexpensive, commercially available, and characterized by an excellent safety profile.     

分次与单次口服PEG-EP进行肠道准备的效果观察

目的探讨分次与单次口服聚乙二醇电解质散(PEG-EP)进行结肠镜检查前肠道准备的清洁效果和耐受性。方法将432例进行结肠镜检查的无症状个体,随机分为A组(分次口服)和B组(单次口服)。A组于检查前夜8时和检查当日5时分别口服半包PEG-EP,B组于检查当日5时一次性口服1包PEG-EP(65.56g/袋),比较两组肠道准备的清洁效果和不良反应的发生情况。结果 A组肠道准备的清洁效果优于B组(P0.05),A组患者的耐受性优于B组(P0.05)。结论与单次口服相比,分次口服PEG-EP,既可以保证更好的肠道清洁效果,又减少不良反应,患者耐受性好,容易接受,值得临床推广应用。     

即时结肠灌注肠道清洁效果的临床评估

目的观察结肠灌注透析仪在结肠镜检查前肠道准备的清洁效果及其不良反应。方法200例接受肠镜检查者肠道清洁前随机分为口服甘露醇组（A组）、即时结肠灌注组（B组）及联合A、B方法组（C组）。据结肠镜检查中肠道清洁程度（I～Ⅲ级）和清洁范围（0～4度）评价肠道清洁效果。结果C组肠道清洁程度和清洁范围最理想（1级：P均〈0.01;I级＋Ⅱ级：P〈0.05;失败率：P均〈0.05。4度：全结肠清洁率为39.39%,P〈0.01）。B组降结肠以下清洁率（62.86%）显著高于A组和C组（P〈0.05和P〈0.01）。此外,3组不良反应发生率差异无统计学意义（P〉0.05）。结论即时结肠灌注法安全、便捷、不良作用轻微,清洁效果也令人满意,尤其适用于降结肠、乙状结肠及直肠检查,特别是镜下高频或微波治疗。结合口服泻剂则能满足全结肠甚至回肠下段检查和治疗的肠腔清洁要求。     

Bowel cleansing with polyethylene glycol electrolyte lavage solution

We reviewed our experience with an oral gut lavage solution (GoLYTELY), used as a rapid bowel cleansing preparation, and the prospective clinical trials reported in the literature to compare the overall experience with this type of preparation for colonoscopy and colon surgery. Five studies (546 patients) compared GoLYTELY to standard preparations for colonoscopy, while three trials (177 patients) have studied surgical patients. After evaluating patient tolerance, quality of colonic cleansing, and changes in microflora and colonic gas, GoLYTELY was found to be safe, rapid, and effective. It is well tolerated by patients and may become the preferred method of bowel cleansing.     

不同肠道准备方法对膀胱癌患者术前肠道清洁效果的影响

目的探讨术前不同肠道准备方法对腹腔镜下根治性膀胱切除联合全去带乙状结肠原位新膀胱术患者肠道清洁效果的影响。方法便利抽样法选择2009年6月至2011年7月在南方医科大学珠江医院泌尿外科行腹腔镜下根治性膀胱切除联合全去带乙状结肠原位新膀胱术患者60例为研究对象,按随机数字表法将其分成对照组和观察组,每组均30例。观察组患者术前口服聚乙二醇电解质+蓖麻油后灌肠,对照组患者术前口服蓖麻油后灌肠。比较两组患者肠道的清洁度、不良反应以及患者服药依从性情况。结果与对照组比较,观察组患者肠道清洁情况较好,不良反应发生少且依从性强,差异有均有统计学意义(均P<0.05)。结论口服聚乙二醇电解质+蓖麻油后灌肠能提高患者的肠道准备效果,可减少不良反应,更有利于保证手术的顺利进行。