低位直肠癌保肛手术的护理

我国直肠癌患者中以低位直肠癌多见,约占全部直肠癌的65％～75％。自1908年Mile倡导经腹会阴联合直肠癌根治术以来,此术式一直作为治疗直肠癌的金标准。近年来,随着对直肠肛管解剖和直肠癌淋巴结转移规律的不断深入研究以及手术器械的改进和辅助治疗护理手段的完善,     

低位直肠癌保肛手术疗效观察

我们1991-07～2002—12对低位直肠癌行保肛手术26例，效果较好．总结如下。     

低位直肠癌保肛手术31例治疗体会

我们于1984年1月～1996年7月对31例低位直肠癌行保留肛门癌肿切除术。报告如下。1临床资料1．1一般资料31例中,男17例,女14例;年龄32～78岁,平均57岁。均因便血就诊。肛门指检发现肿块,病理确诊。肿块距肛缘4.0～8．0cm,平均7．0cm;肿块大小2．0～5.0cm。1．2Dukes分期以1978年Dukes分期补充意见为标准：A0期3例,A1期2例,A2期2例（A期共7例）,B期16例,C1期3例,C2期3例,D期2例。组织学分型：腺癌20例,粘液腺癌5例,印戒细胞癌3例,其他3例。1．3治疗与结果31例中23例行Dixon手术（l例应用双吻合器,8例丝线手法缝合）,2…     

双吻合器在低位直肠癌保肛手术中的应用

目的:探讨双吻合器在低位直肠癌保肛手术中的应用及临床价值。方法:应用双吻合器对34例低位直肠癌患者行低位前切除保肛手术,并对患者术后的并发症和排便功能进行分析。结果:全组手术无死亡,术后发生吻合口瘘1例(2%),吻合口狭窄1例(2%),局部复发2例(5%),盆腔内复发2例(5%),术后排便次数增多28例(82%)。结论:双吻合器的应用提高了低位直肠癌保肛手术的成功率,且生活质量高,并发症少,值得临床推广应用。     

保肛手术治疗低位直肠癌50例疗效分析

目的探讨低位直肠癌的保肛手术治疗。方法通过对50例低位直肠癌患者直肠癌下缘距肛缘距离1．5～7cm进行Dukes分期和病理分型，选择了直肠前切除术（Dixon术）、改良Parks（经肛门结肠肛管吻合术）术和局部扩大切除术，其中32例Dixon手术中28例按直肠系膜癌系膜全切除术（TME）原则进行低位Dixon手术；9例行改良Parks；9例行经肛门括约肌直肠癌局部扩大切除。对术后控制排便功能和局部复发率进行了随访。结果无术后死亡病例，术后出现吻合口痿1例，发生在使用吻合器组中，其发生率为3．6％（1／28）；切口感染5例，发生率10％（5／50），经局部换药，均自行愈合；术后吻合狭窄1例，发生在使用吻合器组中，发生率约3．6％（1／28），经术后定期扩张，吻合口狭窄加重引起排便困难后改行Miles手术。术后控制排便能力均良好。随访50例，随访时间2～22月，平均10．5个月，无一例局部复发，患者均健在。结论保肛手术已经成为低位直肠癌手术治疗的首选术式，TME在低位直肠癌保肛手术中起着重要作用，改良Parks术、局部扩大切除术和吻合器在低位直肠癌的保肛手术中广泛应用，严格掌握低位直肠癌保肛手术的适应证，可防止并发症的发生。     

低位保肛手术治疗直肠癌的临床效果评价

选取我科收治入院的90例低位直肠癌患者,其中观察组45例采用直肠癌前侧切除手术方,对照组45例采用腹会阴联合切除手术,并对患者术后随访2年,回顾性分析两组患者手术后的临床效果。对照组术后日排便次数5.8±2.7次,发生并发症9例,局部复发11例,5年内生存者32例;观察组日排便次数3.2±1.1次,发生并发症3例,局部复发2例,5年生存者40例。观察组术后日排便次数、并发症发生率和局部复发率均明显低于对照组,5年内生存率明显高于对照组,差别均具有统计学意义（P＜0.05）。直肠癌患者运用低位保肛手术治疗效果明显,术后并发症较少,可以明显的改善患者术后的生活质量,预后较好,减轻患者的病痛。     

8例低位直肠癌Welch手术保肛诊疗体会

近年来各种保留肛门括约肌的手术，用于治疗低位直肠癌，多数都获得成功，从而减轻了患者的心理压力，提高了患者的生存质量。作者1999年11月至今采用Welch手术，治疗直肠癌8例，报告如下。     

低位直肠癌保肛治疗的体会

目的探讨低位直肠癌保肛手术的可行性.方法回顾分析低位直肠癌保肛手术45例的治疗资料,其中行低位前切除术24例,超低位前切除术9例,Bacon术4例,Parks术8例.结果术后出现并发症吻合口出血4例,吻合口漏5例,切口感染2例.术后随访1～7年,局部复发率为15.6%,5年生存率53.3%;而同期Miles术式分别为13.7%,58.6%两者结果比较无差异.结论保肛手术只要完善患者病情的术前评估,严格合理地选择手术适应证,实施全直肠系膜切除术,低位直肠癌保肛手术是可行的.     

中低位直肠癌保肛手术的护理

对38例中低位直肠癌病人应用吻合器吻合方法行低位直肠前切除术,术前给予心理护理、肠道准备等,术后给予密切观察病情,做好引流管、心理、饮食护理及并发症的观察和护理。结果病人均顺利完成手术,痊愈出院。     

Review of bowel dysfunction of rectal cancer patients during the first five years after sphincter-preserving surgery: A population in need of nursing attention

PurposeThe aim of the review was to summarize the longitudinal changes in bowel dysfunction among patients with rectal cancer within the first five years following sphincter-preserving resection.MethodsA series of literature searches were conducted on six English-language electronic databases. Articles published after 1990 were searched. A total of 29 articles (reporting 27 studies) was found.ResultsBowel dysfunction, including an alteration in the frequency of bowel movements, incontinence, abnormal sensations, and difficulties with evacuation, is reported among patients with rectal cancer within the first five years after sphincter-preserving resection. These problems are most frequent and severe within the first year, especially within the first six months, and stabilize after one year. Some of the problems may last for years.ConclusionSupportive care for bowel dysfunction is needed, and should include the provision of information and psychological support delivered in multiple steps. Oncology nurses can play an important role in providing supportive care for rectal cancer patients with bowel dysfunction.     

心理社会因素对直肠癌Miles术后患者的影响

目的调查心理社会因素和人格特征对直肠癌Miles术后患者康复的影响。方法采用症状自评量表(SCL-90)、艾森克个性评定量表(EPQ)和社会支持量表(SSRS)调查了96例直肠癌Miles术后患者(观察组),并与同期正常健康人98例(对照组)进行对照。结果观察组SCL-90总分、阳性项目数、躯体化、强迫、人际敏感、抑郁、焦虑、敌对、恐怖、偏执、精神病性格因子得分明显高于对照组(P<0.01);EPQ中神经质(N)分明显高于对照组、内外向(E)分明显低于对照组(P<0.01);SSRS社会支持总分、主观支持分及支持利用度明显低于对照组(P<0.01)。结论不良的个性特征以及缺乏对社会支持的认识和利用是影响直肠癌Miles术后患者康复的重要因素。     

Robotic versus conventional laparoscopic surgery for rectal cancer: systematic review and meta-analysis

Background: The purpose of this meta-analysis is to evaluate the evidence available on the safety as well as effectiveness of robotic resection as compared to conventional laparoscopic surgery for rectal cancer.

Material and methods: A comparison of laparoscopic and robotic surgical treatments for rectal cancer was collected. Eligible trials that analyzed probabilistic hazard ratios (HR) for endpoints of interest (including perioperative morbidity) and postoperative complications were included in our review.

Results: A total of six studies were included based on the present inclusion criteria. The pooled data showed that R-TME appeared to have association with remarkable reduction in the postoperative morbidity rate as compared to L-TME. Moreover, R-TME was also linked to lower conversion, decreased lymph node number, and longer operation time compared with L-TME. However, there was no difference in hospital stay, positive range of circumferential resection and blood loss between the two study groups.

Conclusions: Robotic rectal cancer surgery provides favorable outcomes and is considered as a safe surgical technique in terms of postoperative oncological safety. Like laparoscopic TME surgery, robotic surgery may be a valid alternative and complementary approach with beneficial effects on minimally-invasive surgery.     

Robotic surgery for rectal cancer

Laparoscopic surgery has gained acceptance as a less invasive approach in the treatment of colon cancer. However, laparoscopic surgery for rectal cancer, particularly cancer of the lower rectum, is still challenging because of limited accessibility. Robotic surgery overcomes the limitations of laparoscopy associated with anatomy and offers certain advantages, including 3‐D imaging, dexterity and ambidextrous capability, lack of tremors, motion scaling, and a short learning curve. Robotic rectal surgery has been reported to reduce conversion rates, particularly in low anterior resection, but it is associated with longer operative times than the conventional laparoscopic approach. Postoperative morbidities are similar between the robotic and conventional laparoscopic approaches, and oncological outcomes such as the quality of the mesorectum and the status of resection margins are also equivalent. The possible superiority of robotic surgery in terms of the preservation of autonomic function has yet to be established in research based on larger numbers of patients. Although robotic rectal surgery is safe, feasible, and appears to overcome some of the technical limitations associated with conventional laparoscopic surgery, the advantages provided by this technical innovation are currently limited. To justify its expensive cost, robotic surgery is more suitable for select patients, such as obese patients, men, those with cancer of the lower rectum, and those receiving preoperative chemoradiotherapy.     

临床护理路径在腹腔镜下直肠癌Miles手术患者护理中的应用

目的:探讨临床护理路径在腹腔镜下直肠癌Miles手术患者护理中的应用效果。方法:将60例患者随机分为观察组与对照组各30例。对照组实施常规护理,进行一般宣教,内容包括手术时间、麻醉方式、术后出现的并发症及相关注意事项,术后对患者满意度进行调查,并记录患者术后并发症情况;观察组充分了解患者对护理的需求,制订临床护理路径,依据路径表进行各项护理。结果:与对照组比较,观察组并发症发生率更低,患者对护理的满意度更高,住院时间更短(P<0.05)。结论:临床护理路径为患者提供了科学的护理指导,可显著提高患者对护理的满意度,减少并发症,缩短住院天数。     

直肠癌腹腔镜下Miles手术期临床护理路径的实施及效果

目的探讨临床护理路径对直肠癌腹腔镜下Miles手术疗效和术后患者生存质量的影响。方法对我科收治的60例接受腹腔镜下Miles手术的低位直肠癌患者施行临床护理路径和常规护理,评估患者疗效和术后生存质量。结果观察组患者满意率为（95．0±0．4）％,平均住院时间（14．5±1．2）d,住院费用（28156．0±572．5）元,对照组分别为（75．0±2．6）％,（16．5±1．3）d和（34245．0±785．6）元,两组间差异具有统计学意义（P〈0．05）;观察组患者术后并发症、接受和护理造口时间显著低于对照组（P〈0．05）;两组患者术前生存质培差异无统计学意义（P〉0．05）,观察组术后评分显著高于对照组,患者生存质量显著增加（P〈0．05）。结论临床护理路径显著降低直肠癌腹腔镜下Miles手术患者住院时间和费用,减少术后并发症,提高患者满意度,显著增加术后患者生存质量,是腹腔镜下Miles手术护理方式的最佳选择。     

低位直肠癌经肛门局部切除疗效观察

目的评价经肛门局部切除治疗低位直肠癌的效果。方法回顾性分析我院2003—2006年49例低位直肠癌经肛门行局部切除术患者（局部切除术组）的临床资料,其中T,期37例,T2期12例;以45例行根治术的I期直肠癌患者作为对照（根治术组）,其中T1期11例,T2期34例。将两组患者的手术并发症发生率、5年复发率、5年生存率进行对比分析。结果局部切除术组并发症发生率为4．1％（2／49）,根治术组为15．6％（7／45）,两组比较差异有统计学意义（X2=4．69,P〈0．05）。局部切除术组患者5年生存率为97．9％,根治术组患者为95．6％,两组比较差异无统计学意义（x2=0．439,P〉0．05）。局部切除术组中T2期患者术后复发率为33．3％（4／12）,高于根治术组T2期患者术后复发率（5．9％,2／34）,两者比较差异有统计学意义（x2=5．89,P〈0．05）;低分化癌患者术后均转移复发。结论对于T1期直肠癌,经肛门局部切除是合理选择,而T2期直肠癌及低分化肿瘤不宜单纯采用局部切除术。     

回肠造口在直肠癌低位前切除术中的作用

目的探讨直肠癌低位前切除术行回肠造口能否降低吻合口瘘的发生率。方法回顾性分析新野县人民医院普外科2004年4月至2010年4月间78例行直肠癌低位前切除术患者的临床资料,按是否同时行回肠造口术分为两组：A组（同时行回肠造口）38例,B组（未行回肠造口术）40例,卡方检验比较两组患者术后吻合口瘘的发生率。结果两组患者术后共发生吻合口瘘9例,其中A组1例,发生率为2.6%;B组8例,发生率为20.0%。两组患者吻合口瘘发生率比较差异有统计学意义（χ2=6.059,P=0.016）。结论直肠癌低位前切除术同时行回肠造口可能会降低术后吻合口瘘的发生率。     

3D腹腔镜与开腹直肠癌根治术对男性性功能及泌尿功能的影响

目的对比分析3D腹腔镜与开腹直肠癌根治术围手术期相关因素对性功能和泌尿功能的影响。 方法回顾性分析2015年1月至2016年10月北京大学首钢医院37例男性直肠癌患者临床资料,患者的性功能及泌尿功能分别通过性功能评分（IIEF）和泌尿功能评分（IPSS）问卷调查表的形式获得,所有患者随访时间点为术后3个月、6个月和12个月。采用t检验比较传统开腹手术组和3D腹腔镜手术组患者的年龄、体质量指数（BMI）、手术时间及失血量的差异,采用χ²检验比较2组患者肿瘤TNM分期、肿瘤位置、淋巴结转移与否、T分期、术式、并发症及化疗等指标的差异。各观察指标对IIEF和IPSS评分的影响分析采用秩和检验比较各组内的差异;术后12个月的IIEF和IPSS评分的影响因素采用多元线性回归分析。 结果15例患者接受3D腹腔镜手术,22例患者接受开腹手术。2组患者年龄、BMI、TNM分期、肿瘤位置、淋巴结、T分期、术式、并发症及化疗方面比较,差异无统计学意义（P均>0.05）。3D腹腔镜直肠癌手术组患者手术时间明显长于传统开腹手术组［（222.67±41.40）min vs （159.36±21.26）min］,差异具有统计学意义（F=6.414,P<0.05）,但3D腹腔镜手术组手术出血量明显少于传统开腹组［（375.45±252.20）ml vs （161.33±165.57）ml］,差异具有统计学意义（F=2.654,P<0.05）。低位肿瘤患者在术后3、6、12个月的IIEF评分较高位肿瘤患者减低,差异具有统计学意义（Z=-3.698、-3.445、-3.668,P均<0.05）。术中出血大于500 ml患者的IIEF评分在术后3、6、12个月均明显减低,差异具有统计学意义（Z=-2.785、-2.644、-2.538,P均<0.05）;在术后3、6、12个月,高龄组的IPSS评分均高于低龄组,差异具有统计学意义（H=15.810、17.926、18.162,P均<0.05）。术后3个月低位肿瘤患者的IPSS评分明显高于高位肿瘤患者,差异具有统计学意义（Z=-0.268,P=0.045）。多元线性回归分析结果显示,患者年龄、肿瘤位置、失血量与术后12个月性功能相关（P=0.039、0.001、0.019）,年龄与术后12个月患者泌尿功能相关（P<0.05）。 结论手术类型不是影响性功能及泌尿功能的危险因素,患者年龄、肿瘤位置、失血量是性功能障碍的危险因素,年龄是影响泌尿功能的危险因素。     

Anastomotic leakage in rectal cancer surgery: Retrospective analysis of risk factors

BACKGROUNDAnastomotic leakage (AL) after restorative surgery for rectal cancer (RC) is associated with significant morbidity and mortality.AIMTo ascertain the risk factors by examining cases of AL in rectal surgery in this retrospective cohort study.METHODSTo identify risk factors for AL, a review of 583 patients who underwent rectal resection with a double-stapling colorectal anastomosis between January 2007 and January 2022 was performed. Clinical, demographic and operative features, intraoperative outcomes and oncological characteristics were evaluated.RESULTSThe incidence of AL was 10.4%, with a mean time interval of 6.2 ± 2.1 d. Overall mortality was 0.8%. Mortality was higher in patients with AL (4.9%) than in patients without leak (0.4%, P = 0.009). Poor bowel preparation, blood transfusion, median age, prognostic nutritional index < 40 points, tumor diameter and intraoperative blood loss were identified as risk factors for AL. Location of anastomosis, number of stapler cartridges used to divide the rectum, diameter of circular stapler, level of vascular section, T and N status and stage of disease were also correlated to AL in our patients. The diverting ileostomy did not reduce the leak rate, while the use of the transanastomic tube significantly did.CONCLUSIONClinical, surgical and pathological factors are associated with an increased risk of AL. It adversely affects the morbidity and mortality of RC patients.