Living with a permanent intestinal stoma: changes told by stoma patients

This study relates to the first part of a study developed with persons with permanent intestinal stomas, assisted in specialized outpatient clinics in Campinas, SP (Brazil), aiming to identify the information provided to these patients about their stoma and their difficulties in living with this device. It was verified that patients received insufficient information concerning the stoma before the surgery, what could have contributed to postoperative fears and difficulties in adaptation to the stoma. Results suggest that nurses should assume their roles as patient educators in the whole preoperative process in order to facilitate improvement of quality of life for the stoma patient.     

预防性末端回肠造瘘在低位直肠癌保肛手术中的临床应用

目的 观察预防性末端回肠造瘘在低位直肠癌保肛手术中的应用效果.方法 将80例低位直肠癌患者随机分为观察组和对照组,各40例;两组均行前切除保肛手术,遵循全直肠系膜切除原则;观察组术中采用预防性末端回肠造瘘术,对照组不用.结果 观察组出现吻合口瘘1例(2.5％),行骶前引流管低压冲洗引流后愈合,住院时间(10±2.5)d.对照组出现吻合口瘘5(12.5％)例,其中行横结肠造瘘2例、回盲部造瘘1例、腹会阴联合切除术1例、对症处理1例,住院时间(25±5.5)d.两组吻合口瘘发生率、住院时间比较,P均＜0.05.结论 低位直肠癌保肛手术中的应用预防性末端回肠造瘘,可显著降低吻合口瘘的发生率,不需要二次手术,且住院时间明显缩短.     

保护性造口对直肠癌直肠低位前切除术器官腔隙感染的影响分析

 目的 了解保护性造口对行直肠低位前切除术（Dixon术）直肠癌患者术后器官腔隙感染的影响。方法 前瞻性监测2017-2021年某院实施Dixon术的直肠癌患者术后器官腔隙感染情况,分析感染危险因素,依据肿瘤距肛缘的距离将研究对象分为 ≥ 7 cm、5~7 cm和<5 cm三组,比较各组行保护性造口的比例及感染情况,以及行保护性造口与未行保护性造口患者的感染率。结果 2017-2021年该院行Dixon术的直肠癌患者器官腔隙感染率为4.79%（51/1 064）。危险因素分析显示,男性、术前贫血、术前肠梗阻、引流时间>10 d、肿瘤距肛门距离<7 cm、手术持续时间>3 h为发生器官腔隙感染的独立危险因素,而手术同时行保护性造口是发生器官腔隙感染的独立保护因素。肿瘤距肛门距离 ≥ 7 cm患者术后感染率最低,为2.76%;肿瘤距肛门5~7 cm患者感染率最高,为9.52%;肿瘤距肛门<5 cm患者行保护性造口比例最高,为72.05%。对于肿瘤距肛门距离 ≥ 7 cm患者,行保护性造口并不能有效预防感染的发生;对于肿瘤距肛门<5 cm患者,行保护性造口可明显降低感染率,差异有统计学意义（P=0.02）;肿瘤距肛门5~7 cm患者,行保护性造口后感染率降低幅度也很大,但差异无统计学意义（P=0.07）。结论 行保护性造口对直肠癌患者Dixon术后器官腔隙感染具有保护作用,尤其是对肿瘤距肛门距离<5 cm的患者。     

Quality of life in patients on permanent home parenteral nutrition

A psychosocial survey of patients on permanent home parenteral nutrition (HPN) has been made to assess the quality of life in these patients. All patients on permanent HPN in the period August 1978 to August 1979, including 7 women and 6 men, age range 24-62 yr (median 53) were interviewed, as well as partners of 11 patients who were married or cohabiting. The duration of HPN ranged from 2-43 mon (median 24 mon). They were asked specific questions about physical symptoms, social and leisure activities, interpersonal relationships, sexuality, psychological problems, and feelings about HPN. None had an outside job, but 6 (46%) did most of the housekeeping. Some physical distress was recorded in almost all patients, but 9 (69%) considered themselves healthy or fairly healthy, whereas 4 (31%) felt diseased. Social and leisure activities were normal or only slightly impaired in most. Sexual activity had ceased completely in 5 above 55 yr, in association with onset of the disease; younger patients displayed normal and unchanged sexual activity. Psychological symptoms were recorded in 6 (46%), major symptoms in 4 (31%). Seven partners considered HPN to be a moderate or severe burden, mainly psychological changes in the patient that caused marital tension in 3 cases. Criteria for quality of life were: 1) no major physical distress, 2) no major psychological symptoms, 3) no substantial restriction of social and leisure activities, 4) ability to accept HPN, 5) overall satisfaction with conditions of life. Nine patients who fulfilled at least 3 of these criteria were considered to have a fair quality of life, 4 who complied with less than 3 of the criteria a poor quality of life. The interviews were repeated at intervals of 6-10 mon in 9 patients, and revealed no systematic improvement or deterioration of quality of life during HPN.     

The quality of life with a stoma

This article considers the problems encountered by the ostomate, reviews the present structure and effectiveness of hospital and community-based resources and offers a basis for improving the quality of stoma care.     

激励式护理对直肠癌术后永久性结肠造口的影响

目的 分析激励式护理对直肠癌术后永久性结肠造口的影响.方法 将高唐县人民医院2018年5月-2019年6月收治的直肠癌患者100例作为观察对象,采用随机数字表法分为观察组和对照组各50例,观察组实施激励式护理,对照组实施常规护理,观察比较两组患者的疾病认知水平(合理饮食、规律排便、并发症观察、造口皮肤护理、粪袋清洁)、...     

直肠癌术后常规放射治疗摆位误差分析

目的:通过对直肠癌术后常规放射治疗重复摆位数据的测量,分析误差产生原因,并采取针对性措施减少误差.方法:13例直肠癌术后放射治疗患者,仰卧于床上,采用真空袋固定,由模拟定位机工作站采集定位图像,行等中心放射治疗.每周一、三、五采集验证片,与原定位片比较,测量摆位误差.结果:156幅验证图像与其对应的定位图像比较,X、y、Z轴误差分别为(0.32±0.17)、(0.58±0.27)、(0.53±0.31)cm,正、侧面移位旋转分别为(2.3±1.9)和(1.8±1.6)°.结论:直肠癌术后常规放射治疗中重复摆位存在一定误差,通过采取相应措施可以减小.     

Quality of life of cancer patients with different prognoses

This study examines differences and similarities in the quality of life of 253 cancer patients with good, medium and poor prognoses. Our main hypothesis was that patients with a good prognosis will experience a higher quality of life than patients with a medium or poor prognosis. A multivariate analysis of covariance of eight quality of life scales was performed with prognosis as a factor and with age, sex, and the duration of the illness as covariates. Significant main effects of prognosis were found for the general QOL-scale and for physical aspects of quality of life. There were, however, only marginal and non-significant effects of prognosis groups on social and psychological functioning. A final multivariate analysis confirms earlier findings that performance status shows a weak but significant relationship with the psychological functioning. Thus, the physical condition of the patient at the time of measurement seems to have some influence on the psychological functioning, whereas the severity of the disease as inducated by the classification into prognosis groups does not. These results question the general attitude that seriously ill cancer patients have reduced social and psychological well-being. An alternative interpretation is that the scales used to measure psychological aspects of quality of life are inadequately sensitive.This study is supported by grants no 89090/001-002 from the Norwegian Cancer Society and by the Faculty of Medicine, University of Trondheim. The study has been evaluated and approved by the Regional Ethical Committee for Medical Research.     

Quality of life after gastric bypass surgery: a cross-sectional study

OBJECTIVE: Numerous reports document significant weight loss after gastric bypass; however, there is little objective data on postsurgical changes in health-related quality of life (HRQL). RESEARCH METHODS AND PROCEDURES: This study examined HRQL in four groups of patients: presurgery (T1), several weeks postsurgery (T2), 6 months postsurgery (T3), and 1 year postsurgery (T4). Subjects were given three HRQL measures: the short form 36 (SF-36), the Impact of Weight on Quality of Life-Lite Questionnaire (IWQOL-Lite), and the Bariatric Analysis and Reporting Outcome System (BAROS). Subjects also completed the Beck Depression Inventory (BDI) and the Rosenberg Self-Esteem Scale (RSE). RESULTS: There were no significant differences among the groups on demographics or presurgical body mass index. Results showed significant differences between T1 and T2 on several SF-36 and IWQOL-Lite subscales, as well as the RSE and BDI. Significant differences were found on all measures between T2 and T3. Significant differences were found on all subscales of the IWQOL-Lite, but no subscales of the SF-36, the RSE, or the BDI between T3 and T4. DISCUSSION: This study is the first to objectively document these differences in several objective measures of HRQL, depression, and self-esteem after gastric bypass in a large sample. It is notable that many differences are apparent within several weeks after surgery. Furthermore, results indicate that the IWQOL-Lite may be more sensitive than the SF-36 to the changes of quality of life that gastric bypass patients report.     

Quality of life in partners of patients with localised prostate cancer

Purpose

The diagnosis of prostate cancer and the following treatment does not only affect the patient, but also his partner. Partners often suffer even more severely from psychological distress than the patients themselves. This analysis aims to describe the quality of life (QoL) after the cancer diagnosis over time and to identify the effects of possible predictors of partners’ quality of life in a German study population.

Data and methods

Patients with localised prostate cancer and their partners were recruited from a prospective multicenter study in Germany, the Prostate Cancer, Sexuality, and Partnership (ProCaSP) Study. At five observation times during the follow-up period of 2 years after diagnosis, QoL (EORTC QLQ-C30) and personal, social, and cancer-related health factors as well as adaptation and coping factors of 293 couples were observed and analysed with mixed effects analysis.

Results

The men’s prostate cancer diagnosis had a small, but significant impact on their partner’s QoL. However, QoL of partners was most affected by the partners’ own physical health and psychological condition, time, and their relationship quality.

Conclusion

The finding that average QoL increased again 3 months after diagnosis and later should give partners faith and hope for the future. The identified most important predictors of partners’ QoL are potentially susceptible to intervention, and further research on target groups in special need of support and on adequate interventions is needed.     

Quality of life of caregivers of patients with advanced-stage cancer

There has been much research documenting the impact of having a loved one diagnosed with advanced cancer, but little is known about how to reduce care-giver burden. In this randomized controlled trial, the authors examined the potential relationship of an advanced cancer patient's participation in an 8-session, structured, multidisciplinary intervention on the care-giver's burden and quality of life (QOL). Although the patients randomly assigned to the intervention (n = 54) demonstrated improved QOL compared to the control condition (n = 49) participants (P < .05), there was no evidence that improving the patient's QOL made an impact on the caregiver's level of burden or the care-giver's QOL. Further investigation is warranted in this area, including interventions specifically designed and targeted to both reduce caregiver burden and to improve caregiver QOL.     

胃大部切除术后吻合口癌、贲门癌及食管癌的外科治疗

目的 探讨胃大部切除术后吻合口癌、贲门癌及食管癌的外科治疗.方法 回顾性分析21例胃大部切除术后吻合口癌、贲门癌及食管癌患者的临床资料.其中贲门癌术后吻合口癌4例;胃溃疡胃大部切除术后贲门癌2例;胃溃疡胃大部切除术后食管上段癌3例;胃溃疡胃大部切除术后食管中段癌6例;胃溃疡胃大部切除术后食管下段癌6例.行残胃全切+食管部分切除,空肠食管吻合术6例;食管胃部分切除,弓下食管胃吻合3例;食管次全切除结肠代食管12例.结果 术后切口感染1例,吻合口瘘1例,1例死于肺部感染,随访20例患者中,4例术后第3年死于心脑血管意外,存活的16例患者饮食基本正常.结论 胃大部切除术后吻合口癌、贲门癌及食管癌患者若全身情况许可,无远处转移均应争取手术治疗,消化道重建器官的选择应根据患者首次手术切除情况及术者熟练程度而定.     

Quality of life as conveyed by pediatric patients with cancer

Quality-of-life instruments have provided important advances in measuring the quality of life of pediatric patients receiving treatment for cancer. However, the bases of these instruments have not included first-hand reports from the patients; thus, these instruments may be conceptually incomplete. We directly solicited from pediatric patients their perspectives regarding their quality of life during treatment for cancer. We conducted two pilot studies: 23 patients (aged 8-15 years) participated in the first, a cross-sectional study; and 13 patients (aged 10-18 years) participated in the second, a 2-year longitudinal study. Data were analyzed by using a semantic-content method, and the following six domains were recognized in data from both of the studies: symptoms, usual activities, social/family interactions, health status, mood, and the meaning of being ill. These domains were compared with those of seven established pediatric oncology quality-of-life instruments, none of which included all six of these domains; the domain most frequently missing was the meaning of being ill domain. Here we present a new definition of the quality of life of pediatric oncology patients that is based on six domains; this definition may ensure the completeness and sensitivity of these important instruments.     

Quality of life during rehabilitation after coronary artery bypass surgery

The effect of a three-phase comprehensive rehabilitation programme on the quality of life during the first postoperative year after coronary artery bypass surgery was studied in 205 male patients randomly allocated into a rehabilitation (R) and a hospital-based treatment (H) group. The rehabilitation programme included physical exercise, relaxation training, psychological group sessions, dietary advice and discussions about postoperative treatment of coronary disease. There was no difference between R and H groups in the frequency of postoperative complaints, number of hospital admissions and satisfaction of sexual life. An almost significantly greater number of subjects in R group than in H group perceived their health as good 12 months after surgery. The Beck Depression Index score decreased significantly in R group but not in H group during follow-up. A greater increase in hobby activities was observed in R group than in H group. More subjects in R group than in H group considered rehabilitation important for recovery, whereas more patients in H group considered support by the spouse and family, the subjective mental strength and a secure income as important.     

Laparoscopic surgery for rectal cancer

Laparoscopic surgery for colonic cancer is a safe and established alternative to traditional open colectomy. The potential advantages of shorter length of stay, faster recovery and fewer operative complications are well documented. The last 5 years has seen an increase in the number of laparoscopic colorectal operations as more surgeons learn this technique. Short and medium term results have been encouraging with respect to oncological outcomes. However, laparoscopic surgery for rectal cancer remains a contentious issue. The increased complexity of operating within the confines of the pelvis and the greater risk of oncological compromise, have led to some surgeons urging caution. We present the challenges associated with laparoscopic rectal cancer surgery and explain that appropriate patient selection, surgical planning and laparoscopic experience are the key to successful outcomes.Laparoscopic surgery for cancer of the colon is a safe and well established technique in selected patients, when performed by trained and suitably experienced surgeons. Although several studies have documented the benefits of laparoscopic surgery compared with conventional open colectomy such as reduced blood loss, decreased hospital stay and less post-operative pain,^1,2 it is the equivalent oncological outcomes which have led to acceptance of a minimal access approach. However, laparoscopic resection for rectal cancer (defined as carcinoma within 15 centimetres of the anal verge) has not been as thoroughly evaluated and remains controversial.³ The main concern is fear of oncological compromise and that tumour clearance, and lymph node yields, as markers of surgical success may not be comparable with those achieved at open surgery. There is also a perceived risk of technical compromise due to the inflexibility of the instruments used during laparoscopy. This paper aims to highlight the potential benefits and challenges associated with laparoscopic rectal cancer surgery.     

Quality of life in patients with vitiligo

Vitiligo is an important skin disease having major impact on quality of life of patients, many of whom feel distressed and stigmatized by their condition. Society greets vitiligo patients in much the same way as it does any one else who appears to be different. They are started at or subjected to whispered comments, antagonism, insult or isolation. The chronic nature of disease, long term treatment, lack of uniform effective therapy and unpredictable course of disease is usually very demoralizing for patients suffering from vitiligo. It is important to recognize and deal with psychological components of this disease to improve their quality of life and to obtain a better treatment response.     

腹腔镜下直肠癌根治术后医院感染的原因分析及护理

目的 探讨腹腔镜下直肠癌根治术患者医院感染的围手术期护理对策.方法 采用回顾性调查方法对2005年8月-2011年9月腹腔镜下直肠癌根治术患者资料进行分析研究.结果 患者有糖尿病、慢性支气管炎等基础疾病,长时间的手术是引起术后感染主要因素,而患者的一般情况、癌症的临床分期、手术方式与术后感染无明显关系.结论 术前准备工作、手术室空气质量、室温、无菌操作规程及手术时间的长短、术后切口的管理均是影响术后医院感染的主要因素.