腹膜外隧道式结肠造口的观察及护理对策
|
摘要
目的观察腹膜外隧道式结肠造口手术与常规的腹膜内造口术后患者在肠道功能恢复方面及肠造口并发症方面的差异,并探讨护理方法。方法将205例腹会阴联合切除术患者,按造口手术方式分为两组:治疗组隧道式结肠造口,对照组常规的腹膜内造口。观察两组患者围手术期至术后一年肠道功能恢复情况、结肠造口并发症以及排便情况。结果围手术期两组患者肠梗阻发生率、结肠造口并发症的发生率差异无统计学意义(P> 0.05)。术后患者腹胀症状明显、排便时间延长,治疗组高于对照组,差异有统计学意义(P <0.05)。术后一年内自我护理造口的能力和肠梗阻的发生率两组患者差异无统计学意义(P> 0.05);两组患者在术后形成规律排便习惯方面差异有统计学意义(χ~2=6.616,P=0.010)。术后一年内肠造口凹陷、狭窄的发生率两组患者差异无统计学意义(P>0.05);肠造口旁疝、肠造口脱垂的发生率:治疗组明显低于对照组,差异有统计学意义(均P <0.05)。结论腹膜外隧道式结肠造口患者术后近期肠道功能恢复时间长于腹膜内造口患者且腹胀症状明显。护士要加强饮食、活动指导,促进肠道功能恢复;术后远期更易形成规律的排便习惯,造口旁疝、造口脱垂的发生率明显低于腹膜内造口患者,因此对于腹膜内结肠造口患者的护理指导内容可根据其优势进行优化调整。
Objective To observe the differences in intestinal function recovery and intestinal complications between patients undergoing extraperitoneal colostomy and conventional intraperitoneal colostomy, and to explore nursing methods. Methods 205 patients with abdominal perineal resection were divided into two groups according to ostomy: tunnel colostomy in the treatment group and routine intraperitoneal stoma in the control group. We observed the recovery of intestinal function and colostomy complications or defecation from perioperative to one year after surgery. Results There was no significant difference in the incidence of intestinal obstruction and the incidence of colostomy complications between the two groups during the perioperative period(P > 0.05). Postoperative patients had obvious symptoms of abdominal distension and prolonged defecation time,the treatment group was higher than the control group, and the difference was statistically significant(P < 0.05). There was no significant difference in the ability of self-care colostomy and the incidence of intestinal obstruction within one year after operation(P > 0.05). There was a statistically significant difference in the formation of regular bowel habits between the two groups(χ~2=6.616, P=0.010). There was no significant difference in the incidence of intestinal colostomy and stenosis within one year after operation(P > 0.05). The incidence of intestinal parastomal hernia and intestinal ostomy prolapse was lower in the treatment group than in the control group, the difference was statistically significant(P < 0.05). Conclusion In patients with extraperitoneal colostomy,the recovery of intestinal function is longer than that of patients with intraperitoneal colostomy and the symptoms of bloating are obvious. To promote intestinal function recovery, nurses should strengthen the diet and activity guidance; The long-term postoperative period is more likely to form regular bowel habits. The incidence of intestinal parastomal hernia and intestinal ostomy prolapse is significantly lower than that of intraperitoneal colostomy patients. Therefore, the nursing guidance for patients with intraperitoneal colostomy can be optimally adjusted according to its advantages.
Objective To observe the differences in intestinal function recovery and intestinal complications between patients undergoing extraperitoneal colostomy and conventional intraperitoneal colostomy, and to explore nursing methods. Methods 205 patients with abdominal perineal resection were divided into two groups according to ostomy: tunnel colostomy in the treatment group and routine intraperitoneal stoma in the control group. We observed the recovery of intestinal function and colostomy complications or defecation from perioperative to one year after surgery. Results There was no significant difference in the incidence of intestinal obstruction and the incidence of colostomy complications between the two groups during the perioperative period(P > 0.05). Postoperative patients had obvious symptoms of abdominal distension and prolonged defecation time,the treatment group was higher than the control group, and the difference was statistically significant(P < 0.05). There was no significant difference in the ability of self-care colostomy and the incidence of intestinal obstruction within one year after operation(P > 0.05). There was a statistically significant difference in the formation of regular bowel habits between the two groups(χ~2=6.616, P=0.010). There was no significant difference in the incidence of intestinal colostomy and stenosis within one year after operation(P > 0.05). The incidence of intestinal parastomal hernia and intestinal ostomy prolapse was lower in the treatment group than in the control group, the difference was statistically significant(P < 0.05). Conclusion In patients with extraperitoneal colostomy,the recovery of intestinal function is longer than that of patients with intraperitoneal colostomy and the symptoms of bloating are obvious. To promote intestinal function recovery, nurses should strengthen the diet and activity guidance; The long-term postoperative period is more likely to form regular bowel habits. The incidence of intestinal parastomal hernia and intestinal ostomy prolapse is significantly lower than that of intraperitoneal colostomy patients. Therefore, the nursing guidance for patients with intraperitoneal colostomy can be optimally adjusted according to its advantages.
引文
[1]成军,李晓云,晏伟,等.直肠癌腹腔镜腹会阴联合切除术腹膜外造口与腹膜内造口的比较[J].中国微创外科杂志, 2017,17(12):1080-1082.
[2]渠时学,谢光伟,丁硕,等.腹膜外乙状结肠造口术在腹腔镜Miles术中的应用[J].腹腔镜外科杂志, 2008, 13(1):31-32.
[3]WangFB,Pu YW,ZhongFY,etal.Laparoscopicpermanent sigmoidstomacreationthroughtheextraperitonealroute versustransperitonealroute. Ameta-analysisofstoma-related complications[J]. Saudi Medical Journal, 2015, 36(2):159-163.
[4]AkamotoS,NogeS,UemuraJ,etal.Extraperitonealcolostomy inlaparoscopicabdominoperinealresectionusingalaparoscopic retractor[J]. Surgery Today, 2013, 43(5):580-582.
[5]于周满,杨军,王淑春.腹腔镜ELAPE术中乙状结肠腹膜外隧道造口的临床效果观察[J].中国现代普通外科进展, 2018,(4):305-306, 329.
[6]LeroyJ,DianaM,CallariC,etal.Laparoscopicextraperitoneal colostomy in elective abdominoperineal resection for cancer:a single surgeon experience[J]. Colorectal Disease, 2012, 14(9):e618-e622.
[7]Hamada M, Nishioka Y, Nishimura T, et al. Laparoscopic Permanent SigmoidStomaCreation ThroughtheExtraperitonealRoute[J].SurgicalLaparoscopy,Endoscopy&PercutaneousTechniques,2008, 18(5):483-485.
[8]曹晖,陶元生.腹腔镜Miles术中两种结肠造口方式的疗效报告[J].腹部外科, 2013, 26(3):209-210.
[9]戴功建,金黑鹰.腹腔镜下直肠癌根治术乙状结肠腹膜外造口的体会[J].临床和实验医学杂志, 2013,(17):1392-1393.
[10]蒋雪峰,肖宝来,胡小苗,等.隧道式腹膜外乙状结肠造口在腹腔镜Mile术中的应用分析[J].临床外科杂志, 2013, 21(7):525-526.
[2]渠时学,谢光伟,丁硕,等.腹膜外乙状结肠造口术在腹腔镜Miles术中的应用[J].腹腔镜外科杂志, 2008, 13(1):31-32.
[3]WangFB,Pu YW,ZhongFY,etal.Laparoscopicpermanent sigmoidstomacreationthroughtheextraperitonealroute versustransperitonealroute. Ameta-analysisofstoma-related complications[J]. Saudi Medical Journal, 2015, 36(2):159-163.
[4]AkamotoS,NogeS,UemuraJ,etal.Extraperitonealcolostomy inlaparoscopicabdominoperinealresectionusingalaparoscopic retractor[J]. Surgery Today, 2013, 43(5):580-582.
[5]于周满,杨军,王淑春.腹腔镜ELAPE术中乙状结肠腹膜外隧道造口的临床效果观察[J].中国现代普通外科进展, 2018,(4):305-306, 329.
[6]LeroyJ,DianaM,CallariC,etal.Laparoscopicextraperitoneal colostomy in elective abdominoperineal resection for cancer:a single surgeon experience[J]. Colorectal Disease, 2012, 14(9):e618-e622.
[7]Hamada M, Nishioka Y, Nishimura T, et al. Laparoscopic Permanent SigmoidStomaCreation ThroughtheExtraperitonealRoute[J].SurgicalLaparoscopy,Endoscopy&PercutaneousTechniques,2008, 18(5):483-485.
[8]曹晖,陶元生.腹腔镜Miles术中两种结肠造口方式的疗效报告[J].腹部外科, 2013, 26(3):209-210.
[9]戴功建,金黑鹰.腹腔镜下直肠癌根治术乙状结肠腹膜外造口的体会[J].临床和实验医学杂志, 2013,(17):1392-1393.
[10]蒋雪峰,肖宝来,胡小苗,等.隧道式腹膜外乙状结肠造口在腹腔镜Mile术中的应用分析[J].临床外科杂志, 2013, 21(7):525-526.