A prospective study of speech and voice rehabilitation after total laryngectomy with the low-resistance Groningen,Nijdam and Provox voice prostheses

In a prospective study the Groningen, Nijdam, and Provox voice prostheses were evaluated with respect to speech and voice rehabilitation. At ≈ 1, 4, and 10 months after operation, patients were submitted to a standardized speaking task to evaluate phonatory skills (phrase length, phonation duration, dynamics on tone, dynamics on sentence, speech rate and availability of sound), speech quality (fluency and overall intelligibility), voice quality and stoma technique (stoma noise). Tracheoesophageal speech rehabilitation proved to be successful in 94–100% of patients, as measured at ≈ 10 months after operation. Furthermore, no significant overall differences were found between the three prostheses. There was a significant improvement in time for speech rate and stoma noise. As for the time effects (e.g. improvement in performance over time) no differences between the three prostheses were found.     

运用肛双管引流直肠癌术后吻合口漏患者的护理

目的 探讨直肠癌术后吻合口漏患者运用肛双管引流的效果。方法 将采用肛双管引流的51例患者与33例单纯扩肛的患者进行比较。经肛双管引流的患者采用定时、低压冲洗,加强肛门局部护理的方法。单纯扩肛的患者扩肛3～4次/d,5～10 min/次,持续5～9 d。结果 双管引流组患者吻合口漏愈合时间为(10.3±2.3)d,与单纯扩肛组(14.6±5.1)d相比,显著缩短,经t检验,P<0.05,有显著性差异。结论 通过适当的护理措施,经肛双管引流能促进吻合口愈合,减少并发症。     

Readability of printed educational materials used to inform potential and actual ostomates

• ? This paper is primarily concerned with the use of readability formulas to determine the reading ease of printed education materials (PEMs) given to ostomy patients. Whilst the particular clinical focus is stoma care nursing, the content is relevant to all nurses who use printed text to inform their patients. PEMs have significant advantages in conveying information compared with verbal presentations alone.
• ? Methods to calculate readability using the Flesch, FOG and SMOG readability formulas are described. Presentation factors that affect readability are briefly reviewed, including use of ‘white space’, font size and paper colour. The problem of functional illiteracy and the need for indirect assessment of patient literacy are discussed.
• ? PEMs in use are often found to be difficult to read. Stress is identified as a potential factor in further reducing a patient's ability to deal with information.
• ? Three commercially available PEMs are evaluated for ease of reading and their score on the FOG index indicates that only about 40% of the UK population would understand them.
• ? Nurses are advised to evaluate the readability of their PEMs and to assess indirectly the literacy of their patients, so that they can more sensitively match PEMs to patient ability and need.

     

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.     

肠造口周围皮肤常见问题护理现状

通过对肠造口周围常见皮肤问题分类及产生原因进行分析,找出皮肤问题易发因素,并指导患者及其家属采取必要的预防措施及针对性护理,避免造口周围皮肤问题的发生,减轻患者的痛苦,提高肠造口患者生活质量。     

结肠造口患者造口自我护理能力和希望水平的相关性研究

目的探讨结肠造口患者的造口自我护理能力和希望水平及其相关性。方法采用一般情况调查表、造口自我护理量表-普通版、Herth希望量表对102例结肠造口患者进行调查。结果造口患者的自我护理能力总分为(38.77±5.85)分;希望总分(38.98±4.85)分,均处于高水平。希望总分、身体形象改变、家庭人均月收入和自我接受造口与结肠造口患者的造口自我护理能力密切相关(P0.01或P0.05)。结论护士应注意给造口患者以希望和力量,促使患者接受造口和身体形象的改变,以提高其造口自我护理能力。     

Long-Term Outcome of Surgically Treated Crohn’s Colitis: A Prospective Study

PURPOSE Although bowel-sparing techniques have been published for treatment of Crohns disease of the small bowel because of its relentless nature, extent of resection in Crohns colitis is still a topic of debate. This study was designed to prospectively evaluate the long-term outcomes of patients with isolated Crohns colitis to identify patients that may benefit from initial more aggressive resection.METHODS We identified 179 patients with Crohns disease operated on for primary colonic disease. They were divided into segmental colectomy, total abdominal colectomy, and total proctocolectomy groups, based on their initial operation. They were further characterized by extent and location of colonic involvement. Long-term outcome variables evaluated included colonic and small-bowel surgical recurrences, postoperative complications and long-term sequelae, long-term need for medical therapy, and need for permanent fecal diversion.RESULTS Fifty-five patients underwent segmental colectomy, 49 total abdominal colectomy, and 75 total proctocolectomy. Patients with diffuse colonic involvement were significantly less likely to undergo segmental colectomy than total abdominal colectomy (P < 0.0001) or total proctocolectomy (P < 0.0001). Patients with distal involvement or pancolitis were significantly less likely to undergo segmental colectomy than total abdominal colectomy (P < 0.0001) or total proctocolectomy (P < 0.0001). Overall there were 31 patients (24.4 percent) with surgical Crohns recurrences during follow-up: 19 (38.8 percent) in the segmental colectomy, 8 (22.9 percent) in the total abdominal colectomy, and 4 (9.3 percent) in the total proctocolectomy group. There was a significant difference in time to recurrence between the three groups by log-rank test (P = 0.017). Segmental colectomy patients had a significantly shorter time to first recurrence than total proctocolectomy patients (P = 0.014). After adjusting for extent of disease, the segmental colectomy group had a significantly greater risk of surgical recurrence than the total proctocolectomy group (P = 0.006). Total proctocolectomy patients were significantly less likely to be still taking medications one year after the index operation than total abdominal colectomy patients (P = 0.003) and segmental colectomy patients (P = 0.0003). During follow-up, patients with isolated distal disease were significantly more likely to require a permanent stoma than patients with isolated proximal disease (P = 0.004).CONCLUSIONS A more aggressive approach should be considered in patients with diffuse and distal Crohns colitis. Total proctocolectomy in the properly selected patients is associated with low morbidity, lower risk of recurrence, and longer time to recurrence. Patients after total proctocolectomy are more likely to be weaned off all Crohns-related medications. Long-term rate of permanent fecal diversion is significantly higher in patients with distal disease.Reprints are not available.Read at the meeting of The American Society of Colon and Rectal Surgeons, Dallas, Texas, May 8 to 13, 2004.     

双腔管冲洗引流并尿激酶溶解术治疗高血压脑出血

目的:探讨双腔管冲洗引流并尿激酶溶解术治疗高血压脑出血的方法及效果.方法:回顾性分析38例在CT定位钻孔抽吸部分血肿后行双腔管冲洗引流并尿激酶注入治疗的高血压脑出血病人的临床特点及疗效.结果: 血肿清除率高,病人恢复良好,死亡率低,并发症少.结论:双腔管冲洗引流并尿激酶溶解术是高血压脑出血的一种简单、有效的治疗方法.     

The use of an ileostomy connector to diminish the frequency of defecation prior to ileostomy closure in patients with a pelvic pouch

A new method for allowing stool passage into the pelvic pouch before ileostomy closure to verify the defecation state and diminish stool frequency is reported herein. This was accomplished by fitting an ileostomy connector connecting the proximal and distal openings of the diverting loop stoma. The ileostomy connector was initially in place for 6 h a day, the length of time being gradually increased until it was able to be left in for 24 h a day over a 3-month period. The calculated daily frequency of stools decreased from 24 to 6 or 7 times, and the mean daily frequency immediately after ileostomy closure was 6.5 times. Physiological study also showed an improvement, with squeeze pressure increasing from 35 cmH₂O to 116 cmH₂O and the maximum tolerated volume increasing from 35 ml before, to 90 ml 3 months following the use of an ileostomy connector. Thus, we conclude that an ileostomy connector may be useful to predict postoperative functional outcome and its complications, and to diminish the frequency of defecation before ileostomy closure in patients with a covering loop stoma.This study was submitted as a poster presentation at the meeting of the XIVth Biennial Congress of the University of Colon and Rectal Surgeons in Creta, Greece, October 25–29, 1992.     

自制快速膀胱穿刺针及临床应用

介绍了自制快速膀胱穿刺针的结构、组成、功能和临床使用方法，具有操作简单、患者痛苦小、可替代开放性手术的特点。