Surgery for necrotising enterocolitis: primary anastomosis or enterostomy?

The ideal surgical management of neonates with necrotising enterocolitis (NEC) is still a matter of debate. The purpose of this study was to compare the results of bowel resection with primary anastomosis with the results of bowel resection with enterostomy. Sixty-three neonates with NEC had a bowel resection in the acute phase of the disease in the period between February 1990 and March 2001. Thirty-four of them (54%) underwent resection of the bowel with primary anastomosis (Group A), and 29 (46%) had resection with enterostomy (Group B). Group A had a lower gestational age and lower birth weight. Mortality, complication rate, and postoperative weight gain were not significantly different between the groups. However, Group B had a significantly longer primary hospital stay (80±49 days versus 58±31 days, P<0.04) and needed a 2nd hospital stay for restoring gastrointestinal continuity. For both reasons, it can be argued that primary anastomosis is superior to enterostomy after resection.     

Deflating proximal enterostomy for jejunoileal atresia

A modification is described to avoid postoperative gaseous distension and facilitate early oral feeding after resection and anastomosis for jejunoileal atresia. Accepted: 13 May 1997     

封闭式灌肠在高龄左半结肠癌肠梗阻术中的应用

目的 总结高龄左半结肠癌肠梗阻切除吻合术中应用封闭式顺行灌肠法防止吻合口瘘的经验。方法 对1998年至2004年期间收治的37例高龄左半结肠癌肠梗阻患者术中应用封闭式顺行灌肠，并行Ⅰ期切除吻合。结果 37例高龄患者术后均未发生吻合口瘘，恢复良好。结论 术中应用封闭式顺行灌肠法，使高龄左半结肠癌致肠梗阻患者行Ⅰ期切除吻合成为可行。     

微信随访对结肠造口患者术后生活质量的影响

目的探讨微信随访对结肠造口患者生活质量的影响。方法选择2011年5月至2013年6月我院普外科行结肠造口患者40例,按随机数字表法分为对照纽和微信组,每组20例。对照组接受常规护理和宣教;微信组在对照组的基础上,出院后与患方建立微信随访。三个月后收集两组资料,对比两组患者生活质量情况,内容包括：造口护理能力、排便规律情况、良性心理建立、正常社交功能恢复。结果微信组患者的生活质量明显高于对照组,差异有铳计学意义（P〈0．01）。结论微信随访能有效改善结肠造口患者的生活质量,减少造口并发症的发生,建立良好正面的心理,帮助患者恢复社会功能,值得借鉴。     

新生儿暂时性短肠综合征治疗体会

目的 探索肠外营养(parenteral nutrition,PN)对新生儿暂时性短肠综合征(temporary short bowel syndrome,TSBS)患儿造瘘期间的治疗作用,并对防治并发症进行探索.方法 回顾性分析2001年1月至2015年12月在我院PN支持治疗的21例新生儿TSBS患儿的诊疗经过,并对其进行随访.结果 符合入组标准的患儿共21例,所有患儿均在新生儿期因各种原因行高位小肠造瘘术,术后需长期依赖PN.其中男12例,女9例.入院年龄1d至8个月(中位年龄2个月),随访3～140个月,中位随访时间21个月.随访至2015年12月时,存活15例,病死6例;存活组中13例关瘘,2例未关瘘;病死组中2例关瘘,4例未关瘘.经Fisher's Exact检验,病死组患儿均发生并发症,存活组仅5例发生并发症(P=0.012);病死组中3例保留回盲部,存活组中9例保留回盲部,两组间差异无统计学意义.经Studentt检验,病死组存留小肠长度(57.5±14.1)cm,显著短于存活组(115.9±46.7)cm(P=0.008).两组患儿的出生体重及入院时年龄别体重z值无统计学意义.结论 新生儿TSBS患儿存留小肠越短,并发症发生率越高,死亡风险越大.合理营养支持对该类患儿后续治疗意义重大,积极随访对预防、早期发现和治疗相关并发症作用明显.     

41例肠造口患者造口皮肤黏膜分离的护理

分析和总结了41例肠造口皮肤黏膜分离患者的临床资料和护理经验.通过制订并实施有效的创面换药和造口护理方案,促进了创面愈合,保证了造口袋的有效粘贴,同时也有助于肠造口患者的心理康复.患者创面均愈合良好.     

临床护理路径在肠造口术患者中的应用

目的探讨临床护理路径在肠造口术患者中的应用效果。方法选择肠造口术患者36例,将其随机分为观察组和对照组各18例,观察组患者采用肠造口术临床护理路径进行连续而完整的护理,对照组患者接受常规护理,比较两组患者在造口并发症、平均住院日数、平均住院费用以及患者满意度的差异。结果观察组与对照组患者的造口并发症分别为0和27．77％、平均住院日数分别为（16．12±5．46）d和（21．18±4．88）d、平均住院费用分别为（20325．68±5676．47）元和（22348．18±4479．90）元,两组比较差异有统计学意义（x2=4．5878,t分别为-2．88,-3．372,P〈0．05）,观察组患者满意度94．44％明显高于对照组55．55％,差异有统计学意义（X2=7．2517,P〈0．05）。结论临床护理路径的实施可以减少肠造口术患者造口并发症的发生,减少患者的痛苦,缩短住院日数和住院费用,减轻患者的经济负担,提高患者对护理质量的满意度。     

Comparative study between window and conventional enterostomies in preterm neonates with small bowel perforations

Objectives

Small bowel perforations in the neonatal period can be secondary to necrotizing enterocolitis (NEC), ischemic necrosis, or occlusive anomalies of the small bowel; furthermore, they may be of no discernible cause. Depending on the clinical condition of the infant and the extent of the disease, a number of surgical options are available; one of which is exteriorization. To reduce the morbidity of stoma among patients, we adopted a technique called window enterostomy (WEnt). The objectives of this study were to describe the technique and to compare WEnt with conventional enterostomy (CEnt) in preterm infants undergoing surgery for focal NEC or isolated small bowel perforation (ISBP).

Methods

We reviewed all cases of NEC and ISBP between January 1996 and March 2006 from our institution. Patients with focal NEC or ISBP who required a surgical intervention were included and categorized into the WEnt and the CEnt groups. We collected multiple data as study variables: demographics; site of perforation; operative time; need for a second operation; postoperative morbidity; duration of total parenteral nutrition; and postoperative weight gain.

Results

Twenty-four neonates met the criteria for study inclusion. Of these, 14 underwent CEnt and 10 underwent WEnt. The median gestational age and birth weight of the neonates were 25.4 weeks (SD = 1.4) and 814.4 g (SD = 195.1), respectively. In comparing the 2 groups, we found statistically significant differences in the operative time for the primary and secondary procedures, duration of total parenteral nutrition, time to full oral feeding, and weekly postoperative weight gain. The rate of postoperative complications was higher among the infants from the CEnt group.

Conclusion

Our results suggest that WEnt is a quick and workable technique with minimal morbidity for preterm neonates with focal NEC or ISBP.     

延续性护理在老年肠造口出院患者中的应用

目的 探讨延续性护理在老年肠造口患者中的应用效果.方法 选择80例老年肠造口患者为研究对象,随机抽取40例为对照组,仅给予常规的护理;另40例为实验组,在常规护理的基础上提供延续性护理.比较两组患者对肠造口护理相关知识掌握程度、患者的满意度.结果 实验组患者对造口周围皮肤护理方法、更换造口袋、日常护理方法、肠造口观察等方面健康知识项目的掌握正确率分别为92.5％、90.0％、95.0％、95.0％,明显优于对照组的72.5％、70.0％、75.0％、80.0％,两组比较差异有统计学意义(P＜0.05).实验组患者对护理工作及生活质量的满意度为97.5％,明显高于对照组的82.2％,两组比较差异有统计学意义(P＜0.05).结论 延续性护理能提高老年肠造口患者对肠造口相关知识的掌握程度,提高患者的满意度.     

结直肠癌造口患者夫妻疾病沟通体验的质性研究

目的探讨结直肠癌患者夫妻疾病沟通体验,为进一步促进夫妻间有效沟通提供依据。方法采用目的抽样法,选取2019年9月—12月在郑州市某三级甲等医院治疗和复诊的结直肠癌造口患者进行半结构式访谈,并用Colaizzi 7步分析法分析资料。结果共提炼4个主题,治疗期消极沟通体验主题包括男性患者缺乏沟通意识、缺乏情感沟通、避免沟通敏感话题;康复期积极沟通体验主题包括积极沟通患病后新生活、沟通默契感增加;消极沟通对患者的影响主题包括负性情绪增加、内心孤独感增加、自信心下降、配偶过度保护产生矛盾;患者对夫妻有效沟通的期待主题包括获得专业知识指导,提高沟通效能以及希望获得沟通技能培训。结论结直肠癌造口患者不同阶段夫妻疾病沟通体验存在差异,消极沟通会对患者心理产生负面影响,医护人员应关注此类患者,给予有效干预措施。