Objective To evaluate anal function in patients with rectal carcinoma after low anastomosis operation. Methods Five hundred and forty-one patients with low rectal carcinoma were followed up for 1-3 years to assess anal function after low or ultra-low Dixon anastomosis. The evaluation was based on Xu Zhong-fa Assessment Criteria of Anal Function, anastomotic position and time-to-operation. Defecation function training and rehabilitation instructions were administered after the operation. Results The evaluation of defecation function showed that in the low Dixon operation group, 75.8%(211/278) scored “excellent”, 11.8%(33/278) scored “good”, 10.1%(28/278) scored “fair” and 2.2%(6/278) scored “poor”. In the ultra-low Dixon operation group, 70.7%(186/263) scored “excellent”, 13.3%(35/263) scored “good”, 10.6% (28/263) scored “fair”, and 5.3%(14/263) scored “poor”. No statistical difference was found between the low and ultra-low Dixon groups in this evaluation (Z= –1.429,P=0.136). However, there was statistical difference in the “awareness of defecation”(Z= –4.610,P=0.000) and “sense of defecation” (Z= –5.252, P=0.000) domains between the two groups. The defecation functions were similar between the low and the ultra-low Dixon operation groups after 6-month post-operation training(Z= –0.550, P=0.582). Conclusions There is no difference in defecation function between low and ultra-low Dixon anastomotic operation patients with rectal carcinoma by nursing.
Objective To study the relationship between autonomic nerve preservation and sexual and urinary functions after total mesorectal excision in patients with cancer of the lower rectum, and to explore improved nursing methods for these patients. Methods Eligible patients with cancer of the lower rectum were non-randomly assigned to either a control group (n=278)or an autonomic nerve-preserving group (n=263). The recovery time of micturition desire, catherization time, lower urinary tract infection rate, residual urine, severity of urinary disorders and sexual disorders were observed. Results The recovery time of micturition desire, catherization time, lower urinary tract infection rate, residual urine, severity of urinary disorders and sexual disorders were lower in the autonomic nerve-preserving group than in the control group. (Plt;0.05) . Conclusion Autonomic nerve preservation radical resection leads to better maintenance of urinary and sexual functions for patients with cancer of the lower rectum. Nursing should be focused on the prevention of urinary tract complications and the rehabilitation of sexual and urinary functions.
目的 探讨直肠癌低位、超低位前切除并行横结肠预防性造口术后其并发症的护理对策。 方法 对2011年12月-2012年5月收治的43例低位直肠癌行预防性横结肠造口患者的临床资料进行回顾性分析,并就其发生并发症的原因及护理方法予以总结。 结果 43例患者均在直肠癌前切除术后行预防性横结肠袢式造口术。术后拔管时间2~5 d,造口排气时间19~73 h,均未出现吻合口瘘,但发生造口脱垂1例,造口回缩1例,造口周围皮肤疾病2例,经积极治疗护理后均痊愈出院。 结论 术后精心护理对降低横结肠造口术后并发症,提高患者生活质量,改善预后十分重要。
目的 调查胃肠道疾病患者围手术期的疼痛状况,为建立无痛病房,优化医疗和护理服务提供依据。 方法 对2011年12月5日-2012年1月14日胃肠外科所有的新住院患者共227例,采用《四川大学华西医院住院病人疼痛现状调查问卷》进行调查,并同期调查胃肠外科27名主管医师对疼痛药物了解状况。 结果 有明确行为能力的216例患者完成调查问卷,其中有195例(90.28%)接受手术治疗,全身麻醉患者193例(占手术患者98.97%),诊断为胃肠道肿瘤163例(占手术人数的83.59%),手术等级为三级146例(占手术人数的74.87%)。有168例(86.15%)患者术后镇痛,在术后镇痛过程中使用镇痛泵156例(92.86%),其中75例(48.08%)认为镇痛泵镇痛“基本有效”,30例(19.23%)认为“无效”。39例术后未使用镇痛泵,其中20例(51.28%)认为“未使用术后镇痛泵”最主要原因为“不了解镇痛泵”。受调查的主管医师了解的疼痛药物仅占罗列药物52种的(20 ± 5.36)种。 结论 疼痛现象在胃肠道疾病围手术期患者中属普遍现象,由于不断增强镇痛意识和镇痛需求与相关知识缺乏的矛盾存在,及较少的医疗护理干预,导致镇痛效果不佳,影响了疼痛管理长效机制的建立和无痛病房的建设。