针对性护理配合在膀胱全切原位回肠代膀胱术中的应用效果

目的 观察护理配合在经腹腔镜下膀胱全切原位回肠代膀胱术中的应用效果。方法 回顾性分析2018年3月~2019年3月在我院行膀胱全切除原位回肠代膀胱术实施针对性手术配合的48例膀胱癌患者。观察患者手术时间、术中出血量、肠功能恢复时间、新膀胱功能、并发症发生情况及护理满意度。结果 48例患者手术时间5~9 h,平均手术时间（5.98±0.45）h,术中出血量200~1000 ml,平均出血量（398.50±20.64）ml。术后2~3 d胃肠功能恢复,术后3周回肠代膀胱造影、静脉肾盂造影显示,双肾良好,无输尿管反流、梗阻,充盈良好。所有患者术后均未发生尿失禁、排尿困难等并发症。护理满意度调查,满意28例,一般18例,不满意2例,满意度为95.83%。结论 经腹腔镜下膀胱全切除原位代膀胱术患者采用针对性护理配合,可促进术后恢复,预防并发症发生,且术后膀胱功能良好,值得临床推广应用。     

膀胱全切回肠代膀胱术患者的围术期护理

目的 总结膀胱全切除回肠代膀胱术病人的围术期护理.方法 对12例膀胱肿瘤的患者行膀胱全切回肠代膀胱术,术前做好心理护理、术前准备;术后密切观察病情及生命体征变化,予以对症护理及出院指导.结果 12例膀胱全切回肠代膀胱术无1例并发症发生,患者病情稳定,均取得满意的治疗效果.结论 加强膀胱全切除回肠代膀胱术病人的围术期护理是手术成功的保证.     

腹腔镜肝切除手术的护理配合

目的：总结腹腔镜肝切除的手术配合经验。方法回顾我院2012年1月~2013年8月79例经腹腔镜肝切除手术的配合经验。结果79例均顺利完成腹腔镜下肝切除,手术时间120~246min,平均136min,肝癌患者术后随访6~12个月无肿瘤复发。结论腹腔镜肝切除是一种安全可行的微创手术方式,配备相对固定的手术室护士,术中准确、熟练、默契的手术配合,严格的无瘤技术操作,对顺利完成手术具有重要意义。     

腹腔镜下全子宫切除术的手术配合

目的 探讨如何做好腹腔镜下全子宫切除术的手术配合工作.方法 总结160例腹腔镜下全子宫切除术的护理配合经验.结果 160例患者均获得满意疗效.结论 充分的术前准备,完善的器械设备系统,手术室护士娴熟的配合技术,做好术后的仪器处理,是手术成功的关键.     

内镜下甲状腺切除87例的手术配合及护理

目的 探讨内镜下甲状腺切除的有效手术配合要点及护理措施.方法 回顾性总结分析了2010年5月至2010年10月收治的87例患者的手术配合要点及护理措施.结果 87例手术均获成功,术后随访患者均对手术效果非常满意.结论 内镜下甲状腺腺切除术是安全可行的,此项技术能顺利完成,有效手术配合和护理起一定作用.患者颈部无明显瘢痕,取得了较好的手术及护理效果.     

全肺切除术的手术护理配合

本文通过对165例全肺切除手术护理配合的总结,提高手术室护士的业务水平,以保证手术的顺利开展.手术护士应做到:①以病人为中心,实施整体护理;②认真做好术前的各项护理准备工作;③熟练掌握手术的配合,密切观察患者的情况;④树立无菌技术操作和无瘤操作观念;⑤加强全肺切除病人的静脉输液的管理;⑥注意胸腔闭式引流的护理.     

经腹全胃切除治疗近侧胃癌

目的：探讨近侧胃癌的术式选择的意度。方法：对18例术前均经纤维胃镜及消化道钡餐造影确诊。其中7例合并程度不同的心肺疾患的近侧胃癌患者经腹全胃切除治疗并观察疗效。结果：全组无手术死亡。术后并发症为11．1％，均为术口感染。术后1、3年生存率分别为85．7％（12／14），50％（7／14）。近切端阳性率为5．5％。结论：本术式与传统的胸腹联合切口比较，优点是手术时间短，创伤小，术中心肺干扰小，术后胸部并发症少，术后恢复快。主要适用于尚未浸润食道下端的近侧胃癌。尤对高龄、体弱或心肺功能差，估计难以耐受经胸手术的患者更合适。     

全胃切除术后“0”形空肠环代胃术11例报告

全胃切除术后，消化道重建的方法颇多，目前尚无理想的方法。本文报告我院于１９９２年３月至１９９７年１０月对胃的恶性肿瘤行根治性全胃切除，“０”形空肠环代胃术１１例，取得了较满意的临床疗效。     

电视胸腔镜下肺叶切除的手术配合

电视胸腔镜手术(video-assisted thoracoscopic surgery,VATS)在临床上已得到较为广泛的应用,国内外开展的VATS已经涉及胸外科手术的各个领域.该手术技术具有创伤小、痛苦轻、恢复快、疗效可靠、符合美容要求等优点,已成为胸外科常用的手术方法之一[1].本文以肺叶切除为例,就VATS肺叶切除的手术配合报告如下.     

带蒂回盲肠间置代胃在贲门癌手术中的临床应用

目的：探讨带蒂回盲肠间置代胃在贲门癌手术中的临床应用价值。方法：在11例贲门癌手术中施行带蒂回盲肠间置代胃重建胃肠道，术后对病人行上消化道钡餐造影检查胃排空功能并随访。结果：带蒂回盲肠间置代胃具有贮存食物、良好的排空及抗返流功能，病人术后生存质量满意。结论：带蒂回盲肠间置代胃术是贲门癌在行远端食管及近端胃次全切除术后胃肠道重建较为理想的术式之一。     

功能训练对根治性膀胱全切后原位乙状结肠代膀胱患者的效果

目的:对根治性的膀胱全切除原位乙状结肠代膀胱患者采取系统性膀胱功能训练的临床效果和尿流动力学进行分析.方法:分析中国医科大学盛京医院2014年5月至2016年5月收治的根治性膀胱全切除原位乙状结肠代膀胱80例患者的资料,根据临床训练方法分成两组,将采取普通膀胱功能训练40例患者设为对照组,将采取系统性膀胱功能训练的40例患者设为观察组,比较两组的临床效果和尿流动力学特征.结果:观察组术后9个月残尿量、膀胱容量和最大尿流率等尿流动力学指标均优于对照组,且术后膀胱输尿管吻合口狭窄、夜间尿失禁、输尿管返流等总并发症发生率(2.50％)低于对照组(25.00％),差异均有统计学意义(P<0.05);观察组总体健康评分(83.40±14.30)高于对照组(65.33±13.10),差异有统计学意义(P<0.05).结论:对根治性的膀胱全切除原位乙状结肠代膀胱患者采取系统性膀胱功能训练能够改善尿流动力学指标,减少术后并发症且提高生活质量.     

Recommendations for the reporting of urinary bladder specimens containing bladder neoplasms Association of Directors of Anatomic and Surgical Pathology

The Association of Directors of Anatomic and Surgical Pathology have developed recommendatlons for the surgical pathology repotting of common malignant tumors. The recommendations for carcinomas of the urinary bladder are reported herein.     

Prognostic factors in radical cystectomy affecting survival

Introduction

The aim of the study was to evaluate the prognostic factors in radical cystectomy affecting survival.

Material and methods

A total of 100 hundred patients were included in the study. Incontinent diversion was applied to 73 of these, and continent diversion to 27. Prospective and retrospective data of the patients were examined. The prognostic value for survival was evaluated for of lymph node involvement, tumor grade (low grade: grade 0-II, high grade: ≥ III or epidermoid carcinoma), tumor stage (low stage: stage pT0-2, high stage: stage ≥ 3a pT3a), presence of preoperative unilateral of bilateral hydronephrosis, presence of preoperative uremia (serum urea value: ≤ 60), and age (> 70 and ≤ 70 years of age) on survival were investigated. Kaplan-Meier survival analysis and Log-Rank statistical methods were used in the study.

Results

Grade, stage, uremia, and lymph node involvement had significant effects on survival (p values 0.0002, 0.03, 0.01, and 0.02, respectively). Presence of preoperative hydronephrosis and age had no statistically significant effects on survival (p values 0.8 and 0.2, respectively).

Conclusions

Tumor grade, tumor stage, preoperative uremia, and lymph node involvement are prognostic factors affecting survival. Advanced age and presence of preoperative hydronephrosis have no prognostic value for survival. The presence of uremia in the preoperative assessment of the patients is more important than hydronephrosis.     

Recommendations for the reporting of urinary bladder specimens containing bladder neoplasms Association of Directors of Anatomic and Surgical Pathology

The Assoclatlon of Directors of Anatomic and Surgical Pathology have developed recornmendatlons for the surgical pathology reporting of common malignant tumors. The recommendations for carcinomas of the urinary bladder are reported herein.     

Clinical features of bladder cancer in primary care

Background

Bladder cancer accounts for over 150 000 deaths worldwide. No screening is available, so diagnosis depends on investigations of symptoms. Of these, only visible haematuria has been studied in primary care.

Aim

To identify and quantify the features of bladder cancer in primary care.

Design and setting

Case-control study, using electronic medical records from UK primary care.

Method

Participants were 4915 patients aged ≥40 years, diagnosed with bladder cancer January 2000 to December 2009, and 21 718 age, sex, and practice-matched controls, were selected from the General Practice Research Database, UK. All clinical features independently associated with bladder cancer using conditional logistic regression were identified, and their positive predictive values for bladder cancer, singly and in combination, were estimated.

Results

Cases consulted their GP more frequently than controls before diagnosis: median 15 consultations (interquartile range 9–22) versus 8 (4–15): P<0.001. Seven features were independently associated with bladder cancer: visible haematuria, odds ratio 34 (95% confidence interval [CI] = 29 to 41), dysuria 4.1 (95% CI = 3.4 to 5.0), urinary tract infection 2.2 (95% CI = 2.0 to 2.5), raised white blood cell count 2.1 (95% CI = 1.6 to 2.8), abdominal pain 2.0 (95% CI = 1.6 to 2.4), constipation 1.5 (95% CI = 1.2 to 1.9), raised inflammatory markers 1.5 (95% CI = 1.2 to 1.9), and raised creatinine 1.3 (95% CI = 1.2 to 1.4). The positive predictive value for visible haematuria in patients aged ≥60 years was PPV of 3.9% (95% CI = 2.2 to 3.2).

Conclusion

Visible haematuria is the commonest and most powerful predictor of bladder cancer in primary care, and warrants investigation. Most other previously reported features of bladder cancer were associated with the disease, but with low predictive values. There is a need for improved diagnostic methods, for those patients whose bladder cancer presents without visible haematuria.     

全膝关节置换术的康复治疗及护理

目的 探讨人工全膝关节置换术后的康复训练方法。方法 回顾分析2001年8月至2005年8月16例（17膝）人工全膝关节置换术后病人康复训练的过程及效果。结果 人工全膝关节置换术后经过系统康复训练，所有膝关节功能评分达到（70-86分）平均80分。结论 人工全膝关节置换手术效果与术后全面系统的康复训练密切相关。     

Non-visible versus visible haematuria and bladder cancer risk: a study of electronic records in primary care

Background

Diagnosis of bladder cancer relies on investigation of symptoms presented to primary care, notably visible haematuria. The importance of non-visible haematuria has never been estimated.

Aim

To estimate the risk of bladder cancer with non-visible haematuria.

Design and setting

A case–control study using UK electronic primary care medical records, including uncoded data to supplement coded records.

Method

A total of 4915 patients (aged ≥40 years) diagnosed with bladder cancer between January 2000 and December 2009 were selected from the Clinical Practice Research Datalink and matched to 21 718 controls for age, sex, and practice. Variables for visible and non-visible haematuria were derived from coded and uncoded data. Analyses used multivariable conditional logistic regression, followed by estimation of positive predictive values (PPVs) for bladder cancer using Bayes’ theorem.

Results

Non-visible haematuria (coded/uncoded data) was independently associated with bladder cancer: odds ratio (OR) 20 (95% confidence interval [CI] =12 to 33). The PPV of non-visible haematuria was 1.6% (95% CI = 1.2 to 2.1) in those aged ≥60 years and 0.8% (95% CI = 0.1 to 5.6) in 40–59-year-olds. The PPV of visible haematuria was 2.8% (95% CI = 2.5 to 3.1) and 1.2% (95% CI = 0.6 to 2.3) for the same age groups respectively, lower than those calculated using coded data alone. The proportion of records of visible haematuria in coded, rather than uncoded, format was higher in cases than in controls (P<0.002, χ² test). There was no evidence for such differential recording of non-visible haematuria by case/control status (P = 0.78), although, overall, the uncoded format was preferred (P<0.001).

Conclusion

Both non-visible and visible haematuria are associated with bladder cancer, although the visible form confers nearly twice the risk of cancer compared with the non-visible form. GPs’ style of record keeping varies by symptom and possible diagnosis.     

儿童眼球穿孔伤的护理措施探讨

目的 探讨儿童眼球穿孔伤的护理措施。方法 连续观察记录儿童眼球穿孔伤56例，采用针对儿童特点而设计的护理方法，并进行总结。结果 经过针对性护理，绝大多数患儿安全渡过手术期，并获得较为理想的治疗效果。结论 儿童眼球穿孔伤治疗过程中护理是不可忽视的重要环节。     

Structural and functional modification of hollow organs (urinary bladder and stomach) in vibration syndrome

Exposure to total and local vibration leads to the formation of specific forms of hollow organ diseases: vibration cystopathy and gastropathy. Their characteristic signs are organ dysfunction, thinned wall, atrophy of the mucosa, reduction of the capillary bed, and degenerative atrophic changes in the epithelium, associated with reduction of the protein-producing function and focal metaplasia. Vibration cysto-and gastropathies are systemic manifestations of microangio-and visceropathies of vibration origin. __________ Translated from Byulleten’ Eksperimental’noi Biologii i Meditsiny, Vol. 142, No. 12, pp. 693–697, December, 2006     

浅表膀胱癌经尿道电切术的护理体会

目的:总结浅表膀胱癌经尿道电切术病人的护理措施。方法:回顾性分析68例浅表膀胱癌经尿道电切术病人的临床资料。结果:本组病人经过术前、术后的精心护理后,均顺利完成手术。结论:完善的术前与术后护理是浅表膀胱癌经尿道电切术病人手术成功的关键。