江苏省某医院失禁患者皮肤护理现状调查

目的：了解住院失禁患者目前的皮肤护理情况,为制定失禁患者皮肤护理方案提供参考依据。方法选取江苏省某三级综合医院住院失禁患者作为研究对象,采用调查问卷方式对失禁患者的照护者（护士和家属）进行现场的调查。结果住院患者失禁发生率5.06%,会阴部皮肤清洁后42.9%患者未使用任何皮肤保护剂,失禁患者失禁相关性皮炎（IAD）发生率28.57%。结论失禁患者临床护理工作仍然存在很多误区,预防失禁相关性皮炎的发生没有引起足够的重视,没有实施积极有效的皮肤保护措施,失禁患者皮肤护理知识缺乏,急于需要构建失禁皮肤护理指南,为失禁患者皮肤护理提供科学、优质的护理方案。     

Long-term results of open and closed sphincterotomy for anal fissure

Three hundred fifty patients who underwent open or closed lateral internal anal sphincterotomy for acute or chronic anal fissure between January 1981 and June 1985 were reviewed. Minimum follow-up was 14 months (mean, 37 months). No patient underwent an additional procedure at the time of sphincterotomy. Twenty-one failed to heal or developed a recurrence in the interval (6 percent). Five of these individuals were found subsequently to have Crohn's disease. Excluding these patients, the incidence of nonhealing was 4.6 percent. Eight patients (2.3 percent) developed postoperative infections requiring drainage, one half of which were associated with fistulas. Sixty patients (17 percent) complained of incontinence for flatus or feces. For two thirds, this was transient. There was no statistically significant difference in rate of healing or morbidity when comparing the open with the closed method.     

Overt Rectal Prolapse and Fecal Incontinence

PURPOSE  Rectal prolapse is frequently associated with fecal incontinence; however, the relationship is questionable. The study was designed to evaluate fecal incontinence in a large consecutive series of patients who suffered from rectal prolapse, focusing on both past history, anal physiology, and imaging. METHODS  Eighty-eight consecutive patients who suffered from an overt rectal prolapse (72 women, 16 men; mean age, 51.1 ± 19.5 years) as a main symptom were analyzed; 48 patients also experienced fecal incontinence compared with 40 without incontinence. Logistic regression analyses were performed. RESULTS  The two groups of patients did not differ with respect to parity, weekly stool frequency, main duration of symptoms before referral, occurrence of dyschezia, and digital help to defecate. Patients with prolapse who were older than 45 years (odds ratio (OR), 4.51 (1.49–13.62); P = 0.007) and those with a past history of hemorrhoidectomy (OR, 9.05 (1.68–48.8); P = 0.01) were significantly more incontinent. Incontinent group showed frequent internal anal sphincter defect compared with the continent group (60 vs. 6.2 percent; P = 0.0018). CONCLUSIONS  In patients with overt rectal prolapse, the occurrence of fecal incontinence needs special consideration for age and previous hemorrhoid surgery as causative factors. Anal weakness and sphincter defects are frequently observed.     

逼尿肌尿道外括约肌协同失调的肉毒素A治疗

目的探讨肉毒素A(BTX-A)经尿道尿道外括约肌注射,治疗逼尿肌尿道外括约肌协同失调(DESD)的效果。方法对11例因患DESD致慢性尿潴留和尿失禁患者,行经尿道尿道外括约肌注射100UBTX-A治疗,对治疗前后的残余尿(PVR)、最大尿道压(MUP)、排尿期最大逼尿肌压(MPdet)和国际尿失禁咨询委员会尿失禁评分调查简表(ICI-Q-SF)评分进行比较。结果治疗后,MUP、MPdet和ICI-Q-SF显著降低,PVR显著减少。7~30天达最大疗效,单次注射疗效持续2~3个月,重复注射可持续更长时间。无严重不良反应发生。结论BTX-A尿道外括约肌注射治疗DESD,安全,微创,疗效确切;但需要重复注射维持疗效。     

静态尿道压力测定和应力性尿道压力测定在女性真性压力性尿失禁诊断中的应用

目的探讨静态尿道压力测定(RUPP)和应力性尿道压力测定(SUPP)在女性真性压力性尿失禁(GSI)诊断中的应用价值。方法对30例临床诊断为GSI的患者进行RUPP及SUPP测定,比较其结果,以15例正常女性作为对照。结果静态尿道压力测定,SCI组的最大尿道关闭压和控制带长度较正常对照组小。应力性尿道压力测定中,患者压力传导率(PTR)及尿道关闭压(UCP)以多次咳嗽的平均值计算,GSI组PTR及UCP各为(0.63±0.24)、(-26.58±21.43cmH2O),而正常组PTR及UCP各为(1.78±0.12)与(83.42±37.23cmH2O)。两组间上述指标的差异均有显著性意义(p<0.01)。结论SUPP和RUPP在GSI的诊断中均具有一定意义,对于症状较轻的尿失禁患者的诊断,两者联合应用可以提高GSI的诊断水平。     

TVT-O和TVT治疗单纯女性压力性尿失禁的疗效对比:立足随机对照试验的Meta分析

目的:系统评价经阴道无张力尿道中段悬吊带术(闭孔路径)(TVT-O)和经阴道无张力尿道中段悬吊带术(TVT)治疗女性压力性尿失禁的客观成功率和并发症发生率。方法:计算机配合手工检索1994年1月~2007年6月各数据库和灰色文献中TVT-O和TVT疗效的随机对照试验(RCT),用Revman4.2.2软件,对两种术式的客观成功率、并发症发生率进行Meta分析。结果:共纳入10个随机对照试验。TVT-O组553例,TVT组575例。Meta分析显示,TVT-O客观成功率、主观成功率均与TVT相似[P>0.05,OR 0.78,95%可信区间(CI):0.47~1.30;P>0.05,OR 0.93,95%CI:0.51~1.68)],TVT-O的"膀胱损伤"发生率低于TVT(P<0.01,OR 0.16,95%CI:0.05~0.49),TVT-O的"尿路症状"发生率与TVT相似(P>0.05,OR 0.90,95%CI:0.61~1.34)。因文献的异质性和结论的高敏感性,不能确定TVT-O"术后疼痛"发生率是否增高。结论:TVT-O术是一种疗效确切的无张力阴道吊带术,与TVT术的成功率、尿路症状相似而膀胱损伤的风险减少。但须进一步研究确证"术后疼痛"发生率是否增加。     

The impact of surgical treatment on the mental health of women with obstetric fistula

Obstetric fistula is estimated to affect 2 million women worldwide and has considerable social and psychological effects on affected individuals. In this prospective study, 51 consecutive women with obstetric fistula admitted to the Barhirdar Hamlin Fistula Centre in the north of Ethiopia were screened using the General Health Questionnaire (GHQ-28) for potential mental health disorder before and 2 weeks after fistula surgery. Prior to surgery, all women screened positive. By 2 weeks after, this had dropped to 36% ( P = 0.005). 27% of the 45 women who were cured of their incontinence screened positive, while all 6 of those with severe residual incontinence continued to screen positive. We conclude that surgical treatment of obstetric fistula results in marked improvements in mental heath.     

女性压力性尿失禁患者在不同膀胱容量下漏尿点压的对照研究

目的:探讨女性压力性尿失禁患者在不同膀胱灌注量下漏尿点压的差异。方法:回顾性分析2016年1月至2018年12月本院收治的12例女性压力性尿失禁患者,在术前行尿动力检查时分别给予膀胱灌注200、250、300、350 mL时,测出腹压漏尿点压及咳嗽漏尿点压并分别进行比较。结果:不同膀胱容量下同时测得的腹压漏尿点压及咳嗽...     

电针深刺八髎穴治疗女性压力性尿失禁的临床观察

目的:评价电针深刺八髎穴治疗压力性尿失禁的疗效.方法:将60例压力性尿失禁的女性患者按就诊先后顺序分为两组,每组30例.对照组给予盆底肌训练,治疗组给予电针深刺八髎穴(上髎、次髎、中髎和下髎).结果:治疗组总有效率为93.3%,对照组为33.3%,治疗组的总有效率明显高于对照组(P<0.05).治疗后,两组国际尿失禁咨询委员会尿失禁问卷表简表(ICIQ-SF)评分及漏尿量均低于治疗前(均P<0.05),治疗组ICIQ-SF评分及漏尿量均低于对照组(均P<0.05).结论:长针深刺八髎穴能改善压力性尿失禁女性临床症状,疗效优于盆底肌训练.