Conversations for providers caring for patients with rectal cancer: Comparison of long‐term patient‐centered outcomes for patients with low rectal cancer facing ostomy or sphincter‐sparing surgery

For some patients with low rectal cancer, ostomy (with elimination into a pouch) may be the only realistic surgical option. However, some patients have a choice between ostomy and sphincter‐sparing surgery. Sphincter‐sparing surgery has been preferred over ostomy because it offers preservation of normal bowel function. However, this surgery can cause incontinence and bowel dysfunction. Increasingly, it has become evident that certain patients who are eligible for sphincter‐sparing surgery may not be well served by the surgery, and construction of an ostomy may be better. No validated assessment tool or decision aid has been published to help newly diagnosed patients decide between the two surgeries or to help physicians elicit long‐term surgical outcomes. Furthermore, comparison of long‐term outcomes and late effects after the two surgeries has not been synthesized. Therefore, this systematic review summarizes controlled studies that compared long‐term survivorship outcomes between these two surgical groups. The goals are: 1) to improve understanding and shared decision‐making among surgeons, oncologists, primary care providers, patients, and caregivers; 2) to increase the patient's participation in the decision; 3) to alert the primary care provider to patient challenges that could be addressed by provider attention and intervention; and 4) ultimately, to improve patients' long‐term quality of life. This report includes discussion points for health care providers to use with their patients during initial discussions of ostomy and sphincter‐sparing surgery as well as questions to ask during follow‐up examinations to ascertain any long‐term challenges facing the patient. CA Cancer J Clin 2016;66:387–397. © 2016 American Cancer Society.     

经鼻内窥镜下扩展性骨窗伴高位造口行泪囊鼻腔吻合术治疗慢性泪囊炎

目的:探讨经鼻内窥镜下扩展性骨窗伴高位造口行泪囊鼻腔吻合术(DCR)治疗慢性泪囊炎的疗效及安全性。方法:回顾性临床研究。选取本院2018-01/2020-01确诊为慢性泪囊炎患者50例59眼。根据手术方式分为两组：单纯造口组23例29眼采用经鼻内镜下平中鼻甲腋行DCR(即单纯造口术),改良组27例30眼采用经鼻内镜下扩展性骨窗伴高位造口行DCR。比较两组患者的临床总有效率、术后并发症发生率以及满意率的情况。结果:术后12mo,单纯造口组有效率为79%,改良组为97%(P=0.039)。而单纯造口组并发症总发生率为28%,改良组为7%(P=0.042)。且单纯造口组满意率为65%,改良组为93%(P=0.030)。结论:采用经鼻内镜扩展性骨窗伴高位造口DCR治疗慢性泪囊炎,可提升手术的有效率,降低并发症发生率。     

经外侧裂-岛叶人路与经皮质造瘘术对基底核脑出血周围水肿带的影响

目的比较经外侧裂-岛叶人路与经皮质造瘘术对高血压性基底核区脑出血周围水肿带的影响。方法回顾性分析63例基底核区高血压性脑出血病人的临床资料,其中行经外侧裂-岛叶人路手术33例（经外侧裂-岛叶入路手术组）．行经皮质造瘘术30例（经皮质造瘘手术组）。结果与经皮质造瘘手术组比较,经外侧裂-岛叶人路手术组术后7d血肿周围水肿体积、术后48h残余血肿量均明显减小（P〈0．05）,术后7dGCS评分明显升高（P〈0．05）,住院时间明显缩短（P〈0．05）。经外侧裂-岛叶人路手术组血肿全部清除21例,大部分清除12例;术后再出血1例,癫痫3例,脑积水2例。经皮质造瘘手术组血肿全部清除12例,大部分清除18例;术后再出血2例,癫痫5例,脑积水5例,失语3例。结论显微镜下经外侧裂-岛叶入路手术能明显减轻脑出血周围水肿,可作为高血压性脑出血手术治疗的首选术式。