回肠襻式造口还纳和Hartmann术后造口还纳术后并发症的对照分析

目的 对比分析老年人回肠襻式造口还纳与Hamnann's术后造口还纳的并发症.方法 对1999年～2003年进行的回肠襻式造口还纳术和行Hartmann's术后造口还纳术各40例老年患者进行术后并发症的比较.结果 患者行回肠襻式造口术的病因第1位是直肠癌低位吻合[24例(60%)],其次是结肠多发息肉病C6例(15%)];行Hartmarm's术最常见的病因是结肠癌[22例(55%)]和结肠癌肠梗阻、穿孔[8例(20)].Hartmann's术后造口还纳并发症较回肠襻式造口还纳并发症更为多见.结论 回肠襻式造口还纳和Hartmann's术后造口还纳相比有较多优势,是一种能减少造口还纳并发症的手术方式.     

手辅助腹腔镜技术在乙状结肠造口还纳术中的应用观察

目的 观察手辅助腹腔镜技术(HALS)在乙状结肠造口还纳术中的应用效果.方法 选取择期行乙状结肠造口还纳术的患者48例,其中23例术中采用HALS(观察组),25例术中采用常规开腹(OS,对照组),比较两组手术时间、住院时间、术中出血量、术后AVS评分及术后并发症.结果 观察组手术时间(103.52±18.28)min...     

全结肠切除回肠肛管吻合回肠造口还纳术后护理

家庭性结肠息肉病归属于腺瘤性息肉综合征,是一种常染色体显性遗传性疾病,偶见于无家族史者,全结肠与直肠均可多见腺瘤（其临床表现主要大便带血,大便次数增多,常有较多黏液便,有的病人排便时可出现小息肉脱出肛门。此外患者还有不同程度的腹部不适,以及疲乏、无力、消瘦等全身症状,手术治疗是提高生存率的有效手段）。     

出院计划在直肠癌肠造口患者中的应用效果

背景直肠癌是常见的消化系统恶性肿瘤,手术是治疗的主要方式,术后肠造口影响患者的躯体结构、生活方式、心理调试、社会适应性.探索提高直肠癌肠造口患者造口适应性和生活质量的方法有助于患者顺利回归家庭与社会.目的探讨出院计划服务对直肠癌肠造口患者造口适应性、生活质量与造口并发症的影响.方法采用便利抽样法选择2016-10/2018-03在广西壮族自治区人民医院治疗的直肠癌肠造口患者100例为研究对象.采用随机数字表将其分为对照组与观察组,每组50例.对照组采用常规护理及电话随访,观察组在常规护理的基础上实施出院计划模式进行延续性护理,两组病人干预时间均为6 mo.比较两组患者的造口适应性、生活质量、造口并发症发生率等指标.结果出院3 mo和6 mo,观察组造口适应性明显高于对照组,差异均有统计学意义(t=2.136和6.713, P0.05);观察组总体生活质量高于对照组,差异均有统计学意义(t=22.52和24.87, P0.05); 6 mo内,观察组造口并发症发生率低于对照组,差异有统计学意义(χ~2=15.072, P 0.05).结论出院计划模式应用于直肠癌肠造口患者的延续护理中,能提高患者了造口适应性及生活质量,降低造口并发症发生率,值得进一步推广应用.     

末端回肠造口早期还纳的可行性及安全性的Meta分析

目的通过Meta分析来评价早期还纳末端回肠造口的可行性及安全性，为造口还纳的最佳时机提供循证医学证据。 方法检索万方、中国知网、Cochrane Library、PubMed、SpringerLink、EBSCO、MEDLINE等数据库，以"末端回肠造口" "早期还纳" "ileostomy" "early clsure" "stoma" "reversal"为检索词检索从2000年1月至2019年11月所有对比早期还纳及晚期还纳的文献，提取相关临床资料和数据，根据纳入和排除标准，并根据Cochrane文献质量评估手册和NOS量表评估文献质量，最后采用RevMan5.3进行Meta分析。 结果最终9篇文献符合纳入标准，早期还纳组手术时间少于晚期还纳组（P= 0.0005）、造口相关并发症及肠梗阻发生率低于晚期还纳组（P<0.00001），切口感染发生率高于晚期还纳组（P<0.0001），差异均有统计学意义；术后并发症（P=0.67）、术后吻合口漏发生率（P=0.39）基本相似，差异均无统计学意义。 结论早期还纳末端回肠造口是安全可行的，并不增加手术并发症，且能够减少造口相关并发症，提高患者的生活质量。     

现代信息技术在肠造口患者延续性护理中的应用概况

肠造口是肠道肿瘤外科手术常用的手术方式之一,永久性肠造口改变了正常的排便方式,对患者的身心带来极大影响,易造成痛苦和不适,延续性护理有利于提高肠造口患者的生活质量。对出院后肠造口患者的延续性护理所采用的现代信息技术包括电话、短信、QQ、微信等。该文对电话、手机短信、QQ、微信等信息技术在肠造口患者延续性护理中的应用进展作一综述,以期为促进网络信息技术的临床应用提供参考依据。     

肠造口患者的围手术期护理

2002年2月～2005年1月，我院共收治直肠癌患者233例．其中行肠造口137例，男79例，女58例；年龄18～76岁，平均47岁。经精心治疗及护理效果满意。现将护理体会报告如下。     

电话随访卡在肠造口出院患者健康教育中的应用

2007年7月以来,我们应用电话随访卡对40例患者进行连续性全方位健康教育,效果满意。现报告如下。     

老年永久性肠造口患者不同阶段的生活质量

目的了解老年永久性肠造口者不同阶段生活质量现状,探讨其影响因素。方法选取中国14所三甲医院不同阶段(术后住院期、术后化疗期及居家康复期)的123例老年永久性肠造口者,采用自编的一般资料调查问卷,中文版造口患者生活质量量表(C-COH),造口患者自我效能量表及领悟社会支持量表(PSSS)进行问卷调查。结果老年造口者生活质量处于中等水平,且术后住院期、术后化疗期及居家康复期的生活质量得分呈上升趋势(P0.05)。术后住院期生活质量的影响因素是体质指数、社会支持和自我效能(P0.05);术后化疗期生活质量的影响因素是自我效能、陪护者和医保比例(P0.05);居家康复期生活质量的影响因素是自我效能、造口并发症和自理程度(P0.05)。结论老年永久性肠造口者不同阶段生活质量的影响因素有所不同,医护人员应结合其机体特点,针对个体情况和所处阶段,充分评估和筛选影响生活质量的高危因素,制定患者易接受、理解和吸收的分阶段个体化干预措施,以提高生活质量。     

老年肠造口患者症状群与生活质量的相关性

目的 了解老年肠造口患者的症状群与生活质量的现状,分析症状群与生活质量的关系.方法 采用方便抽样法,使用一般资料调查表、中国大肠癌造口患者症状评估量表、生活质量核心问卷调查134例老年肠造口患者.结果 四个肠造口症状群依次为:心理症状群、能量缺乏症状群、消化系统症状群、疼痛症状群,主观幸福感下降(85.07％)、情绪低...     

Pursestring skin closure after stoma reversal

A simple, inexpensive, reliable, and cosmetically attractive method of stoma closure is presented.     

Purse-string approximation is superior to primary skin closure following stoma reversal: a systematic review and meta-analysis

Background

The incidence of surgical site infection (SSI) following stoma reversal can reach 40 %. A recent variation on primary linear closure (PLC) is purse-string approximation (PSA), where the skin is approximated via a purse-string suture but not closed. The optimal technique remains to be determined. The objective of this review was to compare outcomes with PLC versus PSA for skin closure following stoma reversal.

Methods

A literature search of Embase and Medline was performed to identify studies comparing PLC with PSA published between 1966 and 2012. Reviews of each study were conducted and data extracted. Random-effects methods were used to combine data, and between-study heterogeneity was assessed.

Results

Six out of 47 identified studies met the inclusion criteria: 2 randomized controlled trials and 4 case controlled series. For the primary outcome of SSI rate, 233 patients in the PLC and 170 patients in the PSA group were available for comparison. PSA resulted in a reduced rate of SSI (2.4 % PSA vs. 29.6 % PLC; OR 0.083, 95 % CI = 0.03–0.21, p < 0.001). No differences were noted in length of hospital stay. Three studies assessed self-reported cosmetic results at a minimum of 7 months post-operatively. Patients who underwent PSA reported greater satisfaction with the cosmetic outcome (Standard mean difference = 0.47 on ten-point scale, 95 % CI 0.15–0.79, p = 0.005).

Conclusions

Purse-string approximation of stoma wounds is associated with an 80 % reduction in SSI with no negative effect on length of hospital stay or long-term cosmetic outcome.     

Early closure of temporary stoma of the small bowel

AIM: Transient small bowel stoma is usually closed 9-12 weeks after initial operation (late closure). Since these stoma have a poor physiological and psychological impact with frequent social consequences, we wanted to estimate feasibility and results of early closure of small bowel stoma. PATIENTS AND METHOD: From January 1998 to December 2001, 39 patients (21 women and 18 men, mean age: 64 years) with a transient small bowel stoma were elected for early closure. Early closure was performed only if the patient was in good condition, and without developing wound or general sepsis. In the other patients, the stoma was closed in the usually recommended delay (> 8 weeks). Fifteen patients had an early closure of their stoma in a mean delay of 10.0 +/- 0.8 days after the initial procedure. Twenty-four patients had a late closure of their stoma in a mean delay of 11.4 +/- 3.7 weeks. RESULTS: There were no postoperative deaths and no intestinal fistula. Four (10%) wound abscesses occurred and were managed without any surgical procedure, 3 in the early closure group (20%) and 1 in the late closure group (4%) (P=0.85, NS). Time to recovered bowel activity and to resumed oral feeding were equivalent in the two groups. The mean length of hospital stay was longer in the delayed group (34.5 +/- 18.6 days) than in the early group (23.1 +/- 4.6 days) (P<0.01). CONCLUSION: Early closure of bowel stoma can be performed without major complications in elective patients. This procedure shortens hospital stay.     

Reinforcement of closure of stoma site using a biological mesh

Incisional hernia at the site of stoma closure is an under-reported problem, having been recently shown to occur in up to 30 % of patients. This technical note describes a technique for the placement of intraperitoneal biological mesh to prophylactically reinforce stoma closure sites. Seven consecutive patients underwent mesh placement as part of a pilot study. Following closure of the stoma through a trephine incision, 6 anchoring sutures were placed between the peritoneum/deep fascia and the edges of the mesh circumferentially. The mesh was delivered into the peritoneal cavity and parachuted up against the abdominal wall, and the sutures tied. If closure was performed through a midline laparotomy, the anchoring sutures were placed in a similar fashion through the midline incision. The fascia above the mesh and soft tissues was then closed. The mesh was successfully placed in all 7 patients. Follow-up at 30 days showed one superficial wound infection. An ultrasound scan of this patient revealed that the mesh was still in place and that the infection did not breach the fascia. No other early adverse events occurred. Prophylactic biological mesh reinforcement of stoma closure sites is technically feasible and safe in the short term. Longer-term results from a prospective randomised trial are needed, including clinical and radiological assessment for hernia rates, to establish what if any are the realisable benefits of this technique.     

Use of figure of eight suture for groin closure with no heparin reversal in patients undergoing cryoballoon ablation for atrial fibrillation

Purpose

We aimed to demonstrate the feasibility of figure of eight (FoE) suture for groin access closure in cryoballoon (CB) ablation and its impact on the lab workflow.

Methods

We retrospectively analyzed all patients who underwent CB ablation in our institution from June 2018. From June 2019, we have been consistently using FoE suture for hemostasis (FoE+ group), and before that conventional manual compression was utilized (FoE- group). Ablations were performed under uninterrupted oral anticoagulant strategy. Both femoral veins were punctured, and a single introducer was placed in each vein. In the FoE- group, after ablation, protamine was administered, and manual compression was applied. In the FoE+ group, the suture was placed in both groins without protamine administration and manual compression. All patients were in decubitus position until the next morning.

Results

A total of 190 consecutive patients (73.2% male, 59.7?±?11.0 years old) were evaluated, 90 being in the FoE+ group. There was no difference in the mean procedure duration between two groups (72.7?±?23.1 min vs 73.7?±?27.1 min, p?=?0.784). However, the total lab time was significantly longer in FoE- group (132.9?±?35.3 min vs 109.9?±?32.6 min, p?<?0.0001). There was no difference in complication rates. No major vascular complications were found in our cohort.

Conclusions

Utilization of FoE sutures for hemostasis seems to be a safe and effective after cryoballoon ablation. It abolishes the need for protamine administration which can cause serious adverse events. As manual compression is unrequired, EP lab workflow improves due to significantly shortened total lab time per patient.

     

Purse-string skin closure versus linear skin closure techniques in stoma closure: a comprehensive meta-analysis with trial sequential analysis of randomised trials

Objectives

To compare purse-string skin closure (PSC) and linear skin closure (LSC) techniques in patients undergoing stoma closure

Methods

We conducted a systematic review of literature and meta-analysis of outcomes according to PRISMA statement standards to compare PSC and LSC techniques in stoma closure. Trial sequential analysis (TSA) was performed to assess the possibility of type I or II error and compute the information size required for conclusive meta-analysis.

Results

We identified six randomised controlled trials (RCTs) and eight observational studies, enrolling a total of 1102 patients. The included populations in the PSC and LSC groups were comparable in terms of baseline characteristics. The risk of surgical site infection (SSI) was significantly lower in the PSC group (OR 0.10; 95% CI 0.06, 0.18; P?<?0.00001). There was no difference between the two groups in terms of operative time (MD 1.80; 95% CI ??1.35, 4.96; P?=?0.26), anastomotic leak (OR 0.73; 95% CI 0.21, 2.48; P?=?0.61), incisional hernia (OR 0.59; 95% CI 0.25, 1.37; P?=?0.22), small bowel obstruction (OR 0.96, 95% CI 0.50, 1.86; P?=?0.91), and length of hospital stay (MD ??0.04; 95% CI ??0.51, 0.42; P?=?0.86). Patient satisfaction was higher in the PSC group. TSA showed that the risk of type 1 error was minimal and meta-analysis was conclusive.

Conclusions

PSC is associated with significantly lower risk of SSI and better patient satisfaction compared with LSC in closure of stomas and should be the closure technique of choice. The current available evidence is robust and conclusive highlighting that the results of the current study should be incorporated into clinical practice without a need for further trial data.

     

Surgical closure of adult patent ductus arteriosus using a pursestring suture

A 52-year-old woman with patent ductus arteriosus underwent transpulmonary surgical closure through a median sternotomy. The procedure was performed under cardiopulmonary bypass with normothermia and a beating heart, using transductal balloon occlusion and a pursestring suture around the orifice of the ductus. The use of a pursestring suture allowed minimization of the risk of balloon breakage, obviated the need for profound hypothermia and circulatory arrest, and greatly increased the technical facility of the procedure.     

心导管术拔鞘管后应用经皮血管闭合器临床观察

目的　与人工压迫止血比较 ,观察心导管术拔鞘管后应用经皮血管闭合器 (Perclose)止血的疗效及安全性。方法　 189例病人在心导管术后 ,分为人工压迫止血组(95例 ,其中单纯冠脉造影 4 6例 ,行冠脉成形术 4 9例 )和Perclose止血组 (94例 ,其中单纯冠脉造影 2 5例 ,行冠脉成形术 70例 )。观察两组止血时间 ,下床活动时间 ,血管并发症。结果　Perclose止血组与人工压迫止血组相比 ,止血时间 ,下床活动时间明显缩短。Perclose止血组未见血管并发症 ,与人工压迫止血组相比差异有显著性 (P <0 0 1)。应用Per close止血成功率为 98 9%。结论　心导管术拔鞘管后应用经皮血管闭合器 (Perclose) ,缩短了止血时间和下床活动时间 ,并可减少血管穿刺点并发症及病人不适感。