鼻腔泪囊吻合术中填充美乐胶治疗小泪囊泪囊炎

目的：观察美乐胶(MeroGel)在经鼻内镜下鼻腔泪囊吻合术(EN-DCR)治疗小泪囊泪囊炎的疗效。

方法：选取2014-06/2018-12我院收治的小泪囊泪囊炎患者185例185眼,鼻腔泪囊吻合术(DCR)中分别使用MeroGel、明胶海绵、膨胀海绵和凡士林纱条,观察各组患者术后并发症和造口恢复情况。

结果：使用MeroGel的患者术后眼角和鼻腔渗血少,后期复查无痛苦,造口恢复情况较其他各组更佳(P<0.05)。

结论：MeroGel减少了DCR术后渗血,同时其可降解性有助于EN-DCR术后造口黏膜上皮化,尤其在小泪囊泪囊炎术后,能抑制造口粘连及周边肉芽组织增生,大大提高小泪囊泪囊炎的成功率,相比于其他填塞材料,使用MeroGel后并发症更少,患者更舒适。     

The incidence and causes of permanent stoma after anterior resection

Aims Defunctioning stomas are used following anterior resection to guard against the serious consequences of anastomotic leak such as pelvic sepsis and generalized peritonitis. This study aims to determine what proportion of patients undergoing anterior resection have a defunctioning stoma, how many of these patients do not have their stoma closed, and the reasons for this. Methods All patients undergoing a resection for rectal cancer in our institution in a five year period (January 1995 to December 1999) are included in the study. Anterior resection was performed on 154 patients, divided into 76 anterior resections (AR) and 78 low anterior resections (defined as the anastomosis within 6 cm of the anal verge). The data from these patients were analysed retrospectively. Results Of the total of 154 patients undergoing anterior resection, 59 (38%) were defunctioned, divided into 33 with loop ileostomy and 26 with loop colostomy. Five of these patients had not had their stoma closed at a median follow up of four years (range 1.5–6.5 years). The reasons for non closure were anastomotic stricture (2), metastatic disease (2), and patient choice (1). When comparing AR and LAR, 16% of patients had a defunctioning stoma after AR, compared with 60% after LAR (P < 0.01). Conclusion Anterior resection is being performed for very low rectal tumours in order to avoid a permanent stoma. However we have found that 8% of patients who are defunctioned with a stoma at anterior resection will not have their stoma closed, and conclude that patients should be warned of this pre‐operatively.     

造瘘口切口辅助技术在腹腔镜膀胱根治性切除及回肠通道术中的应用

目的：探讨造瘘口切口辅助技术（通过造瘘口切口取标本,行肠吻合及输尿管吻合）在腹腔镜膀胱根治性切除及回肠通道术中的安全性、实用性。方法：将60例需行膀胱根治性切除及回肠通道术的患者随机分为造瘘口切口辅助技术组（试验组）及传统下腹正中切口辅助技术组（对照组）,比较2组患者尿流改道手术时间、术中出血量、并发症发生率、术后住院日、术后疼痛评分的差异。结果：试验组尿流改道手术时间少于对照组[（105.0±18.9） min vs.(117.0±17.7) min,P<0.05];术后疼痛评分低于对照组（4.03±1.50 vs. 5.40±1.69,P<0.05）;术后住院时间少于对照组[（8.27±1.86） d vs.(9.70±1.87) d,P<0.05];术中出血量2组间差异无统计学意义[试验组：（260±155） mL,对照组：（271±154） mL,P=0.784]。试验组并发症发生4例,其中2例为肠梗阻,1例造瘘口旁疝,1例尿路感染;对照组并发症发生6例,其中肠梗阻3例,切口感染2例,尿路感染1例。组间总体并发症发生率无明显统计学差异。结论：造瘘口切口辅助技术...     

The comparison between experimental nursing and routine nursing interventions on the quality of life of stoma patients: A systematic review and meta‐analysis

The advance in nursing care for stoma patients is a challenging issue, which will influence the life quality. The quality of life is a major issue in the recovery of stoma patients. The evidence of experimental nursing has not been explored enough. A systematic search and a meta‐analysis were performed for the studies of experimental nursing interventions versus routine warming interventions on patients with a stoma. The comparisons between nursing interventions were performed to find which kind of intervention will be superior in improving life quality. After a restricted selection, 10 studies, 460 subjects with experimental nursing intervention, and 478 controls with the routine nursing intervention were enrolled in a variety of causes of the stoma. The focused outcome was the quality of life. The meta‐analysis was performed by Review Manager 5.4. Among the stoma patients, the meta‐analysis favours the experimental nursing intervention group with higher scores of life quality when compared to the routine nursing intervention group. The meta‐analysis results were with positive mean differences, significant tests for overall effect, and significant heterogeneities in the random‐effects model. The experimental nursing intervention showed higher positive effects on the quality of life when compared to routine nursing intervention for stoma patients. Experimental nursing intervention might be an option for stoma nursing practitioners to improve stoma care.     

长效抗菌敷料在肠造口所致周围皮肤瘙痒患者中的应用效果

目的 探讨长效抗菌敷料在肠造口所致造口周围皮肤瘙痒患者中的应用效果。 方法 选取2013年1月-2016年12月行肠造口手术并发造口周围皮肤瘙痒的直肠癌患者167例。采用随机数字表法将其分成实验组和对照组。实验组采用长效抗菌敷料(洁悠神)进行治疗,对照组使用皮炎平乳膏进行治疗。 结果 治疗第1、2周,2组患者肠造口周围皮肤瘙痒复发率比较,差异无统计学意义(P>0.05);第3、4周,实验组肠造口周围皮肤瘙痒复发率低于对照组(χ²=14.056,P<0.001; χ²=15.465,P<0.001)。实验组舒适度和生活质量均高于对照组。 结论 长效抗菌敷料可以治疗由肠造口所致造口周围皮肤瘙痒,降低患者瘙痒感和瘙痒复发率,提高造口患者舒适度,从而改善造口患者生活质量。     

综合护理干预对膀胱癌术后腹壁造口患者生活质量及并发症的影响

目的探讨综合护理干预对膀胱癌术后腹壁造口患者生活质量以及并发症的影响。方法选取膀胱癌全切尿流改道术患者60例,按照随机数表法分为观察组和对照组各30例。对照组给予常规护理,观察组给予综合护理干预,比较2组患者治疗后的社会功能、认识功能、躯体功能、情绪功能、角色功能、总体健康情况以及术后并发症发生情况、治疗后对腹壁造口相关知识的掌握情况。结果治疗后,2组患者的躯体功能、情绪功能、角色功能、社会功能、认知功能以及总体健康情况都有所改善,且观察组的(76.12±6.49、65.15±3.48、67.89±6.18、49.12±3.17、58.14±6.12、61.03±6.12)分均高于对照组的(65.14±7.12、58.12±6.17、59.12±6.10、45.26±4.18、53.12±6.49、56.12±3.98)分,差异有统计学意义(P0.05);治疗后,观察组患者恶心、呕吐、失眠以及疼痛的并发症发生率分别为3.33%、6.67%、0、3.33%,低于对照组的23.33%、40.00%、16.67%、30.00%,差异有统计学意义(P0.05);治疗后,观察组患者造口袋更换、并发症预防、饮食知识掌握分别为(16.23±3.19、15.45±1.98、20.13±3.49)分,高于对照组的(13.12±2.52、13.78±3.61、18.02±3.12)分,差异有统计学意义(P0.05)。结论综合护理可有效提高膀胱癌术后患者的自我护理能力以及生活质量,改善患者总体健康情况,并提高护理质量。     

Obstructive and secretory complications of diverting ileostomy

This review aimed to highlight the etiology, diagnosis, treatment, and prevention of obstructive and secretory complications associated with diverting ileostomy (DI). Obstructive complications at the stoma site are termed stoma outlet obstruction (SOO) or stoma-related obstruction (SRO). The incidence of SOO/SRO is 5.4%-27.3%, and the risk factors are multifactorial; however, the configuration of the stoma limb and the thickness of the rectus abdominis muscle (RAM) may be of particular concern. Trans-stomal tube decompression is initially attempted with a success rate of 33%-86%. A thick RAM may carry the risk of recurrence. Surgical refinement, including a wider incision of the anterior sheath and adequate stoma limb length, avoids tension and immobility and may decrease SOO/SRO. Secretory complications of DI are termed high output stoma (HOS). Persistent HOS lead to water and sodium depletion, and secondary hyperaldosteronism, resulting in electrolyte imbalances, such as hypomagnesemia. The incidence of HOS is 14%-24%, with an output of 1000-2000 mL/d lasting up to three days. Treatment of HOS is commenced after excluding postoperative complications or enteritis and includes fluid intake restriction, antimotility and antisecretory drug therapies, and magnesium supplementation. Intensive monitoring and surveillance programs have been successful in decreasing readmissions for dehydration.