直肠癌前切除术后并发吻合口瘘的预防及护理对策

Prevention and care measures of 186 cases of patients' postoperative anastomotic fistula after rectal carcinoma anterior resection

目的探讨直肠癌前切除术(RCAR)后并发吻合口瘘的预防及护理对策。方法选择2009年2月至2013年2月间接受RCAR的直肠癌患者186例作为研究对象。以数字法随机分成观察组(93例)和对照组(93例),对照组实施常规的围术期护理,观察组在对照组护理基础上给予针对性的护理措施,比较两组吻合口瘘的发生率、术后情况以及患者疼痛症状及焦虑评分。结果观察组吻合口瘘的发生率为5.38%(5/93),明显低于对照组的13.98%(13/93),差异有统计学意义(P<0.05)。观察组吻合口瘘的愈合时间以及住院时间均明显少于对照组,差异均有统计学意义(均P<0.05)。两组手术时间差异无统计学意义(P>0.05)。两组患者的疼痛症状及焦虑情况均有改善,但观察组的改善幅度更大,差异有统计学意义(P<0.05)。结论直肠癌患者实施RCAR后应进行针对性的护理预防,可较好地避免吻合口瘘的发生。

Objective To investigate the prevention and nursing measures of patients with postoperative anastomotic fistula after rectal carcinoma anterior resection and provide theoretical support for the clinical treatment of colorectal cancer （CRC）. Methods From February 2009 to February 2013 in The People＇s Hospitalof Jiangdong District, Neijiang City, 108 patients with CRC accepting rectal carcinoma anterior resection （RCAR） were enrolled in the study and were randomly divided into the observation group （93 cases） and the control group （93 cases）. Both the two groups were given RCAR surgery, the control group received routine perioperative care, while the observation group was given specific nursing interventions on this basis of the routine perioperative care. And then the incidence of anastomotic fistula, postoperative pain and anxiety scores between the two groups were compared. Results The incidence of anastomotic leakage of the observation group was 5.38% （5/93） , significantly lower than 13.98% （ 13/93 ） of the control group （ P 〈 0. 05 ）. The anastomotic fistula healing time and hospital stayof the observation group were significantly less than those of the control group （ P 〈 0.05 ）. The operation time between two groups had no significant differece （ P 〉 0.05 ）. Anxiety symptoms and pain after the two treatment methods have both improved, but the improvement in the observation group was greater （ P 〈 0.05 ）. Conclusion Patients with CRC after surgery should be targeted implementation RCAR preventive care, which can better avoid anastomotic leakage occurred.