永久性肠造口患者疾病获益感的正念认知干预

目的 提高永久性肠造口患者疾病获益感及相应正性认知。方法 将60例结直肠癌行永久性肠造口术后患者随机分为对照组与观察组各30例;对照组行肠造口术后常规护理;观察组在常规护理的基础上,实施正念认知疗法干预方案8周,于干预前、干预完成时、干预完成后4周测评效果。结果 干预后观察组疾病获益感、领悟社会支持、医学应对方式、焦虑抑郁、社会心理适应得分显著优于对照组(P<0.05,P<0.01)。结论 正念认知疗法能促进患者面对身心创伤以积极心态面对,提高疾病获益感,降低焦虑抑郁情绪,从而提高社会心理适应水平。     

应用管状吻合器实施乙状结肠造瘘术

目的：探讨应用管状吻合器实施结肠造瘘术的手术技巧。方法：1999年3月-2002年10月间应用管状吻合器施行乙状结肠造瘘术5例，其中包括直肠下段癌4例和直肠癌伴肠梗阻1例。手术方式是乙状结肠单腔造瘘4例，乙状结肠双腔造瘘术1例。结果：术后无一例发生人工肛门出血、坏死、内陷及感染等并发症。随访平均1．8(1．1—2．9)年，造瘘口的吻合钉在术后1年后逐渐脱落，人工肛门外形及功能良好。结论：应用管状吻合器进行乙状结肠造瘘术，具有操作简便、造瘘口形态一致，手术并发症少的优点。     

达芬奇机器人保肛手术中末端回肠保护性造口的效果分析

目的 观察保护性造口在加速康复外科理念指导下达芬奇机器人保肛手术中的应用效果.方法 选取本院直肠癌患者63例,根据是否行末端回肠保护性造口分为造口组31例与非造口组32例,比较2组围术期指标、肠功能恢复情况以及并发症发生率.结果 与非造口组比较,造口组手术时间延长,术中出血量增加,术后住院时间、术后首次化疗时间均明显缩...     

健康教育对直肠癌永久性结肠造口患者术后自我护理的影响

目的:探讨健康教育对直肠癌永久性结肠造口患者术后自我护理能力的影响.方法:将60例直肠癌永久性结肠造口术后患者随机分为干预组和对照组各30例,对照组给予常规健康指导,干预组在此基础上给予健康教育.分别于入院时和出院时采用自我护理能力实施量表(ESCA)对两组患者进行评估.结果:两组患者出院时ESCA得分均有所增高,干预组增高幅度明显高于对照组(P<0.05).结论:健康教育能有效提高直肠癌永久性结肠造口患者术后自我护理能力,改善患者生活质量.     

延续护理对永久性结肠造口患者生活质量的影响

目的:探讨延续护理对永久性结肠造口患者生活质量的影响。方法:选取在我院因结直肠癌行永久性结肠造口的患者95例作为研究对象,将患者随机分为观察组47例和对照组48例,对照组给予围手术期常规护理,观察组在此基础上由专业护士进行为期3个月的以电话访问、家庭访视、网络视频指导、专家讲座、组织造口联谊会等形式进行延续护理干预,以欧洲癌症研究与治疗组织的生活质量核心量表(中文版)评价两组患者出院后1,3个月时的生活质量。结果:延续护理干预3个月后观察组患者生活质量得分均高于对照组,差异有统计学意义(P0.05)。结论:延续护理可以有效地改善永久性结肠造口患者的生活质量,值得在临床推广应用。     

腹腔镜下乙状结肠腹膜外造口的可行性研究(32例直肠癌应用分析)

[目的]探讨腹腔镜下乙状结肠腹膜外造口术的可行性及其安全性。[方法]32咧享肠癌病例婪施砬会阴联合切除术后行腹膜外造口（腹腔镜手术组），并随机选取同期开腹腹膜外造口术34例作为对照组，比较两组手术时间及并发症发生率。[结果]腹腔镜手术组和对照组造口手术平均时间分别为15min和17min（P〉0．05）。术后随访2-22个月，腹腔镜手术组3例病人出现4例次造口并发症，对照组7例病人出现14例次造口并发症（P〈0．05）。[结论]腹腔镜乙状结肠腹膜外造口术安全可行，在减少造口并发症方面具有一定的优势。     

Effects of pneumoperitoneum with or without colostomy on rat colonic anastomotic healing

Background: Elevated intra‐abdominal pressure and colostomy have adverse effects on colonic anastomoses. The aim of the present study was to investigate the effects of laparoscopic colon surgery with and without diverting colostomy on healing of colonic anastomoses in an experimental model. Methods: Thirty‐six male rats were divided into three equal groups: group 1, control (colonic anastomosis and anaesthesia for 180 min only); group 2, 180 min pneumoperitoneum and colonic anastomosis; and group 3, similar to group 2 with a proximal colostomy. On day 7, bursting pressures, tissue hydroxyproline and nitric oxide concentrations and histopathological inflammation scores were determined and compared. Results: Mean bursting pressures were higher in the control group than the two pneumoperitoneum groups (P = 0.0003). Mean tissue hydroxyproline concentrations showed no difference (P > 0.05). Mean tissue nitric oxide concentrations were significantly increased in the control group (P = 0.0013). Histopathological scores demonstrated increased inflammatory response in group 3 compared to the controls (P = 0.0009). Conclusion: Pneumoperitoneum delays collagen maturation and impairs anastomotic strength in the colon. Following pneumoperitoneum, performance of a diverting loop colostomy to protect the anastomosis will not have additional detrimental effects on anastomotic healing.     

Laparoscopic loop colostomy for advanced ovarian cancer, rectal cancer, and rectovaginal fistulas

OBJECTIVES: The objectives of this study were to present a minimal invasive technique of intestinal diversion for selected cases of advanced inoperable ovarian cancer, rectal cancer, and rectovaginal fistulas, and to discuss indications, pitfalls, and potential complications. METHODS: The technical features of laparoscopic colostomy are described. RESULTS: Between August 1995 and July 1997 laparoscopic colostomy was successfully carried out in 12 patients with advanced ovarian cancer, inoperable carcinoma of the rectum, or rectovaginal fistulas. There were no intraoperative or postoperative complications and postoperative recovery was rapid, with all patients having function of the colostomy within 24 h and regaining their preoperative state of mobility on the second postoperative day. CONCLUSION: The laparoscopic approach allows careful selection of the colostomy site and easy mobilization of the colon, causing only little disruption to intestinal function and, hence, improving postoperative recovery. From our experience, laparoscopic colostomy is in most cases a simple and safe operation and can be used as the preferred technique of intestinal diversion.     

经腹-会阴联合直肠癌根治术后经腹膜外造口对患者旁疝与排便功能的影响

目的探讨经腹-会阴联合直肠癌根治术后经腹膜外造口对患者旁疝与排便功能的影响。 方法选择2016年1月至2017年6月,广元市中心医院行经腹-会阴联合直肠癌根治术78例患者的临床资料。其中经腹膜外造口者40例为观察组,经腹膜内造口者38例为对照组,2组患者均于围手术期接受全程护理。比较2组手术指标、术后并发症发生情况及排便功能。 结果观察组术中出血量、住院时间分别为（104.24±39.08）ml和（15.62±3.10）d,与对照组（120.46±47.35）ml和（17.20±2.95）d,差异有统计学意义（P<0.05）;观察组手术时间、造口时间、术后切口愈合时间分别为（233.12±40.50）min、（21.87±9.23）min和（7.31±0.28）d,与对照组（231.38±39.04）min、（20.95±9.14）min和（7.05±0.34）d,差异无统计学意义（P>0.05）。观察组排便功能优良率显著高于对照组,差异有统计学意义（67.50% vs 34.21%,P<0.05）。观察组造口旁疝的发生率显著低于对照组,差异有统计学意义（2.50% vs 18.42%,P<0.05）;但2组间造口出血、造口水肿、造口回缩或脱垂等发生率比较,差异无统计学意义（P>0.05）。 结论经腹-会阴联合直肠癌根治术后经腹膜外造口可显著降低术后造口旁疝的发生率,促进其排便功能的恢复,整体疗效优于经腹膜内造口。