肠道暂时性造口与还纳方式及适应证选择90例分析

目的探讨肠造口方式对还纳手术的影响及造口还纳手术适应证的把握。方法选择2004年1月至2010年12月肠造口还纳手术的患者90例,统计分析造口原因、造口肠段和方法、造口方式、还纳时间、手术方式、手术时间、术后并发症及住院时间等。结果端式造口59例(其中单腔造口39例,双腔造口20例),袢式造口31例(其中改进式袢式造口18例),端式造口还纳手术时间显著长于袢式造口还纳手术(P<0.05)。手法吻合72例,吻合器吻合18例;端端吻合50例,端侧吻合40例;共发生近期并发症8例,发生率为8.9%,是否使用器械与使用不同吻合方式其并发症发生率无差别。结论暂时性肠造口应尽量选择袢式造口,尤其是改进式袢式造口;肠造口还纳术前应充分检查排除远端肠道狭窄或损伤处未愈合,造口术后3～6个月可行还纳手术,可以根据需要选择端端或端侧吻合、手法或吻合器吻合。     

New technique for enterostomy of extremely low-birth-weight infants--intestinal anchoring with gauze

Background

In enterostomy for extremely low-birth-weight infants (<1000 g), the technique of anchoring the intestine for a stoma to the abdominal wall is very difficult because of the small size and fragile nature of the intestine. Here we describe a novel technique for intestinal anchoring in such infants.

Methods

In our approach to enterostomy, the intestine is anchored only by a strip of gauze packed into the subcutaneous space. No suturing is performed. The efficacy of this technique was evaluated in 21 infants with less than 1000 g of body weight who have intestinal perforation or obstruction.

Results

Two patients (9.5%) had complications that were related to the enterostomy. The complications were parastomal and intrastomal intestinal prolapse, both of which were treated successfully by reoperation. Eighteen patients (86%) survived to closure of the enterostoma.

Conclusions

Intestinal anchoring with gauze is an easy and effective technique for enterostomy in extremely low-birth-weight infants and can be applied in selected cases.     

Utilization of parenteral nutrition following pancreaticoduodenectomy: is routine jejunostomy tube placement warranted?

Introduction Complications following pancreaticoduodenectomy (PD) often necessitate nutritional support. This study analyzes the utilization of parenteral nutrition (TPN) during the surgical admission as evidence for or against routine jejunostomy placement. Methods The California Cancer Registry (1994–2003) was linked to the California Inpatient File; PD for adenocarcinoma was performed in 1,873 patients. TPN use and enterostomy tube placement were determined and preoperative characteristics predictive of TPN use during the surgical admission were identified. Results Fourteen percent of patients received TPN, 23% underwent enterostomy tube placement, and 63% received no supplemental nutritional support. TPN was associated with longer hospital stay (18 vs. 13 days, P < 0.0001). The Charlson Comorbidity Index (CCI) ≥ 3 had nearly two-fold greater odds of receiving TPN (odds ratio [OR] = 1.85, P < 0.005). Conclusion Approximately 1 in 6 patients undergoing PD received TPN, which was associated with prolonged hospital stay. CCI ≥ 3 was associated with increased odds of TPN utilization. Selected jejunostomy placement in patients with high CCI is worthy of consideration.     

腹会阴联合直肠癌根治术后造口旁瘘的护理

介绍了1例腹会阴联合直肠癌根治术后造口皮肤黏膜分离、造口旁瘘患者的护理。通过造口插入肛管持续低负压引流粪水,避免粪水通过瘘口刺激周围组织;及时开放创面,彻底清洗,清除坏死组织,充分引流粪水和脓液;瘘口闭合后拔除肛管,根据创面渗液情况应用相应的湿性愈合敷料进行换药处理。创面愈合后尽早行造口指检,及时发现造口狭窄情况,并指导患者自行扩肛,防止造口狭窄进一步加重。     

回馈教育模式在永久性肠造口患者中的应用

目的:探讨回馈教育模式在永久性肠造口患者中的应用效果及对患者健康素养、自我护理能力、心理韧性的影响。方法:采用便利抽样法,选取2019年1—10月滨州医学院烟台附院胃肠外科收治的70例直肠癌术后永久性肠造口患者为研究对象,于患者入院、术前、术后、出院和造口门诊阶段实施回馈教育模式的造口宣教。干预前后分别采用健康素养调查表(HLMS)、自我护理能力测评表(ESCA)、心理韧性量表(CD-RISC)对患者的健康素养、自我护理能力、心理韧性进行评价。结果:干预后患者的HLMS信息获取能力、经济支持意愿、交流互动能力、改善健康意愿维度得分均高于干预前,干预前后比较差异有统计学意义(P<0.05)。干预后患者ESCA的自我护理技能、自我责任感、自我概念、健康知识水平维度得分高于干预前,干预前后比较差异有统计学意义(P<0.05)。干预后患者CD-RISC的坚韧性、力量性、乐观性维度得分高于干预前,干预前后比较差异有统计学意义(P<0.05)。结论:对永久性肠造口患者实施回馈教育,能提高患者的健康素养和自我护理能力,改善患者心理韧性。     

家庭护理干预对提高肠造口病人生活质量的影响

目的探讨家庭护理干预提高肠造口病人生活质量的效果.方法用随机数字表法将出院1个月内的结肠造口病人86例分为实验组44例和对照组42例.对照组按常规定期复查,实验组在此基础上,由有资格认证的造口治疗师(ET)以定期家访和电话访问的形式进行家庭护理干预,包括为病人及家属提供心理咨询、健康教育、护理指导等,每周1次,每次30～60min,持续时间为3个月.干预前后分别测评病人的生活质量,效果评价指标为欧洲癌症研究与治疗组织的生活质量核心量表(EORTC QLQ-C30).结果干预后实验组病人的生活质量高于干预前(P<0.05),亦高于对照组(P<0.05),差异有统计学意义.结论由ET提供家庭护理干预,能有效提高肠造口病人的生活质量.     

Enterostomy catheter exchange using new polymer-coated guide wire: Technical note

The exchange of enterostomy feeding catheters may be facilitated by the use of a recently developed hydrophilic polymer guide wire. This has been found especially useful in the insertion of catheters constructed of polyurethane or silastic-type materials.     

康乐保造口袋在小儿肠造瘘中的应用

目的:探索康乐保造口袋在小儿肠造瘘中的临床应用效果及护理。方法:将78例肠造瘘患儿随机分为观察组和对照组,每组39例,观察组术后应用康乐保造口袋,对照组术后常规护理,比较两组肠造瘘口并发症和护理工作量情况。结果:观察组造口并发症发生率12.82%,对照组造口并发症发生率41.03%,两组差异具有统计学意义(P<0.01);两组每日护理1例患儿造口所需平均时间及每日每位患儿更换衣物床单平均次数比较,差异均具有统计学意义(P<0.01)。结论:康乐保造口袋在小儿肠造瘘中的应用,能有效降低患儿的不适感,减少造口皮肤并发症的发生率,减轻护士工作量。     

预防性T形肠造口术的应用观察

分析F12005年1月至2012年4月78例行预防性肠造口术患者的临床资料,其中采用传统预防性肠造口术52例（A组）、预防性T形肠造口术26例（B组）,造口回纳局限于腹壁不需进入腹腔．A组与B组的造口同纳手术时间分别为（98±16）和（52±9）min,住院时间分别为（15．3±5．2）和（9．5±2．3）d（均P〈0．05）．提示,预防性T形肠造口的手术方式可靠,具有造口回纳手术创伤小、恢复快等优点,有一定的临床应用价值。     

早产儿肠造瘘术后护理体会

目的:探讨早产儿肠造瘘术后护理要点,以减少其近远期并发症.方法:通过对35例肠造瘘术后早产儿实施加强保暖、密切观察病情、营养支持、科学护理造口、重视宣教等措施观察护理效果.结果:34例患儿病情稳定,带造口袋出院,择期行根治术;1例因多器官功能衰竭死亡.结论:正确科学护理肠造口,可减少术后近远期并发症,促进患儿术后恢复,提高患儿的生存率和生活质量.