永久性结肠造口患者的生存质量及影响因素调查

目的了解永久性结肠造口患者回归社会后的生存质量及影响生存质量的因素，为以后制定患者的出院指导方案提供科学依据。方法用自设问卷调查表及健康状况问卷量表（Short Fort 36 Health Survev Questionnaire,SF-36）来调查永久性结肠造口患者的生存质量及影响因素。结果永久性结肠造口患者生存质量各维度得分均比一般人群低，统计学差异有显著性意义（P〈0．05）；对影响患者生活质量的多项因素进行逐步回归分析，得出影响患者生存质量的主要因素是：家庭关系、费用支付能力、并发症、病程等。结论制定患者出院指导计划时，应把提高患者的长远生存质量作为指导重点。     

结直肠癌患者永久性肠造口后早期压力状况及其影响因素分析

目的:调查结直肠癌患者永久性肠造口后早期压力状况,并分析其影响因素。方法:选择2020年3月至2022年3月于我院行永久性肠造口的160例结直肠癌患者为研究对象,于患者出院前采用一般资料问卷和肠造口压力量表进行调查,分析患者造口后早期压力状况及其影响因素。结果:160例结直肠癌患者的造口相关压力评分量表各条目均分为(2.69±0.55)分,各维度均分从高到低依次为躯体改变、自我概念改变、造口护理、家庭压力。160例患者中,轻度压力22例(13.75%),中度压力110例(68.75%),重度压力28例(17.50%)。性别、家庭人均月收入、术前造口知情情况、造口自理情况、造口及周围皮肤并发症、大便意外渗漏频率、护理造口时间均为永久性肠造口后早期压力的独立影响因素,P<0.05。结论:结直肠癌患者永久性肠造口后早期压力较大,且影响因素众多,护理人员应根据患者具体情况予以相应的措施缓解患者压力。     

永久性肠造口患者心理韧性调查及其影响因素分析

为调查永久性肠造口患者心理韧性现状,并分析其影响因素,选取2018年6月至2019年12月于我院行永久性肠造口的74例直肠癌患者,采用自制调查表采集患者一般资料信息,采用中文版心理韧性量表评估患者心理韧性水平,并分析影响患者心理韧性的相关因素.结果显示,永久性肠造口患者心理韧性总分为(65.29±11.59)分,处于中...     

永久性结肠造口早期患者自我护理能力及其影响因素

目的 探讨结肠造口早期患者自我护理能力及其影响因素.方法 时60例结肠造口术后1～12月的患者采用一般资料调查问卷、自我护理能力量表、社会支持评定量表和健康行为量表进行调查.结果 造口患者自我意愿得分35.48±2.99,为高水平;自护知识得分12.70±2.77,为高水平低值;自护技能得分4.97±2.70,为低水平.社会支持评分37.37±5.27,患者具有满意的社会支持度.健康行为评分104.15±16.87,处于中等水平.年龄是自我意愿和自护技能的影响因素(P<0.01);家庭收入对自我意愿有显著影响(P<0.01);社会支持影响患者的自护技能(P<0.05);健康行为对自护知识有显著影响(P<0.01).结论 造口患者早期自我意愿水平最高,自护知识处于高水平低值,自护技能水平低,影响因素包括年龄、家庭收入、社会支持和健康行为.护理人员应重视造口早期患者自我护理能力的培养,特别是自护知识和技能的教育,以提高患者的生活质量.     

永久性结肠造口患者心理一致感水平调查分析

目的了解永久性结肠造口患者心理一致感水平,为提高患者生活质量提供依据。方法采用一般资料调查表、疾病相关资料调查表和心理一致感量表对300例永久性结肠造口患者进行问卷调查。结果患者心理一致感平均得分为(68.02±9.43)分;男性得分显著高于女性,患者的心理一致感水平与其家庭人均月收入、造口自理水平、造口知识水平呈正相关(均P<0.05)。结论永久性结肠造口患者心理一致感水平受多种因素的影响,女性、收入低、造口知识缺乏的患者应成为干预的重点。     

造口定位及健康教育在预防永久性结肠造口旁疝中的作用

目的:研究造口定位及健康教育在预防永久性结肠造口旁疝中的作用.方法:术前造口定位,按阶段采取多种方式进行讲解预防造口旁疝知识的健康教育.结果:随访2年无一例造口旁疝的发生,大大提高了患者的生活质量.结论:造口定位及健康教育对预防和减少造口旁疝的发生率有十分重要的意义.     

结肠造口并发症与相关因素分析

目的 探讨结肠造口并发症的相关因素。方法 回顾性总结浙江省人民医院1984年至2002年间1263例结肠造口的临床资料，分析手术情形、造口类型及构造、患年龄、性别、体形等个体因素对造口并发症的影响。观察存活时间与造口并发症的伴随情况。结果 1263例结肠造口中有443例(35．1％)出现637个造口并发症。主要为：造口局部坏死2．4％，造口周围皮肤刺激21．9％，造口回缩狭窄5．6％，造口黏膜脱垂10．5％，造口旁疝9．3％；其它如肠梗阻、造口出血等发生率为1．3％。82．7％的并发症出现于术后1年内。急诊造口的局部坏死、回缩狭窄的发生率高于择期造口。袢式造口与末端造口相比，局部坏死率低，但早期皮肤刺激发生率高，后期黏膜脱垂和造口旁疝的发生率高。末端结肠造口通过腹膜外隧道可有效减少并发症的发生率。年龄超过60岁的患，其造口并发症的发生率明显升高。体形消瘦造口脱垂和旁疝的发生率上升，体形肥胖造口局部坏死、皮肤刺激和回缩狭窄的发生率增加。随着观察时间的增加，造口皮肤刺激并发症减少而造口脱垂和旁疝的发生率上升。结论 结肠造口并发症有较高的发生率，与手术情形、患年龄及体形有密切关系。根据个体情况，选择合理的造口类型和构造，有助于减少造口并发症的发生率和改善患的生活质量。     

结肠造口并发症分析

目的探讨结肠造口方式与造口并发症之间的关系。方法回顾性总结385例行结肠造口患者的临床资料,分析造口类型、造口途径等因素对造口并发症的影响。结果 385例结肠造口中有158例(41.0%)出现226个造口并发症。襻式造口与端式造口相比,局部肠坏死率低,但早期皮肤刺激发生率高,后期肠脱垂和造口旁疝的发生率高。端式造口通过腹膜外隧道可有效减少并发症的发生率。结论结肠造口并发症有较高的发生率,与造口类型、造口途径有密切关系。     

直肠癌永久性造口患者体力活动现状及影响因素研究

目的 调查直肠癌永久性造口患者的体力活动现状并分析其影响因素,为医护人员开展直肠癌永久性造口患者体力活动指导和干预提供参考.方法 采用便利抽样法选取直肠癌永久性造口患者286例,采用基本资料调查表和中文版国际体力活动问卷短卷进行调查.结果 45.80％直肠癌永久性造口患者为低水平体力活动,仅25.87％患者达到指南推荐...     

Evaluation of the end colostomy complications and the risk factors influencing them in Iranian patients

INTRODUCTION: The aim of this study was to assess the prevalence of end colostomy complications and the evaluation of factors influencing outcome. PATIENTS AND METHODS: Three hundred and thirty patients with end colostomy were studied. All patient were recalled for examination for recent complications. Early complications included stoma site pain, early dermal irritation (during the first month after surgery), mucosal bleeding, stomal prolapse and psychosocial complications. Late complications included peristomal hernia, stomal stenosis, late dermal irritation (after the first month), stomal retraction, stomal necrosis and other stoma complications (perforation, fistula etc.). Probable underlying factors were studied. To evaluate risk factors affecting complications, univariable analysis and then multivariable analysis by binary logistic regression was performed. RESULTS: One hundred and one (30.6%) patients had no complications and the remainder had at least one of early or late complications. Overall, psychosocial complications, 56.4%; mucosal bleeding, 34.5%; early dermal irritation, 23.5% were the most frequent complications. Peristomal hernia (11.2%) was the most common late complication. Those aged > 40 years had significant associations with psychosocial problem (OR = 2.77), mucosal haemorrhage (OR = 2.19), and early dermal irritation (OR = 3.14). The risks of peristomal hernia and early dermal irritation are greater in the patients with BMI > 25 kg/m2 (OR = 2.08 and 2.55, respectively). CONCLUSION: The risk of most prevalent complications of colostomy construction increases in elder patients. The high prevalence of psychosocial and skin problems in patients with a colostomy, needs special attention especially from the viewpoint of education by trained stoma nurses and preparation of standard equipment.     

A simple purse string suture technique for treatment of colostomy prolapse and intussusception.

A simple purse string technique for treatment of colostomy prolapse and intussusception is described. It is suggested as an alternative to more complicated procedures.     

Morbidity and mortality of colostomy and its closure in children

Background

This study evaluated the complications of colostomy and its closure in infants and children.

Methods

One hundred forty-six colostomies were performed in 86 neonates, 23 infants, and 37 children older than 1 year. These children underwent colostomies for anorectal malformation (84), Hirschsprung’s disease (47), and other miscellaneous (15) conditions like colonic atresia, volvulus, rectal tuberculosis, traumatic rectal perforation, and intestinal obstruction caused by ascariasis.

Results

Of these, 17 (11.6%) had early complications, and 80 (69.8%) had stomal complications. Three patients died, but only 1 death was directly related to colostomy. Colostomy prolapse, peristomal excoriation, and malnutrition were the major complications. The complications were not dependant on the children’s age or primary indication. Sigmoid colostomy had a lower malnutrition rate than transverse colostomy (34.9% v 16.9% P = .009). Among the 56 children who underwent colostomy closure, major complications include death (1.8%), anastomotic leak (7.1%), and wound infection (12.6%).

Conclusions

A divided sigmoid colostomy should be performed whenever possible. Proper stomal care, regular nutritional assessment, and early closure of the colostomy would minimize morbidity and mortality of colostomy and its closure.     

Side-to-end anastomosis in a colostomy for acute malignant large-bowel obstruction: Side-to-end anastomosis with a colostomy (STEC procedure)

This report describes the use of side-to-end anastomosis in a colostomy for an acute malignant large-bowel obstruction. A 59-year-old man presented with a colonic obstruction due to advanced descending colon cancer. The preoperative imaging studies revealed a complete obstruction of the descending colon at the site of the splenic flexure, a remarkably dilated transverse colon, and no other metastatic lesions. Side-to-end anastomosis was performed with the colostomy because of the high comorbidity associated with such cases. When the patient’s general condition improved, a stoma closure was performed under local anesthesia. In conclusion, a side-to-end anastomosis with a colostomy (STEC procedure) was found to be a simple, useful, and cost-effective technique for an acute malignant large-bowel obstruction, particularly in a high-risk patient.     

永久性肠造口患者疾病获益感的正念认知干预

目的 提高永久性肠造口患者疾病获益感及相应正性认知。方法 将60例结直肠癌行永久性肠造口术后患者随机分为对照组与观察组各30例;对照组行肠造口术后常规护理;观察组在常规护理的基础上,实施正念认知疗法干预方案8周,于干预前、干预完成时、干预完成后4周测评效果。结果 干预后观察组疾病获益感、领悟社会支持、医学应对方式、焦虑抑郁、社会心理适应得分显著优于对照组(P<0.05,P<0.01)。结论 正念认知疗法能促进患者面对身心创伤以积极心态面对,提高疾病获益感,降低焦虑抑郁情绪,从而提高社会心理适应水平。     

Long‐term quality of life in patients with permanent sigmoid colostomy

Aim The study aimed to assess quality of life (QoL) in patients with a sigmoid colostomy using a simple general and disease‐specific instrument. A subgroup not doing well was identified and examined further. Method The Short Health Scale (SHS) is a four‐item instrument exploring severity of symptoms, function in daily life, worry, and general well‐being, using visual analogue scales ranging from 0 to 100 where 100 is the worst possible situation. The SHS was delivered to 206 patients with a sigmoid colostomy. It was returned by 181 (87.9%) patients [88 men; median age 73 (33–91) years]. Follow‐up was 61 (10–484) months for 178 (86.4%) patients returning usable questionnaires. A subgroup of 16 patients scoring more than 50 in all four items of the SHS was further examined with StomaQOL where 100 is best possible. Results The median score for severity of symptoms was 18 (2–95), function in daily life 21 (0–95), worry 17 (3–98) and general well‐being 22 (0–99). A score of < 50 in the SHS was recorded in 84.9%, 82.1%, 79.9% and 70.5% respectively. In the group scoring more than 50 in all four items patients diagnosed with irritable bowel syndrome constituted 43.8% to compare with 5.6% in the entire study group (P < 0.001). Median score for StomaQOL was 37 (22–62) in this group. Conclusion Most patients with a permanent sigmoid colostomy have a good QoL consistent with previous findings. However, this is reduced in a subgroup of patients diagnosed with irritable bowel syndrome.     

Risk factors for parastomal hernia in Japanese patients with permanent colostomy

Purpose

Although the definitive risk factors for parastomal hernia development remain unclear, potential contributing factors have been reported from Western countries. The aim of this study was to identify the risk factors for parastomal hernia in Japanese patients with permanent colostomies.

Methods

All patients who received abdominoperineal resection or total pelvic exenteration at our institution between December 2004 and December 2011 were reviewed. Patient-related, operation-related and postoperative variables were evaluated, in both univariate and multivariate analyses, to identify the risk factors for parastomal hernia formation.

Results

Of the 80 patients who underwent colostomy, 22 (27.5 %) developed a parastomal hernia during a median follow-up period of 953 days (range 15–2792 days). Hernia development was significantly associated with increasing patient age and body mass index, a laparoscopic surgical approach and the transperitoneal route of colostomy formation. In the multivariate analysis, the body mass index (p = 0.022), the laparoscopic approach (p = 0.043) and transperitoneal stoma creation (p = 0.021) retained statistical significance.

Conclusions

Our findings in Japanese ostomates match those from Western countries: a higher body mass index, the use of a laparoscopic approach and a transperitoneal colostomy are significant independent risk factors for parastomal hernia formation. The precise role of the stoma creation route remains unclear.