小组教育在直肠癌肠造口家属中的实施与效果评价

目的:探讨在直肠癌肠造口术患者家属中实施以小组为单位的序贯教育对患者家属与肠造口患者康复的影响.方法:选取2013-08/2015-08广西壮族自治区人民医院胃肠外科收治的120例直肠癌造口患者家属为研究对象,随机分为干预组(n=60)和对照组(n=60).对照组在肠造口患者住院期间,由造口治疗师或责任护士在床边对家属与患者进行相关知识教育.干预组在常规教育的基础上,由造口治疗师对肠造口家属中实施以小组为单位的序贯教育.比较采用两种教育方式前后肠造口家属焦虑评分(Self-rating Anxiety Scale,SAS)、造口相关知识掌握情况、更换造口袋操作的合格率,比较肠造口患者的SAS评分、造口并发症发生率、造口适应情况量表(Ostomy Adjustment Inventory,OAI)得分.结果:干预后观察组家属的SAS得分、肠造口患者的SAS得分、总造口并发症发生率低于对照组(41.38分±3.93分vs 46.54分±5.17分,43.02分±4.71分vs 47.15分±4.39分,16.67%vs 43.33%,均P0.05),而造口相关知识掌握程度与更换造口操作的合格率及造口适应情况得分均高于对照组(78.33%vs60.00%,70.00%vs 51.67%,51.27分±6.92分vs 42.63分±5.87分,均P0.05).结论:对肠造口家属实施以小组为单位的序贯教育有利于减轻家属的焦虑,提供给患者更好的照顾,有效促进患者的造口适应性与康复.     

直肠癌患者肠造口的护理

目的探讨结直肠癌患者肠造口的术前术后的有效护理方法,以提高临床护理水平和患者的生活质量。方法对我科2011年1月至2013年3月收治的42例直肠癌造口术患者进行精心护理,包括术前肠道准备、心理护理、健康教育,术后观察造口的颜色、水肿、排泄情况,指导患者及家属更换造口袋,观察和处理造口的并发症,并加强患者饮食指导、心理教育。结果术后出现2例造口周围皮肤炎症、2例造口狭窄、1例造口脱垂。全组患者均治愈出院,无死亡病例,且患者均能够在出院后融入日常生活。结论做好结直肠癌造口术前术后的护理,对减少术后并发症、提高医疗质量、提高患者的生活质量具有重要意义。     

小麦纤维素颗粒治疗妊娠期便秘的多中心临床研究

目的 研究小麦纤维素颗粒(商品名:非比麸)用于妊娠期便秘的疗效和安全性.方法 采用多中心、前瞻性自身对照研究的方法 ,在国内4家医院按入选标准选择140例妊娠期便秘患者.口服小麦纤维素颗粒3.5 g/次,2次/d,治疗2周,观察服药前后便秘症状及大便性状情况,并进行量化评分,比较疗效与不良反应.结果 小麦纤维素颗粒治疗后排便困难显著减轻,大便性状显著改善,用药7 d与14 d有效率分别达到90.0%和93.6%,用药前后对比临床排便症状差异有统计学意义,服药期间未发现明显不良反应.结论 小麦纤维素颗粒治疗功能性便秘疗效确切,安全有效.     

回肠造口术后发生刺激性皮炎的护理

目的探讨回肠造口术后发生刺激性皮炎的护理措施,提高肠造口患者术后生活质量。 方法回顾性分析2014年1月~2014年12月在我院行回肠造口术后发生肠造口周围皮炎患者28例临床资料,并针对并发症情况采取相应的护理措施。 结果7例住院患者由责任护士每天跟踪处理,直至皮炎愈合,另21例通过随访进行追踪评估,全组患者皮炎均在2~8 d内愈合,电话随访1个月均未再发生刺激性皮炎。 结论根据造口周围皮肤发生的状况分析原因,实施必要的健康教育指导,并根据皮炎的程度采取不同的处理方法,避免粪水对皮肤的刺激,促进皮炎尽快愈合。     

预防性回肠造口术后粪水性皮炎的危险因素及护理对策

目的探讨预防性回肠造口术后粪水性皮炎发生的危险因素,提出护理对策及预防措施。 方法采取查阅病历、延续性护理记录、造口门诊就诊记录的方式,回顾性分析在中国医学科学院北京协和医学院肿瘤医院结直肠外科2017年10月至2018年10月间收治的直肠癌行低位前切除＋预防性回肠造口手术的患者的资料共161例,分析粪水性皮炎发生的危险因素。 结果161例研究对象中,粪水性皮炎发生43例,占26.7%。肠造口存在位置不当、周围皮肤不平整、排便出口肠黏膜低或平于皮肤的患者粪水性皮炎的发生率高于肠造口不存在这些问题的患者（P<0.01）;BMI偏高患者粪水性皮炎的发生率高于BMI正常的患者（χ²=3.938,P<0.01）;接受专科护士个性化指导的患者发生粪水性皮炎的比例明显低于未接受个性化指导的患者,差异有统计学意义（χ²=29.625,P<0.01）。 结论术前由患者和家属、肠造口专科护士及医生三方共同帮助患者选择理想的造口位置;术中医生缝合造口时,保证肠造口周围皮肤平坦,注意近端造口黏膜高于皮肤且排便开口不能偏向一侧;术后住院期间专科护士根据患者的造口特点给予个性化护理指导,帮助患者选择适合的造口用品、提高护理技能;出院后加强延续性护理,预防粪水性皮炎发生。     

团队支持训练对直肠癌造口患者康复效果的影响

目的:探讨团队支持训练对直肠癌造口患者出院后的康复效果的影响.方法:选取2011-01/2013-12台州市路桥中医院收治的210例直肠癌造口患者为研究对象,随机分为观察组(n=105)和对照组(n=105).对照组出院后给予常规的电话随访及健康指导,观察组患者出院后参加1次/wk的团队支持训练(至少持续8 wk),然后每周进行电话随访.比较6 wk后患者的遵医行为、造口患者生活质量问卷(city of hope-quality of life-ostomy questionnaire,C O H-Q O L-O Q)得分、一般自我效能感量表(general self-efficacy scale,GSES)得分及康复效果.结果:观察组在正确护理造口、及时更换和清洗造口袋、每日进行规律排便的训练、保持乐观心态、积极融入社会、规律清淡饮食、适当户外康复运动、主动咨询、定期复诊等各个行为上的遵医比例均显著优于对照组(93.3%vs 77.1%,95.2%vs 81.0%,85.7%vs 65.7%,94.3%vs 79.0%,91.4%vs73.3%,89.5%v s 75.2%,87.6%v s 71.4%,90.5%vs 67.6%,88.6%vs 69.5%,P0.01).观察组COH-QOL-OQ量表的生理、心理、社会、精神等4个维度得分及总分均显著高于对照组(7.15±3.01 vs 6.12±2.56,6.55±2.95 vs 5.49±2.62,6.20±3.14 vs 5.02±2.95,6.87±3.08 vs 5.76±2.71,6.65±3.17vs 5.52±2.91,P0.01).观察组GSES总分、高等比例均显著高于对照组(2.91±0.81 vs2.55±0.86,61.9%v s 41.9%,P0.01).观察组在造口感染、造口狭窄、造口旁疝、造口损伤、造口脱垂等造口并发症的发生率显著低于对照组(3.81%vs 16.19%,6.67%vs 25.71%,2.86%vs 15.24%,0.01%v s 13.33%,P0.01).观察组在相对固定时间内排便、排便前有便意、大便成形等排便状况的比例上均显著优于对照组(81.9%vs 61.0%,87.8%vs 62.9%,82.9%vs 61.0%,P0.01).结论:团队支持训练可以明显地提高直肠癌造口患者的自护能力以及自我效能,改善其生活质量,康复效果较为满意,值得临床推广.     

肠造口并发症护理研究进展

肠造口并发症在肠造口术后患者中较普遍,肠造口并发症的发生严重影响肠造口患者术后的生活质量,给患者不仅带来护理上的困难,影响患者的术后康复,还增加了其心理负担,经济负担.降低肠造口并发症的发生率,提高护理质量,对提高患者的护理满意度和生活质量有着重要意义.本文就肠造口并发症的影响因素、类型、护理措施及护理模式作一综述.     

肠造口造口袋底盘渗漏标准化护理

目的探讨标准化护理在肠造口造口袋底盘渗漏中的应用价值。方法对2013年12月至2015年12月在中国医科大学肿瘤医院行肠造口术治疗的150例患者资料进行回顾性分析,将其按护理方式不同分为观察组和对照组,各75例,对照组给予常规护理,观察组在对照组的基础上实施标准化护理。比较两组造口袋底盘渗漏发生率,以及造成皮肤损伤和造口周围皮肤并发症情况。结果观察组造口袋底盘渗漏发生率为6.67%,明显低于对照的22.67%(P0.05)。观察组造口周围皮肤损伤发生率为9.33%,明显低于对照组的26.67%(P0.05)。观察组造口周围皮肤并发症发生率为8.00%,明显低于对照组的21.33%(P0.05)。结论对肠造口造口袋底盘渗漏患者实施标准化护理,有利于降低造口袋底盘渗漏发生率,并减少造口周围皮肤损伤和并发症的发生率,在临床中具有重要意义。     

以自我管理为导向的5A护理对结直肠造口患者自我效能的影响

目的:探讨以自我管理为导向的5A护理对结直肠造口患者自我效能的影响方法:选取自2013-01/2015-06在天津医科大学第二医院接受结直肠造口治疗的患者100例,分为观察组和对照组,每组50例,观察组采取以自我管理为导向的5A护理,对照组患者采取常规护理,造口后进行随访6 mo,对比两组患者的自我效能、生活质量和并发症发生情况.结果:观察组患者在自我效能评分(34.9分±5.0分vs 27.1分±4.2分)、生活质量和并发症[4(8.0)vs 22(44.0)]的发生情况上都明显的优于对照组,差异均具有统计学意义(P0.05).结论:以自我管理为导向的5A护理能够提高结直肠造口患者的自我效能和生活质量,也能减少并发症的发生.     

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...     

Contemporary outcomes of total pelvic exenteration in the treatment of colorectal cancer

Purpose Total pelvic exenteration is performed infrequently in selected patients with locally advanced or recurrent colorectal cancer. We reviewed our contemporary experience with pelvic exenteration for colorectal cancer to identify selection criteria and prognostic factors for longterm survival. METHODS: Between 1991 and 2000, 55 patients (males, 29; median age, 62 years) undergoing total pelvic exenteration for colorectal cancer were identified from a prospective database. Clinicopathologic variables were evaluated as prognostic indicators of long-term survival by log-rank test and multivariate Cox regression. RESULTS: Indications for surgery were recurrent colorectal cancer in 71 percent and primary colorectal cancer in 29 percent. Of 39 patients with recurrent colorectal cancer, 85 percent had previous radiotherapy, and 64 percent had previous abdominoperineal resection. At the time of pelvic exenteration, 49 percent of patients received intraoperative radiation, and 20 percent required sacrectomy. Complete resection with negative margins was achieved in 73 percent. Perioperative mortality after pelvic exenteration was 5.5 percent, and complications included perineal wound infection (40 percent), pelvic abscess (20 percent), abdominal wound infection (18 percent), and cardiopulmonary events (18 percent). Median disease-specific survival for all patients was 48.9 (range, 3.2-105.6) months. Univariate analysis identified five factors associated with decreased survival: male gender, recurrent colorectal cancer, previous abdominoperineal resection, positive surgical margin, and administration of intraoperative radiation. On multivariate analysis, only previous abdominoperineal resection was an independent predictor of unfavorable outcome (P < 0.04). CONCLUSIONS: Total pelvic exenteration can be performed safely in highly selected patients with colorectal cancer and can result in significantly prolonged survival. Less satisfactory outcomes are observed in patients whose indication for pelvic exenteration is recurrent colorectal cancer after abdominoperineal resection. Presented at the meeting of The American Society of Colon and Rectal Surgeons, Chicago, Illinois, June 3 to 7, 2002.     

血浆凝溶胶蛋白与结直肠癌根治术化疗疗效及预后的关系

目的:验证血浆凝溶胶蛋白作为肿瘤侵袭转移关联基质金属蛋白酶类的作用底物,对结直肠癌患者根治术后化疗疗效和预后复发的预测性.方法:将手术后病理证实的40例结直肠癌患者按照临床分期分为两组,A组:Ⅰ、Ⅱ期;B组:Ⅲ期.并且,根据B组病例随访预后复发情况,又进一步将B组分为,B1组:术后辅助化疗转移组;B2组:术后辅助化疗未...     

Fecal Excretion of Calprotectin in Colorectal Cancer Relationship to Tumor Characteristics

Background: The aim of this study was to evaluate fecal calprotectin in patients treated for colorectal cancer. Furthermore, the changes in fecal calprotectin concentration from before to after surgery were investigated. Methods: In 155 patients with newly diagnosed colorectal cancer, two spot samples were taken from the same feces on two consecutive days. Results: Three ways of evaluating calprotectin excretion were compared, (1st spot 1st stool; maximum of 1st spot 1st stool and 2nd spot 1st stool; maximum of 1st spot 1st stool and 1st spot 2nd stool) and gave similar results with median fecal calprotectin values 47 mg/l, 52 mg/l and 54 mg/l, respectively. Median calprotectin concentration did not differ significantly between different tumor stages, although the levels were slightly lower in Dukes stage A tumor than in the rest of the stages. Neither were there any differences in the concentrations related to the localization, size or the histological grading of the carcinoma. As the currently used cut-off level for fecal calprotectin is 10 mg/l, 87% of all patients had elevated fecal calprotectin. Seventy-nine percent of the patients had levels above 15 mg/l and 74% had levels above 20 mg/l (1st spot 1st stool). In patients who delivered fecal samples after the operation the calprotectin value fell significantly from a preoperative median value of 45 mg/l to 14 mg/l after the resection. Conclusions: The majority of patients with colorectal cancer have increased fecal concentration of calprotectin. One single fecal spot seems to be sufficient for determination of the calprotectin level. Measurement of fecal calprotectin may possibly become of value as a marker for colorectal cancer, although calprotectin, similar to fecal occult blood (FOB) tests, is a non-specific test for colorectal pathology, also being elevated in inflammatory bowel diseases. Further investigation of its specificity is therefore needed.     

Impact of a family history of colorectal cancer on age at diagnosis, anatomic location, and clinical characteristics of colorectal cancer

Background: Among the risk factors for colorectal cancer (CRC) is a family history of colorectal cancer. Reliable evidence is needed regarding the clinical characteristics of cancer in patients with this history to determine if a change in the diagnostic approach is needed. Aim of the Study: This study set out to determine specific clinical outcomes in patients with CRC with a family history of one first-degree relative with sporadic colorectal cancer compared to control patients with colorectal cancer but without the family history. Methods: We designed a case-control study of colorectal cancer registry data between 1988 and 1999. Patients with a family history of one first-degree relative with colorectal cancer were compared to those without the history with regard to four characteristics: age at cancer diagnosis, anatomic location of the cancer, presence of distal adenomas with proximal cancer, and stage of disease at diagnosis. Results: Nine hundred and twenty-one patients met the inclusion criteria. Family history was positive in 124 patients. The demography of the populations was similar, except for mean age, which was 65 yr for men with a family history and proximal cancer compared to 70 yr for their counterparts without the family history (p=0.03). The anatomic location of the cancer, presence of distal benign neoplasia when the cancer was proximal, and disease stage at diagnosis were not different between the groups. Conclusions: Men with a family history of sporadic colorectal cancer and proximal colon cancer were younger than men without the family history and proximal colon cancer. The overall results do not indicate that a change in the diagnostic approach is needed.     

Fast-track rehabilitation program vs conventional care after colorectal resection: a randomized clinical trial

AIM:To compare the fast-track rehabilitation program and conventional care for patients after resection of colorectal cancer.METHODS:One hundred and six consecutive patients who underwent fast-track rehabilitation program were encouraged to have early oral feeding and movement for early discharge,while 104 consecutive patients underwent conventional care after resection of colorectal cancer.Their gastrointestinal functions,postoperative complications and hospital stay time were recorded.RESULTS:The restorat...     

早期大肠癌内镜治疗的临床评价

背景：早期大肠癌可以采用内镜下切除治疗，但其疗效和预后仍是人们普遍关心的问题。目的：评价内镜治疗早期大肠癌的疗效和预后。方法：对1986年1月～2005年10月经内镜确诊的早期大肠癌患者，按治疗方法的不同分为内镜治疗组和外科手术治疗组，对两组的临床资料、治疗方法和随访结果进行回顾性分析。结果：99例早期大肠癌（104个癌灶）中，无症状人群普查发现34例，临床就诊发现65例。内镜治疗69例（共72个癌灶），外科手术治疗30例（包括内镜治疗后追加手术者，共32个癌灶）。内镜治疗组癌灶完全切除率为97．5％，无严重并发症发生。外科手术治疗组有1例病理证实癌组织浸润达黏膜下深层，肝脏有多个微结节转移灶。内镜治疗组经3个月～19年的随访，除19例失访、6例死于心脏病等疾病外，无一例肿瘤复发。比较两组黏膜和黏膜下层早期大肠癌的临床资料、随访结果和5年生存率，内镜治疗组的疗效与手术治疗组相似（P〉0．05）。结论：早期大肠癌，特别是黏膜层早期大肠癌内镜治疗的疗效和随访结果与手术治疗相似，且损伤小、安全、简便。黏膜下深层癌易发生转移，内镜下切除应注意判断肿瘤黏膜浸润深度，非提起征是内镜切除的关键指征。无症状自然人群普查是发现早期大肠癌的重要途径。     

Serum ferritin

PURPOSE: There is increasing evidence that screening for colorectal cancer may save lives, and consequently, both professional and public interest in screening for colorectal cancer is increasing. As yet, however, there is no perfect screening test. Insidious blood loss is a common feature of colorectal cancer and may lead to a fall in serum ferritin before the patient becomes anemic. Measurement of serum ferritin, which is widely available and easily and inexpensively performed, has, therefore, been postulated as a potential screening test for colorectal cancer. METHOD: This study used samples of serum collected from 148 patients recruited to a screening study for colorectal cancer. All patients were thoroughly investigated by double-contrast barium enema and/or colonoscopy. Patients were selected randomly from each of three clinical diagnostic groups: 50 patients with proven colorectal cancer, 49 patients without colon disease, and patients with adenomas of the colon. Serum ferritin was assayed by immunoradiometry. The expected adult reference range is 25 to 350 µg/l, and results were reported without patient identification. RESULTS: There were no significant differences in serum ferritin levels among any of the three groups. CONCLUSION: Serum ferritin is unlikely to be of value as a screening test for colorectal cancer.     

血脂异常患者结直肠早期癌发病的危险因素分析

探讨血脂异常患者结直肠早期癌发病的危险因素,以及他汀类药物在其中可能发挥的作用。回顾性分析2018年2月—2021年2月北京友谊医院消化科行内镜治疗合并血脂异常的结直肠肿物患者资料。根据结肠镜及病理结果将266例患者分为结直肠腺瘤组（n=174）和结直肠早期癌组（n=92）。分析两组患者临床资料的差异,采用Logistic回归分析血脂异常患者结直肠早期癌发病的危险因素。结果发现,与结直肠腺瘤组相比,结直肠早期癌组患者的男性比例（64.1%比25.9%）、吸烟比例（41.3%比14.4%）和饮酒比例（37.0% 比17.2%）更高,同时低密度脂蛋白胆固醇［（3.06±0.81） mmol/L比（2.60±0.74） mmol/L］和总胆固醇值更高［（5.27±1.22） mmol/L 比（4.61±1.06） mmol/L］,而他汀用药占比更低（27.2% 比52.9%）,差异均有统计学意义（P均<0.05）。多因素Logistic回归分析显示,男性（OR=3.641, 95%CI：1.694~7.826）、吸烟（OR=2.920, 95%CI：1.159~7.356）以及较高的低密度脂蛋白胆固醇（OR=2.203,95%CI：1.481~3.277）、较高的总胆固醇水平（OR=1.744,95%CI：1.329~2.289）是血脂异常患者结直肠早期癌发生的危险因素,而他汀用药史（OR=0.469,95%CI：0.236~0.932）对避免血脂异常患者结直肠早期癌的发生具有保护作用。应对血脂异常患者进行戒烟宣教,监测低密度脂蛋白胆固醇、总胆固醇水平,必要时使用他汀类药物促进血脂达标,同时积极进行结直肠癌的早期筛查。     

Endoscopic stenting for recurrence-related colorectal anastomotic site obstruction: Preliminary experience

AIM: To evaluate the efficacy of stents in treating patients with anastomotic site obstructions due to cancer recurrence following colorectal surgery.METHODS: The medical records of patients who underwent endoscopic self-expanding metal stents (SEMS) insertion for colorectal obstructions between February 2004 and January 2014 were retrospectively reviewed. During the study period, a total of 218 patients underwent endoscopic stenting for colorectal obstructions. We identified and examined the patients who underwent endoscopic stenting for obstructions caused by cancer recurrence at the anastomotic site following colorectal surgeries for primary colorectal cancer.RESULTS: Five consecutive patients [mean age, 56.4 years (range: 39-82 years); 4 women, 1 man] underwent endoscopic stenting for obstructions caused by cancer recurrence at the anastomotic site following colorectal surgeries for primary colorectal cancer. Technical and clinical success was achieved in all 5 patients, without any early complications. During follow-up, 3 patients did not need further intervention, prior to their death, after the first stent insertion; thus, the overall success rate was 3/5 (60%). Perforations occurred in 2 patients who required a second SEMS insertion due to re-obstruction; none of the patients experienced stent migration.CONCLUSION: SEMS placement is a promising treatment option for patients who develop obstructions of their colonic anastomosis sites due to cancer recurrence.     

Metformin use is associated with a decreased incidence of colorectal adenomas in diabetic patients with previous colorectal cancer

Background

Metformin use has been associated with decreased cancer risk and mortality. However, the effects of metformin on the development of colorectal adenomas, the precursors of colorectal cancers, are not defined.

Aims

This study aimed to evaluate the potential effect of metformin on the incidence of colorectal adenomas in diabetic patients with previous colorectal cancer.

Methods

Among 488 consecutive diabetic patients who underwent colonoscopic surveillance after curative resection of colorectal cancer between 1998 and 2008, 240 patients were enrolled in this study and were compared in two groups: 114 patients taking metformin and 126 patients not taking metformin. Patient demographics, clinical characteristics, and colorectal adenoma incidence rate were analysed.

Results

After a median follow-up of 58 months, a total of 33 patients (28.9%) exhibited adenomatous colorectal polyps among the 114 patients who used metformin, compared with 58 (46.0%) patients with colorectal adenomas among the 126 patients who did not use metformin (odds ratio = 0.48, 95% confidence interval = 0.280–0.816, P = 0.008). After adjustment for clinically relevant factors, metformin use was found to be associated with a decreased incidence of colorectal adenomas (odds ratio = 0.27, 95% confidence interval = 0.100–0.758, P = 0.012) in diabetic patients with previous colorectal cancer. Metformin use in diabetic patients with previous colorectal cancer is associated with a lower risk of colorectal adenoma.