Diverting colostomy is an effective and reversible option for severe hemorrhagic radiation proctopathy

A total of 738 continual CRP patients were screened.After exclusion,14 patients in the colostomy group and 25 in the conservative group were included in the final analysis.Preoperative Hb was only 63 g/L±17.8 g/L in the colostomy group compared to 88.2 g/L±19.3 g/L(P<0.001)in the conservative group.All 14 patients in the former group achieved complete remission of bleeding,and the colostomy was successfully reversed in 13 of 14(93%),excepting one very old patient.The median duration of stoma was 16(range:9-53)mo.The Hb level increased gradually from 75 g/L at 3 mo,99 g/L at 6 mo,and 107 g/L at 9 mo to 111 g/L at 1 year and 117 g/L at 2 years after the stoma,but no bleeding cessation or significant increase in Hb levels was observed in the conservative group.Endoscopic telangiectasia and bleeding were greatly improved.Endoultrasound showed decreased vascularity,and magnetic resonance imaging revealed an increasing presarcal space and thickened rectal wall.Anorectal functions and quality of life were significantly improved after stoma reversal,when compared to those before stoma creation.CONCLUSION Diverting colostomy is a very effective method in the remission of refractory hemorrhagic CRP.Stoma can be reversed,and anorectal functions can be recovered after reversal.     

MRI联合瘘口X线造影诊断肛门闭锁的价值

【摘要】目的 探讨MRI联合X线瘘口造影在诊断肛门闭锁中的价值。方法 16例肛门闭锁合并直肠会阴瘘患儿,体表瘘口注入20ml生理盐水后常规采用MRI检查,并与瘘口造影进行对比。23例结肠造瘘口造影采用球囊导尿管加压注射造影剂后多方位摄片。结果 16例合并直肠会阴瘘患儿MRI可以显示分型及瘘口位置,准确性达100%,有助于显示骶部、神经管及生殖道畸形,而9例通过瘘口造影发现异常通道并显示走形。23例结肠造瘘口造影, 10例对肛门成形术后通道的通畅情况显示良好,11例术前发现异常通道,1例合并巨结肠,1例合并结肠狭窄。结论 低场MRI改良扫描方法后联合瘘道造影诊断肛门闭锁,提高了显示性能。结肠造瘘口造影对肛门成形手术前后均有重要意义。     

互联网＋健康宣教在肠造口患者中的应用

目的探讨互联网＋健康宣教在肠造口患者中的应用效果。 方法选取2017年1月至8月在国家癌症中心/国家肿瘤临床医学研究中心/中国医学科学院北京协和医学院肿瘤医院结直肠外科住院的270例肠造口患者,按照宣教的时间顺序分为观察组和对照组。对照组采用常规围手术期护理模式。观察组在对照组的基础上增加互联网＋的模式,通过公众号的互动、云课堂、门诊病历互联网反馈等形式进行健康宣教,比较两组患者在出院后造口并发症的发生率及护理宣教满意度情况。 结果观察组患者在出院后1个月造口周围粪水性皮炎（χ²=5.391,P=0.02）、皮肤黏膜分离（χ²=4.014,P=0.045）均低于对照组,观察组出院3个月造口周围粪水性皮炎（χ²=5.137,P=0.023）及造口回缩的发生率（χ²=4.060,P=0.044）均低于对照组。统计观察组患者在出院后第3个月的患者满意度,其中宣教途径及方式（χ²=5.40,P=0.02）、问题反馈及时效性（χ²=5.065,P=0.024）优于对照组,差异均有统计学意义（P<0.05）。 结论互联网＋健康宣教在肠造口患者的应用中能明显降低患者早期造口并发症的发生率,提升了患者的生活质量,增加了患者对护理宣教的满意度,值得借鉴和推广。     

Colovesical fistula caused by glucocorticoid therapy for IgG4-related intrapelvic mass

IgG4-related disease(IgG4-RD) is an immune-mediated fibroinflammatory disorder that can occur in almost all systemic organs and generally responds to corticosteroid treatment. We report a rare case of an IgG4-related intrapelvic mass lesion that responded to steroid therapy but caused a fistula between the sigmoid colon and bladder. A 71-year-old man was followed after treatment for hepatocellular carcinoma. Follow-up computed tomography(CT) incidentally depicted left hydronephrosis with an ill-demarcated intrapelvic mass lesion. This lesion was histologically diagnosed as IgG4-RD by open biopsy, and peroral steroid therapy was initiated. One month after starting steroids, a colovesical fistula was detected by follow-up CT. A colostomy and urethral catheterization were emergently performed. The patient recovered and the mass lesion was drastically minimized by the initiation of glucocorticoids; however, he still needs urethral catheterization. IgG4-RD develops in various systemic organs and generally responds well to steroids. Clinicians must be watchful for the complications of responses to corticosteroids, such as fistulization, when the mass lesion of IgG4-RD is adjacent to multiple luminal organs.     

Current state of laparoscopic parastomal hernia repair: A meta-analysis

AIM: To evaluate the efficacy and safety of the laparoscopic approaches for parastomal hernia repair reported in the literature.METHODS: A systematic review of PubMed and MEDLINE databases was conducted using various combination of the following keywords: stoma repair, laparoscopic, parastomal, and hernia. Case reports, studies with less than 5 patients, and articles not written in English were excluded. Eligible studies were further scrutinized with the 2011 levels of evidence from the Oxford Centre for Evidence-Based Medicine. Two authors reviewed and analyzed each study. If there was any discrepancy between scores, the study in question was referred to another author. A meta -analysis was performed using both random and fixed-effect models. Publication bias was evaluated using Begg’s funnel plot and Egger’s regression test. The primary outcome analyzed was recurrence of parastomal hernia. Secondary outcomes were mesh infection, surgical site infection, obstruction requiring reoperation, death, and other complications. Studies were grouped by operative technique where indicated. Except for recurrence, most postoperative morbidities were reported for the overall cohort and not by approach so they were analyzed across approach.RESULTS: Fifteen articles with a total of 469 patients were deemed eligible for review. Most postoperative morbidities were reported for the overall cohort, and not by approach. The overall postoperative morbidity rate was 1.8% (95%CI: 0.8-3.2), and there was no difference between techniques. The most common postoperative complication was surgical site infection, which was seen in 3.8% (95%CI: 2.3-5.7). Infected mesh was observed in 1.7% (95%CI: 0.7-3.1), and obstruction requiring reoperation also occurred in 1.7% (95%CI: 0.7-3.0). Other complications such as ileus, pneumonia, or urinary tract infection were noted in 16.6% (95%CI: 11.9-22.1). Eighty-one recurrences were reported overall for a recurrence rate of 17.4% (95%CI: 9.5-26.9). The recurrence rate was 10.2% (95%CI: 3.9-19.0) for the modified laparoscopic Sugarbaker approach, whereas the recurrence rate was 27.9% (95%CI: 12.3-46.9) for the keyhole approach. There were no intraoperative mortalities reported and six mortalities during the postoperative course.CONCLUSION: Laparoscopic intraperitoneal mesh repair is safe and effective for treating parastomal hernia. A modified Sugarbaker approach appears to provide the best outcomes.     

移行皮瓣成形术治疗结肠造口狭窄

目的探讨手术治疗结肠造口狭窄的新方法并初步评价其效果。方法采用移行皮瓣成形术治疗10例结肠造口狭窄病人。结果10例病人均解除梗阻症状,造口恢复正常排便功能,随访1~2年无狭窄再发生。结论移行皮瓣成形术治疗结肠造口狭窄方法简单,效果良好。     

自我管理教育对结肠造口患者自我管理疾病能力的影响

目的探讨自我管理教育对结肠造口患者自我管理疾病能力的影响。方法选择68例造口患者进行为期6个月的自我管理教育,比较教育前后患者自我管理能力和自我效能水平的变化情况。结果自我管理教育后患者自我管理疾病能力及自我效能水平评分较教育前明显提高,差异具有统计学意义（P〈0．01）。结论自我管理教育可以提高患者的自我管理疾病能力和自我效能水平,从而改善患者的生活质量。     

护理干预对肠造口患者生命质量的影响

目的 探讨直肠癌行Miles术后的患者,对其采取一系列护理干预措施,尽可能减少肠造口对其产生的负面影响,使其在手术后能恢复正常生活.方法 对134例因直肠癌行直肠前切除术（Miles术）患者,术后采取一系列护理干预措施,运用世界卫生组织健康相关生命质量量表（WHOQOL-BREF）,与154例直肠会阴全切除术（Dixon术）的患者（保留肛门者）进行对比.结果 Dixon术的患者生命质量总分为（77.506±17.197）分,Miles术的患者生命质量总分为（76.701±15.138）分,二者在总分、生理领域、心理领域、社会关系领域、环境领域及总体健康感觉方面比较差异均无统计学意义（P＞0.05）.结论 由于肠造口的存在,Miles术后患者的生命质量较低,但是通过护理干预可以使其生命质量得到有效提高.