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ObjectiveTo systematically evaluate the efficacy and safety of omental wrapping technique for pancreaticojejunal anastomosis in preventing complications after pancreaticoduodenectomy. MethodsThis study was conducted according to the PRISMA guideline. English and Chinese databases including CNKI， Wanfang Data， VIP， CBM， the Cochrane Library， PubMed， Embase， and Web of Science were searched for clinical studies on omental wrapping technique for pancreaticojejunal anastomosis in preventing complications after pancreaticoduodenectomy published up to November 2022， and Stata 16 and Review Manager 5.4 were used to perform the meta-analysis. ResultsA total of 15 studies with 1 830 patients were included in this study. The meta-analysis showed that the omental wrapping group had a significantly lower overall incidence rate of postoperative pancreatic fistula （POPF） than the non-omental wrapping group （odds ratio ［OR］=0.30， 95% confidence interval ［CI］： 0.22 — 0.41， P<0.001）， and the subgroup analysis showed that the omental wrapping group had a significantly lower incidence rate of grade B/C POPF than the non-omental wrapping group （OR=0.29， 95%CI： 0.21 — 0.39， P<0.001）. Compared with the non-omental wrapping group， the omental wrapping group had significantly lower incidence rates of postoperative bile leakage （OR=0.30， 95%CI： 0.16 — 0.56， P<0.001）， postoperative hemorrhage （OR=0.35， 95%CI： 0.24 — 0.53， P<0.001）， delayed gastric emptying （OR=0.45， 95%CI： 0.31 — 0.64， P<0.001）， abdominal infection （OR=0.55， 95%CI： 0.40 — 0.75， P<0.001）， reoperation （OR=0.31， 95%CI： 0.18 — 0.54， P<0.001）， and death within 30 days after surgery （OR=0.42， 95%CI： 0.22 — 0.80， P=0.009）， a significantly earlier time to diet （mean difference ［MD］=-0.98， 95%CI： -1.84 to -0.11， P=0.03）， and a significantly shorter length of postoperative hospital stay （MD=-2.44， 95%CI： -4.10 to -0.77， P=0.004）. There were no significant differences between the two groups in the time of operation （MD=-13.68， 95%CI： -28.31 to -0.95， P=0.07） and intraoperative blood loss （MD=-17.26， 95%CI： -57.55 to -23.03， P=0.40）. ConclusionOmental wrapping can reduce the incidence rates of postoperative complications such as pancreatic fistula， bile leakage， postoperative hemorrhage， abdominal infection， and delayed gastric emptying， improve the prognosis of patients， and shorten the length of hospital stay， without increasing surgical difficulty or time of operation.
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SUMMARY: Early closure of a loop ileostomy (ECI) is a relatively new practice, for which there is insufficient evidence regarding its effectiveness in relation to closure at conventional times. The aim of this study was to report postoperative complications (POC) and hospital mortality in patients with loop ileostomy (LI) who underwent ECI, compared with patients with LI who underwent late closure. Un- matched case-control study. Patients with LI who underwent surgery at Clínica RedSalud Mayor Temuco (2010-2022) were included. Cases were defined as patients with LI who underwent early closure and controls as subjects who underwent closure at the usual times. No matching was performed, but a 1:1 relationship between cases and controls was considered. Outcome variables were postoperative complications and hospital mortality. Other variables of interest were surgical time and hospital stay. Descriptive statistics were applied with calculation of proportions and measures of central tendency. Subsequently, t-test and Pearson Chi2 for comparison of averages and proportions was applied, and odds ratios and their respective 95 % CI were calculated. In this study 39 patients with AI were operated on (18 cases and 21 controls). Age and BMI average of the studied subjects was 71.3±7.1 years and 27.3±19.8 kg/m2 respectively. Mean LI closure time, surgical time, and hospitalization were: 10.0±0.7 months; 62.5±10.6min; 3.8±0.1 days respectively. POC were only surgical site infections. Three in cases (16.7 %) and 3 in controls (14.3 %). No anastomotic dehiscence or hospital mortality was observed in either cases or controls. There were no differences in comorbidities or surgical site infection between cases and controls (OR of 0.6 and 1.2 respectively) In this experience, the results of performing the CTI were similar to the late closing in relation to the variables studied.
El cierre temprano de una ileostomía en asa (IA), es una práctica relativamente nueva, sobre la que no hay suficiente evidencia respecto de su efectividad en relación con el cierre en tiempos convencionales. El objetivo de este estudio fue verificar diferencias en la tasa de complicaciones postoperatorias (CPO) y de mortalidad hospitalaria en pacientes con IA sometidos a cierre temprano comparados con pacientes con IA sometidos a cierre tardío. Estudio de casos y controles sin emparejamiento. Se incluyeron pacientes con IA que fueron sometidos a cirugía en la Clínica RedSalud Mayor Temuco (2010-2022). Los casos se definieron como pacientes con IA sometidos a cierre temprano y los controles como sujetos con IA sometidos a cierre en tiempos habituales. No se realizó emparejamiento. Se consideró una relación 1:1 entre casos y controles. Las variables de resultado fueron CPO y mortalidad hospitalaria. Otras variables de interés fueron: tiempo quirúrgico y hospitalización. Se aplicó estadísticas descriptivas (cálculo de proporciones y medidas de tendencia central). Posteriormente, se aplicó prueba t-test y Chi2 para comparación de promedios y proporciones; y se calcularon odds ratios e intervalos de confianza del 95 %. Se operaron 39 pacientes con IA (18 casos y 21 controles). El promedio de edad e IMC fue 71,3±7,1 años y 27,3±19,8 kg/m2, respectivamente. El tiempo promedio de cierre de IA, tiempo quirúrgico y hospitalización fueron: 10,0±0,7 meses; 62,5±10,6 minutos; 3,8±0,1 días, respectivamente. Las CPO fueron infecciones del sitio quirúrgico (3 casos; 16,7 % y 3 controles; 14,3 %). No se observó dehiscencia anastomótica ni mortalidad hospitalaria en casos ni controles. No hubo diferencias en comorbilidades ni en infecciones del sitio quirúrgico entre casos y controles (OR de 0,6 y 1,2, respectivamente). No se evidenciaron diferencias entre realizar cierre temprano o tardío de IA, respecto de las variables CPO y de mortalidad hospitalaria.
Subject(s)
Humans , Middle Aged , Aged , Ileostomy/adverse effects , Ileostomy/methods , Postoperative Complications , Time Factors , Ostomy , Case-Control Studies , Hospital Mortality , Surgical StomasABSTRACT
Objetivo: avaliar os fatores associados ao autocuidado praticado por pessoas com estomias de eliminação. Método: estudo transversal analítico, baseado nas respostas de 153 pessoas com estomia de eliminação, atendidas em um ambulatório de referência no cuidado de pessoas com estomas, no município de Teresina. A coleta de dados ocorreu por meio de um formulário semiestruturado com dados demográficos e acerca do autocuidado. Os dados foram analisados mediante estatística descritiva e inferencial. O teste Qui-quadrado de Pearson foi utilizado na análise inferencial. Resultados: o esvaziamento da bolsa, limpeza do estoma, secagem da pele periestoma, descolamento da placa, medição do estoma, realização do molde, adaptação, autoestima e isolamento social apresentaram associação significativa com o autocuidado (p<0,05). Conclusão: evidenciou-se que os fatores associados ao autocuidado foram os cuidados com o estoma e com o equipamento coletor, além dos impactos na autoestima e na vida social.
Objective: to evaluate the factors associated with self-care practiced by people with elimination stomas. Method: analytical cross-sectional study, based on the responses of 153 people with elimination stoma, treated at a reference outpatient clinic for the care of people with stoma, in the city of Teresina. Data collection took place through a semi-structured form with demographic data and about self-care. Analyzes were performed using inferential statistics, using the chi-square test. Results: Emptying the pouch, cleaning the stoma, drying the peristomal skin, detaching the plaque, measuring the stoma, making the mold, fitting, , self-esteem and social isolation were significantly associated with self-care (p<0.05). Conclusion: it was evident that the factors associated with self-care were care for the stoma and the collection equipment, in addition to the impacts on self-esteem and social life.
Objetivo: evaluar los factores asociados al autocuidado practicado por personas con estomas de eliminación. Método: estudio transversal analítico, basado en las respuestas de 153 personas con estoma de eliminación, atendidos en un ambulatorio de referencia para la atención de personas con estoma, en la ciudad de Teresina. Se realizó la recolección de datos a través de un formulario semiestructurado con datos demográficos y sobre autocuidado. Los datos se analizaron utilizando estadística descriptiva e inferencial, utilizando la prueba Chi-cuadrado de Pearson. Resultados: vaciar la bolsa, limpiar la estoma, secar la piel periestomal, despegar la placa, medir la estoma, hacer el molde, adaptarlo, vaciar la bolsa, la autoestima y el aislamiento social se asociaron significativamente con el autocuidado (p<0,05). Conclusión: se evidenció que los factores asociados al autocuidado fueron el cuidado de la estoma y del equipo de recolección, además de los impactos en la autoestima y la vida social.
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Objetivo: Descrever o processo de elaboração de instrumento para orientar o autocuidado mediado pela aromaterapia de mulheres e homens com estomas intestinais. Métodos: Estudo metodológico - desenvolvimento de produto técnico/inovação tecnológica, realizado em um município da Bahia, Brasil, no ano de 2023. Participaram do estudo 11 pacientes (seis eram mulheres e cinco, homens) e seis enfermeiras(os) avaliadoras(es). Realizou-se as etapas de pesquisa - levantamento da literatura, entrevista individual em profundidade, aplicação de óleos essenciais. Os dados foram submetidos à Análise de Conteúdo Temática Reflexiva, enquadramento teórico à luz da Teoria do Déficit do Autocuidado de Orem, a fim de derivar a estrutura da tecnologia. Resultados: Foi elaborada uma proposta de um instrumento clínico-assistencial de enfermagem para avaliação inicial e plano de cuidados para a implementação da aromaterapia junto a mulheres e homens com estomas intestinais. O instrumento foi composto pelos itens: Histórico de Enfermagem - avaliação inicial (dados sociodemográficos e relacionados à aromaterapia e achados clínicos; Diagnósticos de Enfermagem prioritários; Resultados de Enfermagem prioritários; Intervenções de Enfermagem prioritários; Avaliação/Acompanhamento e documentação clínica. Conclusão: A tecnologia constituiu uma inovação a ser aplicada no cotidiano profissional em enfermagem no Brasil, por ser constituída de conhecimentos próprios da profissão. (AU)
Objective: To describe the process of developing an instrument to guide self-care mediated by aromatherapy for women and men with intestinal stomas. Methods: Methodological study - development of a technical product/technological innovation, carried out in a conducted in a municipality of Bahia, Brazil, in the year 2023. Eleven patients (six women and five men) and six nurse evaluators participated in the study. The research stages were carried out - literature survey, in-depth individual interview, application of essential oils. Data were submitted to Reflective Thematic Content Analysis, a theoretical framework based on Orem's Self-Care Deficit Theory, in order to derive the structure of the technology. Results: A proposal for a clinical nursing care instrument was developed for the initial assessment and care plan for the implementation of aromatherapy with women and men with intestinal stomas. The instrument consisted of the items: Nursing History - initial assessment (sociodemographic data and data related to aromatherapy and clinical findings; Priority Nursing Diagnoses; Priority Nursing Outcomes; Priority Nursing Interventions; Assessment/Follow-up and clinical documentation. Conclusion: The technology constituted an innovation to be applied in the daily professional life of nursing in Brazil, as it was constituted of the profession's own knowledge. (AU)
Objetivo: Describir el proceso de creación de un instrumento para orientar el autocuidado mediado por aromaterapia para mujeres y hombres con estomas intestinale. Métodos: Estudio metodológico - desarrollo técnico de producto/innovación tecnológica, realizado en un municipio de Bahía, Brasil, en el año 2023. Participaron 11 pacientes (seis mujeres y cinco hombres) y seis enfermeros evaluadores. Se realizaron las etapas de la investigación - levantamiento bibliográfico, entrevista individual en profundidad, aplicación de aceites esenciales. Los datos fueron sometidos al Análisis de Contenido Temático Reflexivo, referencial teórico a la luz de la Teoría del Déficit de Autocuidado de Orem, con el fin de derivar la estructura de la tecnologia. Resultados: Se elaboró una propuesta de instrumento clínico-asistencial de enfermería para la evaluación inicial y plan de cuidados para la implementación de aromaterapia con mujeres y hombres con ostomías intestinales. El instrumento constó de: História de Enfermería - evaluación inicial (datos sociodemográficos y datos relacionados con la aromaterapia y hallazgos clínicos; Diagnósticos de Enfermería Prioritarios; Resultados de Enfermería Prioritarios; Intervenciones de Enfermería Prioritarias; Evaluación/Seguimiento y documentación clínica. Conclusión: La tecnología constituyó una innovación para ser aplicada en el cotidiano profesional de la enfermería en Brasil, ya que há sido desarollada por medio del conocimiento propio de la profesión. (AU)
Subject(s)
Surgical Stomas , Self Care , Aromatherapy , Nursing CareABSTRACT
Objetivo: averiguar a percepção de estudantes de enfermagem sobre a telessimulação no ensino do cuidado à criança com estomia intestinal. Método: estudo prospectivo e qualitativo, aprovado pelo Comitê de Ética em Pesquisa, realizado em agosto de 2021, em ambiente virtual. Participaram da pesquisa 31 estudantes de enfermagem regularmente matriculados, com acesso à internet, submetidos a entrevistas guiadas, contendo variáveis sobre a cena assistida, contribuições da telessimulação para a aprendizagem e dificuldades identificadas. A análise dos dados ocorreu conforme analise temática com auxílio do software MAXQDA. Resultados: os estudantes consideraram a telessimulação realística e facilitadora da compreensão do cuidado à criança com estomia intestinal. Surgiram três categorias temáticas: percepções sobre a cena transmitida na telessimulação, pontos negativos da telessimulação e ganhos percebidos após a telessimulação. Conclusão: a telessimulação foi realística, útil para a interação dos estudantes com a temática estomia intestinal em criança e promoveu reflexões quanto ao papel do enfermeiro.
Objective: to examine nursing students' perceptions of telesimulation in the teaching of care for children with intestinal ostomy. Method: this prospective, qualitative study was conducted, with research ethics committee approval, in August 2021, in a virtual environment. Thirty-one regularly enrolled nursing students with Internet access took part in scripted interviews addressing variables of the scene displayed, the contributions of telesimulation to learning, and difficulties identified. The data were subjected to thematic analysis assisted by MAXQDA software. Results: students considered that the software simulation was realistic and facilitated the understanding of child care with intestinal ostomy. Three thematic categories emerged: perceptions of the scene displayed in the telesimulation, adverse aspects of telesimulation, and perceived gains after telesimulation. Conclusion: the telesimulation was realistic, useful the students' interaction with the theme of intestinal ostomy in children, and prompted thinking on the nurse's role.
Objetivo: verificar la percepción de los estudiantes de enfermería sobre la telesimulación en la enseñanza de la atención a niños con ostomía intestinal. Método: estudio prospectivo y cualitativo, aprobado por el Comité de Ética en Investigación, realizado en agosto de 2021, en entorno virtual. Participaron en el estudio treinta y un estudiantes de enfermería matriculados regularmente, con acceso a internet, por medio de entrevistas guiadas que contienen variables sobre la escena asistida, contribuciones de la telesimulación al aprendizaje y dificultades identificadas. El análisis de datos se realizó de acuerdo con el análisis temático con la ayuda del software MAXQDA. Resultados: los estudiantes consideraron la telesimulación realística y facilitadora de la comprensión del cuidado del niño con ostomía intestinal. Han surgido tres categorías temáticas: percepciones sobre la escena transmitida en la telesimulación, puntos negativos de la telesimulación y ganancias percibidas después de la telesimulación. Conclusión: el telesimulación fue realística, útil para la interacción de los estudiantes con el tema ostomía intestinal en niños y promovió reflexiones sobre el papel del enfermero.
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Abstract Objective The purpose was to assess the rates of postoperative complications and the need of temporary stoma of laparoscopic surgical treatment for bowel endometriosis in a referral center. Methods The surgical indication, type of operation, operative time, length of hospital stay, need for a temporary stoma, rate of conversion to open surgery, postoperative complications were evaluated. Results One-hundred and fifty patients were included. The average duration of surgery was significantly longer for segmental resection (151 minutes) than for disc excision (111.5 minutes, p < 0.001) and shaving (96.8 minutes, p < 0.001). Patients with segmental resection had longer postoperative lengths of hospital stay (1.87 days) compared with patients with disc excision (1.43 days, p < 0.001) and shaving (1.03 days, p < 0.001). A temporary stoma was performed in 2.7% of patients. Grade II and III postoperative complications occurred in 6.7% and 4.7% patients, respectively. Conclusion Laparoscopic intestinal resection has an acceptable postoperative complication rate and a low need for a temporary stoma.
Resumo Objetivo O objetivo foi avaliar as taxas de complicações pós-operatórias e a necessidade de estomia temporária do tratamento cirúrgico laparoscópico para endometriose intestinal em um centro de referência. Métodos Foram avaliados a indicação cirúrgica, tipo de operação, tempo operatório, tempo de internação, necessidade de estomia temporária, taxa de conversão para cirurgia aberta, complicações pós-operatórias. Resultados Cento e cinquenta pacientes foram incluídos. A duração média da cirurgia foi significativamente maior para a ressecção segmentar (151 minutos) do que para a excisão do disco (111,5 minutos, p < 0,001) e shaving (96,8 minutos, p < 0,001). Pacientes com ressecção segmentar tiveram maior tempo de internação pós-operatória (1,87 dias) em comparação com pacientes com excisão de disco (1,43 dias, p < 0,001) e shaving (1,03 dias, p < 0,001). Um estoma temporário foi realizado em 2,7% dos pacientes. Complicações pós-operatórias de grau II e III ocorreram em 6,7% e 4,7% dos pacientes, respectivamente. Conclusão A ressecção intestinal laparoscópica apresenta taxa aceitável de complicações pós-operatórias e baixa necessidade de estomia temporária.
Subject(s)
Humans , Female , Postoperative Complications , Laparoscopy , Colorectal Surgery/rehabilitation , Endometriosis/surgery , Surgical StomasABSTRACT
Objetivo:Construir e validar um protocolo clínico direcionado à avaliação de sensibilidade dermatológica ocasionada por dispositivos coletores e adjuvantes utilizados por pessoas com estomias. Metodologia:Pesquisa metodológica, desenvolvida entre os anos de 2020 e 2021, para construção e validação de um protocolo de avaliação dermatológica para pessoas com estomias de eliminação. A construção do protocolo percorreu as etapas: diagnóstico situacional teórico, levantamento do referencial teórico e desenvolvimento do protocolo. Resultados: Para validação foram recrutados 21 juízes, enfermeiros, com experiência na área de Estomaterapia, cujo instrumento para validação do conteúdo avaliou objetivos, estrutura e relevância da tecnologia, sendo disponibilizado via e-mail por formulário eletrônico na plataforma Google Forms. Para análise dos dados utilizou-se a estatística descritiva e o cálculo de índice de validade de conteúdo (IVC). Obteve-se escore global de concordância entre os juízes de 0,92. Conclusão: Conclui-se que o protocolo criado possui fundamentação e validação prática, versatilidade de aplicação, viabilizando um processo assistencial mais congruente com a realidade da pessoa com estomia de eliminação.
Objective:To build and validate a clinical protocol aimed at evaluating the dermatological sensitivity caused by collection devices and adjuvants used by people with stomas. Methodology: Methodological research, developed between 2020 and 2021, for the construction and validation of a dermatological evaluation protocol for people with elimination stomas. The construction of the protocol went through the steps: theoretical situational diagnosis, survey of the theoretical framework and development of the protocol. Results: For validation, 21 judges, nurses, with experience in the area of enterostomal therapy, were recruited, whose instrument for content validation evaluated objectives, structure and relevance of the technology, being made available via e-mail through an electronic form on the Google Forms platform. For data analysis, descriptive statistics and the calculation of content validation index were used. A global score of agreement between the judges of 0.92 was obtained. Conclusion: It is concluded that the protocol created has a practical basis and validation, application versatility, enabling a care process that is more congruent with the reality of the person with an elimination stoma.
Objetivo:Construir y validar un protocolo clínico dirigido a la evaluación de la sensibilidad dermatológica provocada por los dispositivos colectores y adyuvantes utilizados por personas con ostomías. Metodología: Investigación metodológica, desarrollada entre 2020 y 2021, para la construcción y validación de un protocolo de evaluación dermatológica para personas con estomas de eliminación. La construcción del protocolo pasó por las etapas: diagnóstico situacional teórico, levantamiento del marco teórico y desarrollo del protocolo. Resultados: Para la validación fueron reclutados 21 jueces, enfermeros, con experiencia en el área de Estomaterapia, cuyo instrumento para validación de contenido evaluó objetivos, estructura y pertinencia de la tecnología, estando disponible vía e-mail a través de formulario electrónico en Google Plataforma de formularios. Para el análisis de los datos se utilizó la estadística descriptiva y el cálculo del Índice de Validación de Contenido. Se obtuvo una puntuación global de concordancia entre los jueces de 0,92. Conclusión: Se concluye que el protocolo creado tiene base práctica y validación, versatilidad de aplicación, posibilitando un proceso de atención más congruente con la realidad de la persona con ostomía de eliminación.
Subject(s)
Validation Study , Dermatitis, Contact , Surgical Stomas , Enterostomal TherapyABSTRACT
Objective:To evaluate the strategy and skills of reoperation for recurrent carcinoma at the stoma of esophagojejunostomy after total gastrectomy.Methods:The management experience in 18 patients at the Department of General Surgery, Tumor Hospital of Zhengzhou University from Oct 2016 to Jul 2021 were analyzed retrospectively.Results:Thirteen patients underwent left thoracoabdominal combined incision to completely remove the tumor.One patient developed anastomotic leakage, two patients developed pulmonary infection, one patient developed costochondritis, all were cured and discharged after conservative treatment; Nine patients had no postoperative complications. Two patients abandoned surgery due to high position of the tumor, 3 patients due to poor cardiopulmonary function, and were given radiotherapy and chemotherapy.The postoperative follow-up period was 4.6 to 42.9 months. Four patients died of tumor recurrence, and the remaining patients survived until the end of the follow-up. The overall 1-and 3-year recurrence-free survival rates were 100% and 20%, respectively.Conclusion:Surgery on recurrent carcinoma at esophagojejunostomy stoma after total gastrectomy, although difficult and challenging,could still benefit most patients when at the hands of expertise.
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Objective:To investigate the application value of Prolene thread-needle continuous suture method in pancreaticojejunostomy pancreaticoduodenectomy.Methods:The clinical data of 80 patients with preoperative diagnosis of periampullary tumors undergoing pancreaticoduodenectomy who were admitted to Shanxian Central Hospital of Heze City from January 2017 to December 2020 were selected. According to the different methods of anastomosis, 80 patients were divided into A group and B group, each group with 40 patients, the patients in A group were performed pancreatic duct-mucosal anastomosis and the patients in B group were performed Prolene thread-needle continuous suture. The preoperative clinical data, operation-related data, postoperative complications in two groups were compared.Results:There were no statistically significant differences between the two groups in clinical data such as gender, age, albumin level, pancreatic duct diameter, combined underlying diseases, preoperative bilirubin, admission symptoms, preoperative biliary drainage and tumor location ( P>0.05).The operation time, intraoperative blood loss, postoperative drainage, operation durationand postoperative hospital stay in B group were lower than those in A group : (353.64 ± 95.28) min vs. (395.38 ± 110.29)min, (330.19 ± 100.27) ml vs. (397.43 ± 105.97) ml, (330.57 ± 110.68) ml vs. (376.18 ± 94.73) ml, (20.74 ± 8.08) min vs. (31.06 ± 7.83) min, (18.72 ± 6.02) d vs. (23.79 ± 7.41) d, the differences were statistically significant ( P<0.05). The incidence of complications such as pancreatic leakage, pancreatic fistula, abdominal infection, lung infection, biliary fistula and delayed gastric emptying in B group were lower than those in A group : 10.0%(4/40) vs. 20.0%(8/40), 7.5%(3/40) vs. 20.0%(8/40), 2.5%(1/40) vs. 12.5%(5/40), 0 vs. 7.5%(3/40), 5.0%(2/40)vs. 17.5%(7/40), 7.5%(3/40) vs. 17.5%(7/40), the differences were statistically significant ( P<0.05). Conclusions:Prolene thread-needle continuous suture method in pancreaticojejunostomy pancreaticoduodenectomy has the characteristics of simple operation, effective shortening of operation time, reliable anastomosisand can reduce the risk of postoperative pancreatic fistula complications.
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Objective: Currently, the Overlap anastomosis is one of the most favored reconstruction methods of intracorporeal esophagojejunostomy (EJS). Despite many advantages of the method, it remains some shortcomings to be improved when it comes to the retraction of the esophagus stump, the insertion of the anvil fork of the linear stapler into a "pseudo" lumen, and the closure of the common entry hole. This study aims to investigate the safety and feasibility of a multi-mode modified Overlap anastomosis. Methods: A descriptive case series study was conducted. Medical records of 152 consecutive patients who underwent totally laparoscopic total gastrectomy (TLTG) with our multi-mode modified Overlap EJS method by the same surgical team at our department from February 2017 to June 2020 were retrospectively analyzed. The multi-mode modified Overlap method mainly included (1) After ensuring the safety of tumor resection margin (proximal margin was at least 3 cm from the tumor), the esophagus was partially transected from left to right (with 5-8 mm width esophagus continuation). The specimen was then placed in a plastic bag which was tied up at the mouth using strings with a part of the esophageal wall poking through. Then the plastic bag containing the specimen was transferred to the right lumbar region, while the patient's body position was adjusted so that the abdominal esophagus could be pulled by the gravity of the specimen. (2) Using the "three-direction traction" method. The esophageal lumen was properly exposed, then guided by the gastric tube, the anvil fork was accurately placed into the esophageal lumen for completing the side-to-side EJS. (3) The 3-0 barbed suture was used in the closure of the common entry hole of the stapler from dorsally to ventrally with simple one-layer continuous suture (the stitch going from inside to inside) followed by continuous Lembert's suture (the stitch going from outside to outside). Combined with clinicopathological characteristics, the perioperative outcomes and postoperative complications of the whole group were analyzed and evaluated. Results: The study cohort included 129 men and 23 women, with a mean age of (60.2±9.1) years and a mean body mass index (BMI) of (23.2±3.1) kg/m(2). Of the 152 patients, 23 patients (15.1%) had a history of previous abdominal surgery; dentate line was invaded by tumor in 21 patients (13.8%). The mean length of the proximal resection margin was (3.3±0.3) cm and the postoperative pathological examination indicated negative resection margin tumor. The mean operative time and anastomotic time were (302.1±39.9) minutes and (29.8±5.4) minutes, respectively. The mean estimated blood loss was (87.9±46.4) ml. The mean length of postoperative hospital stay was (12.3±7.3) days. The overall severe postoperative complications (Clavien-Dindo ≥ II) occurred in 22 patients (14.5%). Six cases of pancreatic leakage were successfully recovered by adequate drainage, inhibition of pancreatic exocrine secretion and nutritional support. Ten cases of pneumonia and three cases of abdominal infection were cured with anti-infection and physical therapy. Two patients developed anastomotic leakage postoperatively. One case was caused by excessive tension of the Roux loop of the jejunum and excessive opening on the side of the jejunum after side-to-side anastomosis, and the other case was caused by an accidental intraoperative occurrence of "nasogastric tube stapled to the side-to-side anastomosis". Both of them recovered after conservative treatment including adequate drainage, anti-infection, and adequate nutritional support. One patient underwent immediate open surgery because of Peterson's hernia 7 days after TLTG, and the patient died due to extensive small bowel necrosis. Conclusions: Multi-mode modified overlap method simplifies the operation and reduces the difficulty of EJS. It is a safe and feasible method for EJS.
Subject(s)
Aged , Female , Humans , Male , Middle Aged , Anastomosis, Surgical/methods , Feasibility Studies , Gastrectomy/methods , Laparoscopy/methods , Margins of Excision , Plastics , Postoperative Complications/etiology , Retrospective Studies , Stomach Neoplasms/pathologyABSTRACT
Objetivo: descrever e analisar as dificuldades e facilidades percebidas por enfermeiros para implementação do processo educativo dirigido às pessoas com estomia. Método: estudo qualitativo e exploratório, apoiada no materialismo histórico e no método dialético. A coleta ocorreu em um Centro de Reabilitação no Rio de Janeiro, com seis enfermeiros, por meio da triangulação de métodos (observação participante, entrevista e análise de registros de enfermagem), entre dezembro de 2014 e março de 2015. Resultados: os fatores dificultadores do processo educativo foram: estrutura física inadequada, escassez de recursos financeiro e humano. Além disso, apreendeu-se déficit na formação e qualificação dos enfermeiros. Os fatores facilitadores incluíram: fornecimento de equipamentos e adjuvantes para as pessoas com estomia e criação de grupos de apoio para esta clientela. Conclusão: concluiu-se que existem contradições e discrepâncias na execução do processo educativo relacionadas à organização laboral, à formação e aos aspectos legais.
Objective: to describe and analyze what nurses perceive to be difficult and simple to implement in the process of educating people with ostomies Method: this qualitative, exploratory study was supported by historical materialism and the dialectical method. Data were collected from six nurses at a Rehabilitation Center in Rio de Janeiro, using a triangulation of methods (participant observation, interview, and analysis of nursing records), between December 2014 and March 2015. Results: the factors that hampered the educational process were inappropriate physical structure, and scarcity of financial and human resources. There was also found to be a deficit in the nurses' training and qualification. Enabling factors included: provision of equipment and adjuvants for people with ostomies, and creation of support groups for this clientele. Conclusion: it was concluded that execution of the educational process suffers from contradictions and discrepancies relating to work organization, training, and legal aspects.
Objetivo: describir y analizar lo que las enfermeras perciben como difícil y simple de implementar en el proceso de educación de las personas con ostomías Método: este estudio cualitativo, exploratorio, se sustenta en el materialismo histórico y el método dialéctico. Se recolectaron datos de seis enfermeras en un Centro de Rehabilitación de Río de Janeiro, mediante una triangulación de métodos (observación participante, entrevista y análisis de registros de enfermería), entre diciembre de 2014 y marzo de 2015. Resultados: los factores que obstaculizaron el proceso educativo fueron estructura física inadecuada y escasez de recursos financieros y humanos. También se constató un déficit en la formación y calificación de las enfermeras. Los factores habilitantes incluyeron: provisión de equipo y adyuvantes para personas con ostomías y creación de grupos de apoyo para esta clientela. Conclusión: se concluyó que la ejecución del proceso educativo adolece de contradicciones y discrepancias relacionadas con la organización del trabajo, la formación y los aspectos legales.
Subject(s)
Humans , Rehabilitation Centers , Self Care , Health Education , Surgical Stomas , Nurses, Male , Brazil , Adaptation to Disasters , Qualitative ResearchABSTRACT
Objetivo: analisar as dissertações e teses defendidas nos cursos de Pós-Graduação Stricto Sensu em Enfermagem, no Brasil, relativas ao tema criança com estoma, destacando seus aspectos epistemológicos. Método: estudo documental, descritivo, considerando o recorte temporal entre 2009 e 2019. Utilizou-se a Metodologia de Categorização Epistemológica para a Pesquisa na Enfermagem. Resultados: selecionaram-se doze estudos: dez dissertações de mestrado e duas teses de doutorado. Nota-se o predomínio de estudos na área/campo epistêmico assistencial, na linha de pesquisa: Processo de Cuidar em Saúde e Enfermagem. Identificou-se um maior interesse de estudos no contexto domiciliar e ambulatorial. Há predomínio da abordagem qualitativa e uso da entrevista para coleta de dados. Conclusão: os aspectos epistemológicos destacados possibilitam afirmar que as dissertações e teses relacionadas ao tema estão predominantemente orientadas para um pragmatismo epistemológico da assistência de enfermagem à criança com estoma e sua família, com objetos científicos delimitados para alcançar a compreensão desse fenômeno.
Objective: to examine postgraduate Nursing dissertations and theses defended in Brazil on the subject of children with stoma, highlighting their epistemological aspects. Method: this descriptive study considered studies published between 2009 and 2019 using the Epistemological Categorization methodology for research in Nursing. Results: twelve studies were selected: ten master's dissertations and two doctoral theses. The predominant epistemic area/field was "care", in the research line: "care process in health, and nursing". Studies were found to show greater interest in the home and outpatient context. The qualitative approach and data collection by interview predominated. Conclusion: from the epistemological aspects highlighted, it can be said that the dissertations and theses on the subject of children with stomata were predominantly oriented towards an epistemological pragmatism in nursing care for children with stoma and their families, with scientific objects delimited to achieve an understanding of this phenomenon.
Objetivo: analizar las disertaciones y tesis de posgrado en Enfermería defendidas en Brazil sobre el tema de niños con estoma, destacando sus aspectos epistemológicos. Método: este estudio descriptivo consideró estudios publicados entre 2009 y 2019 utilizando la metodología de Categorización Epistemológica para la investigación en Enfermería. Resultados: se seleccionaron doce estudios: diez tesis de maestría y dos tesis doctorales. El área / campo epistémico predominante fue el "cuidado", en la línea de investigación: "proceso de cuidado en salud y enfermería". Se encontró que los estudios muestran un mayor interés en el contexto domiciliario y ambulatorio. Predominó el enfoque cualitativo y la recolección de datos por entrevista. Conclusión: a partir de los aspectos epistemológicos destacados, se puede decir que las disertaciones y tesis sobre el tema de los niños con estoma estuvieron orientadas predominantemente hacia un pragmatismo epistemológico en la atención de enfermería al niño con estoma y sus familias, con objetos científicos delimitados para lograr un entendimiento. de este fenómeno.
Subject(s)
Humans , Child , Ostomy/education , Child Care , Education, Nursing, Graduate , Brazil , Nursing Research , Data Collection , Surgical Stomas , Nursing CareABSTRACT
ABSTRACT Objective: to analyze the knowledge and practices of nursing professionals in caring for people with colostomy bag. Method: a qualitative and descriptive study conducted with 21 nursing professionals from a General Surgery Unit. Data collection used triangulation of techniques, based on non-participant observation, analysis of nursing records, and semi-structured interviews. Analysis followed the spiral technique assumptions. Results: it was possible to comprehend the theoretical and scientific knowledge that subsidize practice; identify contradictions related to statement and care in the profession's daily work and the intervening factors, which can facilitate and/or make the nursing care process difficult. Final Considerations: knowledge and practices of professionals in caring for ostomates occur within work experiences, in which socialization of knowledge makes it possible to expand the perspectives of care.
RESUMEN Objetivo: analizar el conocimiento y las prácticas de los profesionales de enfermería en el cuidado de las personas con estoma de eliminación intestinal. Método: estudio cualitativo, descriptivo, realizado con 21 profesionales de enfermería de una Unidad de Cirugía General. La recopilación de datos utilizó la triangulación de técnicas, basadas en la observación no participante, el análisis de los registros de enfermería y las entrevistas semiestructuradas. El análisis siguió los supuestos de la técnica espiral. Resultados: fue posible comprender los conocimientos teóricos y científicos que respaldan las prácticas, identificar contradicciones relacionadas con el discurso y la atención en el trabajo diario de la profesión, así como los factores intervinientes, que pueden facilitar y / o dificultar el proceso de atención de enfermería. Consideraciones finales: el conocimiento y las prácticas de los profesionales en el cuidado de personas con estoma se producen en el contexto de experiencias y experiencias laborales, en las que la socialización del conocimiento permite ampliar las perspectivas de la atención.
RESUMO Objetivo: analisar os saberes e práticas dos profissionais de enfermagem no cuidado às pessoas com estoma intestinal de eliminação. Método: estudo qualitativo, descritivo, realizado com 21 profissionais de enfermagem de uma Unidade de Cirurgia Geral. A coleta de dados utilizou a triangulação de técnicas, a partir da observação não participante, análise dos registros de enfermagem e entrevista semiestruturada. A análise seguiu os pressupostos da técnica de espiral. Resultados: foi possível apreender os conhecimentos teóricos e científicos que subsidiam as práticas, identificar contradições relacionadas ao discurso e ao cuidado no cotidiano laboral da profissão, bem como os fatores intervenientes, os quais podem facilitar e/ou dificultar o processo de cuidar da enfermagem. Considerações Finais: os saberes e práticas dos profissionais no cuidado às pessoas com estoma ocorrem no contexto das vivências e experiências laborais, em que a socialização do conhecimento possibilita ampliar as perspectivas de cuidado.
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RESUMO Objetivo caracterizar população atendida em Programa de Assistência a Estomizados. Métodos estudo transversal, com base nos dados do Programa de Assistência a Estomizados. População de 852 pacientes cadastrados. Utilizou-se de formulário contendo variáveis sociodemográficas e clínicas. Dados analisados por comparação de médias, empregando-se o teste t de Student e a análise de variância. Resultados a faixa etária mais exposta ao procedimento cirúrgico investigado foi a de adultos/ idosos (93,0%), do sexo masculino (52,5%). As malformações congênitas e neoplasias foram as principais causas de estomias para o grupo de crianças e adultos/idosos, respectivamente. Conclusão a faixa etária mais exposta ao procedimento estudado foi a de adultos/idosos, do sexo masculino e oriundos da região metropolitana do estado investigado. Entre crianças, as malformações congênitas requereram confecção de ileostomia temporária; entre adultos/idosos, a neoplasia correspondeu à indicação mais frequente de colostomias permanentes.
ABSTRACT Objective to characterize the population served by the Assistance Program for Ostomy Patients. Methods cross-sectional study, based on data from the Assistance Program for Ostomy Patients. Population of 852 registered patients. A form containing sociodemographic and clinical variables was used. Data analyzed by average comparison, using Student's 't' test and analysis of variance. Results the age group most exposed to the investigated surgical procedure was adult/elderly (93.0%), male (52.5%). Congenital malformations and neoplasms were the main causes of ostomy for the group of children and adults/elderly, respectively. Conclusion the age group most exposed to the studied procedure was adult/elderly, male and from the metropolitan region of the investigated state. Among children, congenital malformations required the making of a temporary ileostomy; among adults/elderly, the neoplasm corresponded to the most frequent indication of permanent colostomies.
Subject(s)
Health Profile , Surgical Stomas , Nursing CareABSTRACT
OBJETIVO: compreender o cuidado realizado pelos profissionais de saúde na assistência à criança estomizada. MÉTODOS: estudo descritivo-exploratório com delineamento na investigação qualitativa interpretativa realizado em um hospital público de Brasília. População constituída por nove mães de crianças estomizadas. Realizado no período entre dezembro de 2015 e fevereiro de 2016. Utilizados dados do diário de campo e do roteiro de entrevista semiestruturado e realizada análise das narrações por meio da análise de conteúdo, modalidade temática. RESULTADOS: nas narrativas maternas prevaleceram relatos de dificuldade no manejo da estomia, por dificuldade no entendimento das orientações fornecidas pelos profissionais de saúde, sendo unânime em narrar que aprenderam mais com a prática de outras mães do que com os profissionais. Reforçaram também a falta de preparo desses profissionais em lidar na assistência dessas crianças. CONSIDERAÇÕES FINAIS E IMPLICAÇÕES PARA A PRÁTICA DE ENFERMAGEM: ao compreender o cuidado, foi possível concluir e apoiar a necessidade de estabelecer prioridades para esse cuidado. As evidências encontradas podem fortalecer o cuidado prestado pelos profissionais de saúde que atuam com as famílias e as crianças com estomias, não apenas nos cuidados de rotina, como também nas ações educativas para serem preparadas a lidarem com a situação.(AU)
Objective: to understand the care provided by the health professionals to stomized children. Methods: a descriptive-exploratory study with design based on the interpretative qualitative research conducted in a public hospital in Brasília. The population consisted of nine mothers of stomized children. The research was performed between December 2015 and February 2016. Data from the field diary and from the semi-structured interview script were used and the analysis of the speeches was performed through content analysis, thematic modality. Results: in the maternal speeches reports prevailed of difficulty in the ostomy handling, because it was difficult to understand the guidelines provided by the health professionals, with unanimity in stating that they learned more from the practice of other mothers than from the professionals. They also reinforced the lack of preparation of these professionals to deal with the care of these children. Final considerations and implications for the Nursing practice: by understanding care, it was possible to deduce and support the need to establish priorities for this care. The diverse evidence found might strengthen the care provided by the health professionals working with the families and the stomized children, not only in routine care, but also in educational actions to prepare them to deal with the situation.(AU)
Objetivo: comprender la atención de los profesionales de la salud en el cuidado del niño ostomizado. Métodos: estudio exploratorio descriptivo con un diseño de investigación interpretativa cualitativa realizado en un hospital público de Brasiliaentre diciembre de 2015 y febrero de 2016. Población compuesta por nueve madres de niños ostomizados. Se utilizaron datos del diario de campo y del guión de la entrevista semiestructurada; el análisis de las narraciones se realizó mediante el análisis de contenido, modalidad temática. Resultados: en las declaraciones maternas prevalecieron los relatos sobre la dificultad en el manejo de la ostomía, debido a la dificultad para comprender las pautas proporcionadas por los profesionales de la salud, siendo unánimes al afirmar que aprendieron más con la práctica de otras madres que de los profesionales. También insistieron en la falta de preparación de los profesionales para tratar de estos niños. Consideraciones finales e implicaciones para la práctica de enfermería: al comprender la atención brindada, se ha podido concluir que es necesario establecer prioridades para mejorar dicha atención. La evidencia encontrada puede fortalecer la atención brindada por los profesionales de la salud que trabajan con familias y niños con ostomías, no solo en la atención de rutina, sino también en acciones educativas que los capacite para enfrentar la situación.(AU)
Subject(s)
Humans , Professional-Family Relations , Child, Hospitalized , Surgical Stomas , Nursing Care , Nurse-Patient RelationsABSTRACT
OBJETIVO: identificar a percepção de cônjuges de pessoas com estomia intestinal sobre a sexualidade do casal. MÉTODO: trata-se de pesquisa descritiva, com abordagem qualitativa, fundamentada na história de vida focal, utilizando a entrevista em profundidade. Foram entrevistados 13 cônjuges de pessoas estomizadas, no período de agosto a novembro de 2014. As entrevistas foram submetidas à técnica de análise de conteúdo na modalidade temática. RESULTADOS: do processo de análise emergiram quatro categorias temáticas: a) conceituando sexualidade com base na opinião dos participantes sobre sexualidade; b) intimidade sexual, com a exposição de diversas nuanças no exercício da sexualidade, em específico durante o sexo; c) sentimentos gerados pela estomia nos cônjuges, que abordou as sensações vivenciadas após a cirurgia de confecção do estoma; d) e estratégias utilizadas para favorecer o exercício da sexualidade, cujas táticas utilizadas pelo casal nessa área foram elencadas. CONSIDERAÇÕES FINAIS: identificou-se que, na perspectiva dos cônjuges de pessoas com estoma intestinal, a sexualidade está intimamente atrelada ao sexo, sendo que as alterações no exercício da sexualidade do casal variaram desde a inalteração até mudanças radicais, incluindo referências de abdicação dessa dimensão do viver humano, priorizando atividades diversas.(AU)
Objective: to identify the perception of spouses of people with intestinal ostomy on the sexuality of the couple. Method: this is a descriptive research with a qualitative approach, based on the focal life story, using the in-depth interview. Thirteen spouses of ostomized people were interviewed from August to November 2014. The interviews were submitted to the content analysis technique in the thematic modality. Results: four thematic categories emerged from the analysis process: a) conceptualizing sexuality based on the participants' opinion on sexuality; b) sexual intimacy, with the exposure of various nuances in the exercise of sexuality, specifically during sex; c) feelings generated by the ostomy in the spouses, which addressed the sensations experienced after the stoma surgery; d) and strategies used to favor the exercise of sexuality, whose tactics used by the couple in this area were listed. Final considerations: it was found that, from the perspective of the spouses of people with intestinal stoma, sexuality is closely linked to sex, and the changes in the exercise of the couple's sexuality ranged from unchanging to radical changes, including references of abdication of this dimension of human living, prioritizing various activities.(AU)
Objetivo: identificar la percepción de los cónyuges de personas con ostomía intestinal sobre la sexualidad de la pareja. Método: investigación descriptiva con enfoque cualitativo, basada en la historia de vida focal, utilizando la entrevista en profundidad. Fueron entrevistados trece cónyuges de personas ostomizadas de agosto a noviembre de 2014. Las entrevistas fueron sometidas a la técnica de análisis de contenido en la modalidad temática. Resultados: del proceso de análisis surgieron cuatro categorías temáticas: a) conceptualizar la sexualidad basada en la opinión de los participantes sobre la sexualidad; b) intimidad sexual, con la exposición de varios matices en el ejercicio de la sexualidad, específicamente durante el sexo; c) sentimientos generados por la ostomía en los cónyuges, que trató de las sensaciones después de la cirugía de estoma; d) y estrategias utilizadas para favorecer el ejercicio de la sexualidad y se habló de las tácticas de la pareja en esta área. Consideraciones finales: se descubrió que, desde la perspectiva de los cónyuges de las personas con estoma intestinal, la sexualidad está estrechamente vinculada al sexo, y los cambios en el ejercicio de la sexualidad de la pareja iban desde cero cambio hasta cambios radicales, incluyendo referencias a la abdicación de esta dimensión de la vida humana, dándoles prioridad a otras actividades.(AU)
Subject(s)
Humans , Spouses , Sexuality , Surgical Stomas , Sexual Behavior , Health PromotionABSTRACT
RESUMO Objetivo: identificar fatores preditivos da síndrome da ressecção anterior do reto (SRAR) que podem contribuir para o seu diagnóstico e tratamento precoces. Métodos: estudo de coorte retrospectivo de pacientes submetidos à ressecção anterior do reto entre 2007 e 2017 no Serviço de Coloproctologia do Hospital de Clínicas da Universidade Federal do Paraná. Foram realizadas análises de curva ROC (Receiver Operating Characteristic Curve Analysis) ou COR (Característica de Operação do Receptor) para identificar os fatores preditivos da SRAR. Resultados: foram incluídos 64 pacientes com dados completos. A idade dos homens foi de 60,1±11,4 anos e 37,10% eram do sexo masculino. Vinte pacientes (32,26%) apresentaram SRAR. Os sintomas mais relatados foram evacuação incompleta (60%) e urgência (55%). Na análise univariada, a distância da anastomose à margem anal (p<0,001), terapia neoadjuvante (p=0,0014) e confecção de ileostomia no momento da ressecção (p=0,0023) foram preditivos da SRAR. Análise da curva ROC mostrou um ponto de corte de 6,5cm na distância da anastomose à margem anal como preditor da SRAR. Conclusão: distância entre anastomose e margem anal, história de terapia neoajuvante e confecção de estoma são condições que podem ajudar a predizer o desenvolvimento da SRAR. A orientação e o envolvimento na educação do paciente, bem como, o manejo precoce podem reduzir potencialmente o impacto desses sintomas na qualidade de vida dos pacientes.
ABSTRACT Objective: to identify predictors of low anterior resection syndrome (LARS) that can contribute to its early diagnosis and treatment. Methods: we conducted a retrospective cohort study of patients undergoing anterior resection of the rectum between 2007 and 2017 in the Coloproctology Service of the Federal University of Parana Clinics Hospital. We performed Receiver Operating Characteristic Curve (ROC) analysis to identify LARS predictive factors. Results: we included 64 patients with complete data. The men's age was 60.1±11.4 years and 37.10% were male. Twenty patients (32.26%) had LARS. The most reported symptoms were incomplete evacuation (60%) and urgency (55%). In the univariate analysis, the distance from the anastomosis to the anal margin (p<0.001), neoadjuvant therapy (p=0.0014) and ileostomy at the time of resection (p=0.0023) were predictive of LARS. The ROC curve analysis showed a 6.5cm cut-off distance from the anastomosis to the anal margin as a predictor of LARS. Conclusion: distance between the anastomosis and the anal margin, neoadjuvant therapy history and preparation of stoma are conditions that can help predict the development of LARS. Guidance and involvement in patient education, as well as early management, can potentially reduce the impact of these symptoms on patients' quality of life.
Subject(s)
Humans , Male , Female , Anal Canal/physiopathology , Rectal Neoplasms/diagnosis , Rectum/physiopathology , Anal Canal/surgery , Rectal Neoplasms/surgery , Rectal Neoplasms/etiology , Rectum/surgery , Anastomosis, Surgical , Predictive Value of Tests , Risk Factors , Longitudinal Studies , Surgical Stomas , Middle AgedABSTRACT
Objective To compare the efficacy between endoscopic incision (EI) and endoscopic balloon dilation (EBD) for refractory anastomotic benign stricture after colorectal surgery. Methods The clinical data of 72 patients with refractory anastomotic benign stricture after colorectal surgery from June 2011 to June 2016 in Huxi Hospital Affiliated to Jining Medical College were retrospectively analyzed. In the patients, 34 cases were treated with EI (EI group), and 38 cases were treated with EBD (EBD group). The postoperative endoscopic patency rate, symptom relief rate, time of treatment, relapse rate, anastomotic diameter at the last follow- up and complication between 2 groups were compared. Results The patients in 2 groups completed the operation successfully, the anastomotic stricture was relieved and the obstruction symptom disappeared 1 month after operation. There were no statistical differences in endoscopic patency rate and symptom relief rate 6 months after operation between 2 groups (P＞0.05). The endoscopic patency rate and symptom relief rate 12 and 24 months after operation in EI group were significantly higher than those in EBD group, endoscopic patency rate: 88.2% (30/34) vs. 42.1% (16/38) and 64.7% (22/34) vs. 31.6% (12/38), symptom relief rate: 76.5% (26/34) vs. 42.1% (16/38) and 61.8% (21/34) vs. 28.9% (11/38), and there were statistical differences (P＜0.05 or＜0.01). The time of treatment and relapse rate in EI group were significantly lower than those in EBD group:(1.6 ± 0.3) times vs. (2.6 ± 0.8) times and 5.9% (2/34) vs. 73.7% (28/38), the anastomotic diameter at the last follow-up was significantly larger EBD group: (1.87 ± 0.23) cm vs. (1.09 ± 0.18) cm, and there were statistical differences (P＜0.05 or ＜0.01). There was no statistical difference in incidence of complication between 2 groups (P＞0.05). Conclusions The mid- and long-term efficacy of EI in the treatment of refractory anastomotic benign stricture after colorectal surgery is significantly better than that of EBD, and the recurrence rate is low.
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Objective To evaluate the efficacy and safety of endoscopic balloon dilation (EBD) on treatment of benign colorectal anastomotic stenosis.Methods Data of 36 patients with benign colorectal anastomotic stenosis undergoing EBD at Zhongshan Hospital from 2011 to 2015 were reviewed retrospectively.The number of dilation,complications rate,short-term effects and recurrence rate of stenosis were analyzed.Results Thirty-six patients had post-surgery anastomotic stenosis within 2-49 months (median 6 months),including 10 (27.8％) patients of grade 1 stenosis,15 (41.7％) of grade 2 stenosis,and 11 (30.5％) of grade 3 stenosis.The anastomotic distance from anus was 3-24 cm (median 6 cm).The 36 patients underwent 80 times of EBD with mean time of 2.22.Among them,69.4％ (25/36) cases received 1-2 times and 30.6％ (11/36) received 3 times or more.During the EBD operation,14 (17.5％) patients had minor bleeding,and intraoperative or postoperative perforation did not appeared.Postoperative obstructive symptoms were relieved in all patients.The anastomotic diameter was greater than 20 mm and EBD treatment was successful.Postoperative follow-up was 22-76 months (median 44 months).Four (11.1％) patients had recurrence of anastomotic benign stenosis at 7,11,18,and 63 months after the last time of EBD,respectively,and the symptoms were improved after the second treatment.Conclusion EBD is safe and effective in treating benign colorectal anastomotic stenosis,with better short-term and long-term outcomes.
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ABSTRACT BACKGROUND: Ostomy is a surgical procedure that creates a stoma that aims to construct a new path for the output of feces or urine. The relationship of oxidative stress (OxS) markers in patients with ostomy is still poorly described. OBJECTIVE: The present study was aimed at investigating the changes in oxidative stress parameters in peripheral blood collected from ostomy patients when compared with a healthy control group. METHODS: It was evaluated 29 ostomy patients and 30 healthy control patients. The oxidative stress parameters evaluated were: lipid peroxidation [lipid hydroperoxide (LPO), 8-isoprostane (8-ISO) and 4-hydroxynonenal (4-HNE)], protein oxidation and nitration [carbonyl and 3-nitrotyrosine (3-NT)] and DNA oxidation [8-hydroxy-2'-deoxyguanosine (8-OHDG)] in serum from ostomy patients compared to health controls. RESULTS: The data showed an increase of LPO, 8-ISO, 4-HNE, 3-NT and 8-OHDG in serum collected from ostomy patients when compared to healthy controls. CONCLUSION: The findings support the hypothesis that ostomy triggers the oxidative stress observed in the blood collected from these patients.
RESUMO CONTEXTO: Ostomia é um procedimento cirúrgico que cria um estoma com objetivo de construir um novo caminho para a saída das fezes ou urina. A relação dos marcadores de estresse oxidativo em pacientes ostomizados ainda é pouco descrita. OBJETIVO: O presente estudo tem como objetivo investigar as alterações dos parâmetros de estresse oxidativo em sangue de pacientes ostomizados comparados a controles saudáveis. MÉTODOS: Foram avaliados 29 pacientes ostomizados e 30 controles saudáveis. Os parâmetros de estresse oxidativo avaliados foram: peroxidação lipídica [hidroperóxido de lipídio (LPO), 8-isoprostano (8-ISO) e 4-hidroxinonenal (4-HNE)], oxidação e nitração de proteínas [carbonila e 3-nitrotirosina (3-NT)] e oxidação do DNA [8-hidroxi-2'-desoxiguanosina (8-OHDG)] em soro de pacientes ostomizados comparados a controles saudáveis. RESULTADOS: Os dados mostraram um aumento de LPO, 8-ISO, 4-HNE, 3-NT e 8-OHDG em soro de pacientes ostomizados em comparação a controles saudáveis. CONCLUSÃO: Os achados sustentam a hipótese de que a ostomia desencadeia o estresse oxidativo observado no sangue coletado destes pacientes.