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结肠直肠切除术后保留肛门括约功能手术的适应症

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中国药物经济学 2013年第S2期8卷 351-352页

作者：李善军广西来宾市金秀瑶族自治县人民医院广西来宾545700

目的研究结肠直肠切除术后保留肛门括约肌功能手术的适应症。方法对78例进行结肠直肠切除术并保留肛门括约肌治疗患者的临床效果进行观察,根据结果分析行结肠直肠切除术后保留肛门括约功能手术的适应症。结果所有患者的手术进行顺利,无... 详细信息

目的研究结肠直肠切除术后保留肛门括约肌功能手术的适应症。方法对78例进行结肠直肠切除术并保留肛门括约肌治疗患者的临床效果进行观察,根据结果分析行结肠直肠切除术后保留肛门括约功能手术的适应症。结果所有患者的手术进行顺利,无术中突发死亡情况,手术切口吻合处愈合情况良好,吻合口未发现有肠内容物漏出。所有患者的肛门生理功能未见明显损伤。结论结肠直肠切除术后保留肛门括约功能手术对于患有结肠黏膜疾病、病程>10年全结肠炎有广泛纤维化或活检有上皮异型生长者、溃疡性结肠炎穿孔和不能制止的下消化道出血、中毒性结肠炎、结肠腺瘤性息肉病、结肠腺瘤性息肉病等患者具有很好的治疗效果。

关键词：结肠直肠切除术肛门括约功能适应症

结肠直肠切除术后保留肛门括约功能手术的适应症

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中国药物经济学 2013年第6期 317-318页

作者：李善军广西来宾市金秀瑶族自治县人民医院

目的研究结肠直肠切除术后保留肛门括约肌功能手术的适应症。方法对78例进行结肠直肠切除术并保留肛门括约肌治疗的患者的临床效果进行观察,根据结果分析行结肠直肠切除术后保留肛门括约功能手术的适应症。结果所有患者的手术进行顺利,... 详细信息

目的研究结肠直肠切除术后保留肛门括约肌功能手术的适应症。方法对78例进行结肠直肠切除术并保留肛门括约肌治疗的患者的临床效果进行观察,根据结果分析行结肠直肠切除术后保留肛门括约功能手术的适应症。结果所有患者的手术进行顺利,无术中突发死亡情况,手术切口吻合处愈合情况良好,吻合口未发现有肠内容物漏出。所有患者的肛门生理功能未见明显损伤。结论结肠直肠切除术后保留肛门括约功能手术对于患有结肠黏膜疾病、病程>10年全结肠炎有广泛纤维化或活检有上皮异型生长者、溃疡性结肠炎穿孔和不能制止的下消化道出血、中毒性结肠炎、结肠腺瘤性息肉病、结肠腺瘤性息肉病等患者具有很好的治疗效果。

关键词：结肠直肠切除术肛门括约功能适应症

Ⅰ期重建性结肠直肠切除术治疗溃疡性结肠炎的安全性

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世界核心医学期刊文摘（胃肠病学分册） 2005年第12期1卷 14-15页

作者： Ikeuchi H. Nakano H. Uchino M. 赵萌 1- 1 Mukogawa- cyo Nisinomiya Hyogo 663- 8501 Japan Dr.

PURPOSE: The aim of this study was to compare clinical outcomes in patients with ulcerative colitis who underwent restorative proctocolectomy with and without diverting ileostomy. METHODS: A series of 245 consecutive patients who underwent ileal pouch anal anastomosis with mucosectomy with an ultrasonically activated scalpel (harmonic scalpel) was studied. Of these patients, 92 patients had a diverting ileostomy and 150 selected patients did not. The decision for or against an ileostomy was made at the end of the operation. RESULTS: Twelve patients (8 percent) in the group without ileostomy had pouch- related complications, which necessitated secondary ileostomy in five patients (3.3 percent). Intestinal obstruction developed in 17 patients (11.3 percent) who had no ileostomy and in 12 patients (13.0 percent) who underwent ileostomy. Two of 17 patients who had no ileostomy and 1 of 12 patients with ileostomy required laparotomy with division of adhesions, whereas the remaining patients responded to conservative measures. There were no significant differences in the incidence of postoperative complications after the initial operation between the two groups. In the group with ileostomy, the morbidity rate for ileostomy was 12.1 percent, and that for ileostomy closure was 18.7 percent. The total postoperative complication rate for the group with ileostomy was significant higher than that for the group without ileostomy. CONCLUSION: We conclude that restorative proctocolectomy with mucosectomy by use of an ultrasonically activated scalpel and without diversion is a superior therapeutic choice for selected patients.

关键词：结肠直肠切除术回肠造口术溃疡性结肠炎回肠贮袋肠梗阻病例粘连松解术超声刀道性并发症率剥除术

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腹腔镜下结肠直肠切除术围手术期护理

中国局解手术学杂志 2002年第4期11卷 413-414页

作者：刘娜葛淑芝张静波哈尔滨医科大学第一临床医院普外科 150001

腹腔镜技术已成为外科治疗的手段,它具有生理干扰少、创伤小、痛苦轻、并发症少、康复快等优点.我院于1999年至今为6例患有结肠、直肠疾病的患者进行了电视腹腔镜下结肠切除术、直肠切除术.现将围手术期护理体会报告如下.

关键词：结肠癌直肠癌腹腔镜结肠直肠切除术围手术期护理

引导幻想与肌肉松弛在常规结肠直肠切除术中的应用:一项随机、对照、半盲试验

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世界核心医学期刊文摘（胃肠病学分册） 2006年第3期2卷 31-31页

作者： Haase O. Schwenk W. Hermann C. Müller J.M. 廖新华 Klinik Allgemein- Visceral- Geffl-undur Thoraxchirurgie Universitre Medizin Berlin Campus CharitéMitte Schumannstrasse 20/21 D-10117 Berlin Germany.Dr

PURPOSE: The aim of this study was to investigate whether brief psychologic interventions to reduce perioperative stress may improve the postoperative course of patients undergoing abdominal surgery. METHODS: We used a randomized, controlled, partially blinded trial to evaluate the differential effectiveness of two brief psychologic interventions (guided imagery and progressive muscle relaxation) on analgesic requirement, pain perception, pulmonary function, duration of postoperative ileus, and fatigue after conventional resection of colorectal carcinoma in elderly cancer patients. RESULTS: Sixty patients (20 guided imagery, 22 relaxation, 18 control) were evaluated. Acceptance of the brief psychologic interventions was high and 90 percent of the patients indicated that they would recommend it to other patients. Analgesic consumption (P = 0.6) and subjective pain intensity at rest (P = 0.3) and while coughing (P = 0.3) were not different between groups. Recovery of pulmonary function, duration of postoperative ileus, and subjective postoperative fatigue were also not influenced. When the data from intervention groups were pooled, again no benefits were detected compared with the control group. CONCLUSIONS: Brief psychologic interventions such as guided imagery and relaxation yielded a very positive patient response but did not show a clinically relevant influence on the postoperative physiologic course of elderly patients undergoing conventional resections of colorectal cancer.

关键词：结肠直肠切除术肌肉松弛结肠直肠癌半盲手术期间疼痛感受术后肠梗阻腹部手术生理学过程功

伴或不伴暂时性回肠造口的复原性结肠直肠切除术的预后

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世界核心医学期刊文摘（胃肠病学分册） 2006年第10期2卷 3-3页

作者： Remzi F.H. Fazio V.W. Gorgun E. 纪泛扑 Department of Colorectal Surgery/A30 Cleveland Clinic Foundation9500 Euclid AvenueClevelandOH 44195United States.Dr

PURPOSE: Controversy exists regarding the safety for omission of diverting ileostomy in restorative proctocolectomy because of fears of increased septic complications. This study was designed to evaluate the outcomes of restorative proctocolectomy in a consecutive series of patients by comparing postoperative complications, functional results, and quality of life in patients with and without diverting ileostomy. METHODS: Data regarding demograph- ics, length of stay, surgical characteristics, and complications were reviewed and recorded according to the presence (n= 1,725) or absence (n = 277) of a diverting ileostomy at the time of pelvic pouch surgery. Criteria for omission of ileostomy included: stapled anastomosis, tension-free anastomosis, intact tissue rings, good hemostasis, absence of airleaks, malnutrition, toxicity, anemia, and prolonged consumption of steroids. Functional outcome and quality of life indicators were prospectively recorded and compared. RESULTS: Patients in the ileostomy group had greater body surface area and older mean age at time of surgery, were taking greater doses of steroids preoperatively, and required more blood transfusions at the time of surgery compared with the one-stage (P 0.05). Early postoperative ileus was more common in the one-stage group (P < 0.001). There were no differences between the groups in quality of life and functional outcomes. CONCLUSIONS: For carefully selected patients undergoing restorative proctocolectomy with ileal pouch-anal anastomosis, omission of diverting ileost- omy is a safe procedure that does not lead to an increase inseptic complications or mortality. Quality of life and functional results are similar to those who undergo ileal pouch-anal anastomosis with diversion, provided that certain selection factors are considered.

关键词：结肠直肠切除术回肠造口复原性直肠吻合术回肠贮袋生活质量状况毒性反应早期肠梗阻脓毒症

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中毒性巨结肠诊断及外科治疗

中国实用外科杂志 2013年第7期33卷 558-560页

作者：邱辉忠周皎琳北京协和医院基本外科北京100730

中毒性巨结肠(toxic megacolon,TMC)是各种炎症性肠病、细菌性肠病和病毒性肠病等的一种致命并发症,常见于溃疡性结肠炎病人。该病通常发生于急性重症溃疡性结肠炎或慢性溃疡性结肠炎急性发作阶段。某些具有麻醉作用的药物如鸦片类、抗... 详细信息

中毒性巨结肠(toxic megacolon,TMC)是各种炎症性肠病、细菌性肠病和病毒性肠病等的一种致命并发症,常见于溃疡性结肠炎病人。该病通常发生于急性重症溃疡性结肠炎或慢性溃疡性结肠炎急性发作阶段。某些具有麻醉作用的药物如鸦片类、抗胆碱酯类和止泻药以及某些不适宜的医疗操作(如结肠镜检查)等可诱发其发作,一旦确立诊断,应立即进行挽救性治疗。为降低手术风险,提高手术成功率,对于病情危急的TMC病人,应遵循三期手术原则进行外科治疗。

关键词：溃疡性结肠炎结肠直肠切除术回肠贮袋-肛管吻合术

结肠切除术联合回肠直肠吻合术可维持女性溃疡性结肠炎患者的生殖能力

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世界核心医学期刊文摘（胃肠病学分册） 2006年第11期2卷 17-17页

作者： Mortier P.-E. Gambiez L. Karoui M. J.-F. Colombel 王顺涛 Clinique des Maladies de l'Appareil Digestif Hpital Huriez CHRU 59037 Lille Cedex France

Objectives -Restorative proctocolectomy with ileoanal anastomosis (IPAA) is the surgical standard for patients with ulcerative colitis (UC). Significant reduction in female fertility and fecundity after IPAA has been shown in recent studies. In selected cases, colectomy with ileorectal anastomosis (IRA) is another surgical option. The aim of this study was to evaluate fertility in women with UC who underwent IRA. Patients and methods -This study included all women with UC who underwent IRA between 1962 and 1999 and who were 40 years old or younger at the time of surgery, and older than 18 years of age at the time of the interview. Data were collected using a structured telephone interview concerning reproductive behavior and waiting times to pregnancy. Results -Among 40 eligible patients, 37 whose mean age at IRA was 28 years (range 11-39) answered the questionnaire. Twenty-two were unmarried, not wishful of pregnancy and / or already had children. Among 15 females wishing children after IRA, 10 (66%) became pregnant: one had therapeutic abortion, two had a miscarriage, four had 1 child, two had 2 children and one had 4 children. Five patients were sterile after IRA. Conclusion -These preliminary results suggest that IRA for UC preserves female fertility. If confirmed in other series this information should be provided to young women with UC before deciding surgical option.

关键词：结肠切除术回肠直肠吻合术生殖能力溃疡性结肠炎结肠直肠切除术治疗性流产不育者电话访谈自

不同肠道重建方式对低位直肠癌保肛术后肛门功能的影响

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中国医药导报 2013年第14期10卷 68-70页

作者：张国云潘中平葛宁张小玲郑州大学附属郑州中心医院肛肠科河南郑州450007

目的研究直接吻合术、结肠成形袋术和J型贮袋术对低位直肠癌保肛术后肛门功能的影响。方法选择2007年1月～2011年5月在郑州大学附属郑州中心医院治疗的低位直肠癌患者109例,随机分为直吻组36例行直接吻合术,结袋组37例行结肠成形袋术,J... 详细信息

目的研究直接吻合术、结肠成形袋术和J型贮袋术对低位直肠癌保肛术后肛门功能的影响。方法选择2007年1月～2011年5月在郑州大学附属郑州中心医院治疗的低位直肠癌患者109例,随机分为直吻组36例行直接吻合术,结袋组37例行结肠成形袋术,J袋组36例行J型贮袋术,观察三组患者术后肛门功能情况。结果三组均无死亡;直吻组、结袋组、J袋组手术重建成功率[94.44%(34/36)、97.30%(36/37)、94.44%(34/36)]、术后并发症发生率[8.82%(3/34)、5.55%(2/36)、5.88%(2/34)]差异均无统计学意义(均P>0.05)。术后3、6、12个月结袋组和J袋组24 h排便次数、不能区分排便和排气均显著少于直吻组,差异有统计学意义(P术后3、6、12个月三组大便不能完全排空感差异无统计学意义(P>0.05);术后3个月三组肛门功能主观感受评价得分差异无统计学意义(P>0.05);术后6、12个月结袋组[(7.83±1.75)、(8.34±1.85)分]和J袋组[(7.69±1.63)、(8.41±1.74)分]肛门主观感受评价得分显著高于直吻组[(6.36±1.78)、(6.89±1.67)分],差异有统计学意义(P术后3、6、12个月结袋组和J袋组静息压和最大耐受容量高于直吻组,术后12个月结袋组和J袋组最大收缩压和顺应性均高于直吻组,差异均有统计学意义(P0.05)。结论直接吻合术对低位直肠癌全直肠结肠系膜切除术后患者肛门功能影响最为显著,结肠成形袋和J型贮袋术改善患者术后肛门功能作用相似,结肠成形袋方法更简单。

关键词：直肠肿瘤结肠直肠切除术重建术结肠成形袋术 J型贮袋术肛门功能