电话回访健康宣教在结肠癌造口术后出院患者护理中的应用

经腹会阴直肠癌手术（Miles手术）是低位结肠癌在外科治疗中最常见、最有效的手术方法，但术后患者需要终身保持造口，给患者带来巨大的生理压力和心理压力，生活质量受到一定影响。随着优质护理服务的深化，对患者进行生理、心理以及社会的全方位护理干预被越来越多的护理工作者所采用。2010年1月-2012年10月我院结直肠外科对行结肠造口术后的100例直肠癌患者采取电话回访健康宣教，使患者获得最佳的照护，促进了患者康复，提高了患者的生活质量。

经腹膜外结肠插管端式造口术

目的 探讨永久性结肠造口术的新方法并分析其优缺点。 方法 随机选择直肠癌行Miles手术患者132例 ,分为两组 :A组 67例采用经腹膜外结肠插管端式造口术 ,B组 65例行常规夹闭结肠远端的腹壁造口 ,比较两种方法术后患者恢复情况。 结果 术后并发症如严重腹胀、主切口及造口感染、造口狭窄 ,A组分别发生 10、7、 4例 ,与B组的 2 4、15、 2 0例比较 ,有显著差异 (P <0 .0 5 )。外置肠管血运不良A、B组分别为 5例和 6例 (P >0 .0 5 )。结论 经腹膜外结肠插管端式造口术兼备腹膜外隧道法及结肠内插管端式造口的优点 ,克服了其缺点 ,手术简单易行 ,是一种永久性结肠造口的好方法 。

Severe delayed complication after percutaneous endoscopic colostomy for chronic intestinal pseudo-obstruction: A case report and review of the literature

Percutaneous endoscopic colostomy （PEC） is increasingly proposed as an alternative to surgery to treat various disorders, including acute colonic pseudo-obstruction, chronic intestinal pseudo-obstruction and relapsing sigmoid volvulus. We report on a severe complication that occurred two months after PEC placement. A 74-year-old man with a history of chronic intestinal pseudo-obstruction evolving since 8 years was readmitted to our hospital and received PEC to provide long-standing relief. The procedure was uneventful and greatly improved the patient＇s quality of life. Two months later, the patient developed acute stercoral peritonitis. At laparotomy, the colostomy flange was embedded in the abdominal wall but no pressure necrosis was found at the level of the colonic wall. This complication was likely related to inadvertent traction of the colostomy tube. Subtotal colectomy with terminal ileostomy was performed. We review the major features of 60 cases of PEC reported to date, including indications and complications.