Stoma

成釉细胞瘤
  • 文章类型: Journal Article
    背景:超过42000名澳大利亚人生活在造口中,这个数字每年都在增加。造口患者的妊娠是一种罕见但复杂的疾病,关于妊娠造口患者的外科和产科并发症的公开文献有限。本文的目的是回顾造口的结果,围产期发病率和死亡率,产前期在妊娠造口患者中。
    方法:回顾性获得了育龄妇女的数据,有一个造口,在2014年1月至2022年12月期间,她在皇家布里斯班和妇女医院怀孕并出生了九年。记录的数据包括患者人口统计,造口的类型,造口的适应症,需要额外的腹部手术,概念的方法,妊娠并发症,逗留时间,新生儿结局和妊娠后造口并发症。
    结果:总计,有来自13个有气孔的母亲的16个出生。在10例IBD患者中,40%经历了严重的造口并发症。IBD的剖宫产率(CS)为90%,非IBD的剖宫产率为83%。IBD患者的体外受精率为40%,非IBD患者为0%。IBD和35周非IBD患者的平均分娩胎龄为36周。在40%的病例中,分娩给IBD母亲的新生儿出生体重低于2500g,在非IBD母亲中为33.3%(p=0.62)。在16例分娩中,在怀孕期间或产后60天期间,与造口相关的并发症有5例(31.25%)。
    结论:造口患者的妊娠很少发生,并且似乎与高CS发生率有关,早产,低出生体重和造口并发症。
    BACKGROUND: Over 42 000 Australians live with a stoma, and this number increases annually. Pregnancy in stoma patients is a rare but complex condition and there is limited published literature regarding surgical and obstetric complications in pregnant stoma patients. The aim of this paper was to review stoma outcomes, perinatal morbidity and mortality, and early postpartum period in pregnant stoma patients.
    METHODS: Data was retrospectively obtained on women of childbearing age, with a stoma, who had been pregnant and birthed in the last nine years at the Royal Brisbane and Women\'s Hospital between January 2014 to December 2022. Data recorded included patient demographics, type of stoma, indication for stoma, need for additional abdominal surgeries, method of conception, pregnancy complications, length of stay, neonatal outcomes and post pregnancy stomal complications.
    RESULTS: In total, there were 16 births from 13 mothers with stomas. Of 10 births to IBD patients, 40% experienced a serious stomal complication. Caesarean section (CS) rate was 90% for IBD and 83% for non-IBD. In-vitro fertilisation rates were 40% in IBD patients and 0% in non-IBD patients. The average gestational age at delivery was 36 weeks in IBD and 35 weeks non-IBD patients. Neonates delivered to IBD mothers had a birth weight under 2500g in 40% of cases and in non IBD mothers at 33.3% (p = 0.62). Of the sixteen births there was five complications (31.25%) associated with the stoma either during pregnancy or during the sixty-day postpartum period.
    CONCLUSIONS: Pregnancy in stoma patients is a rare occurrence and appears to be associated with high rates of CS, preterm delivery, low birth weight and stomal complication.
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  • 文章类型: Journal Article
    (1)背景:近年来,直肠癌手术中转移气孔的做法发生了变化,从常规的转移气孔转向更具选择性的方法。研究表明,临时回肠造口术的好处并不符合他们的风险,比如高输出气孔,造口功能障碍,再操作。(2)方法:分析了2013年至2021年在英国单个三级结直肠中心接受机器人切除术治疗的所有直肠癌患者。2015年,我们的部门转向了一种更具选择性的方法来临时转移回肠造口术。将该队列分为2015年前治疗的常规改道组和2015年后治疗的选择性改道组。分析并比较两组的短期结果和发病率。(3)结果:A组,63/70患者(90%)的造口转移,而B组中的98/135患者(72.6%)(p=0.004)。两组吻合口漏之间没有显着差异(11.8%vs.17.8%,p=0.312)或其他并发症(p=0.117)。再入院率也没有显著差异(3.8%与2.6%,p=0.312)或再次手术(3.8%与2.6%,p=1.000)造口关闭后。一年后,71.6%和71.9%(p=1.000)的患者无气孔。气孔逆转延迟的一个主要原因是COVID-19大流行,仅发生在B组(0%vs.22%,p=0.054)。(4)结论:对于机器人直肠癌患者,采用更具选择性的方法来转移气孔不会导致更多的并发症或泄漏,可以在直肠癌肿瘤的治疗中考虑。
    (1) Background: In recent years, there has been a change in practice for diverting stomas in rectal cancer surgery, shifting from routine diverting stomas to a more selective approach. Studies suggest that the benefits of temporary ileostomies do not live up to their risks, such as high-output stomas, stoma dysfunction, and reoperation. (2) Methods: All rectal cancer patients treated with a robotic resection in a single tertiary colorectal centre in the UK from 2013 to 2021 were analysed. In 2015, our unit made a shift to a more selective approach to temporary diverting ileostomies. The cohort was divided into a routine diversion group treated before 2015 and a selective diversion group treated after 2015. Both groups were analysed and compared for short-term outcomes and morbidities. (3) Results: In group A, 63/70 patients (90%) had a diverting stoma compared to 98/135 patients (72.6%) in group B (p = 0.004). There were no significant differences between the groups in anastomotic leakages (11.8% vs. 17.8%, p = 0.312) or other complications (p = 0.117). There were also no significant differences in readmission (3.8% vs. 2.6%, p = 0.312) or reoperation (3.8% vs. 2.6%, p = 1.000) after stoma closure. After 1 year, 71.6% and 71.9% (p = 1.000) of patients were stoma-free. One major reason for the delay in stoma reversal was the COVID-19 pandemic, which only occurred in group B (0% vs. 22%, p = 0.054). (4) Conclusions: A more selective approach to diverting stomas for robotic rectal cancer patients does not lead to more complications or leaks and can be considered in the treatment of rectal cancer tumours.
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  • 文章类型: Journal Article
    背景:肠造口是儿科外科护理中最常见的部分之一,以及由此引起的并发症对患者的总体预后有重大影响。然而,关于中低收入国家主要并发症的数据仍然有限.这项试点回顾性队列研究旨在调查患病率,类型,以及菲律宾三级政府医院儿科患者的主要造口并发症的管理。
    方法:回顾了2018年6月至2023年6月被分类为Clavien-DindoIII-V的主要造口并发症的儿科患者的病历。患者相关因素(年龄,性别,诊断)和手术相关因素(造口类型和位置,外科医生的专业知识)进行了分析。描述性统计数据以人口概况为特征,卡方检验和t检验分析了分类变量和连续变量,分别。多变量逻辑回归评估了与主要造口并发症的独立关联。
    结果:在1041例小儿造口患者中,102例有严重并发症,患病率为9.8%。直接归因于造口并发症的死亡率占总病例的1.3%,5年内有14人死亡.新生儿占很大一部分,主要诊断为先天性疾病,如肛门直肠畸形和先天性巨结肠。与其他造口类型相比,回肠造口显示出更高的主要并发症发生率。气孔脱垂和粘连性肠梗阻是需要手术干预的最常见的造口并发症,而造口翻修是最常见的矫正程序。从造口到出现主要并发症的中位时间为14个月,近一半的并发症发生在第一年。在分析的危险因素中,只有回肠造口术的存在与主要并发症的发展显着相关。
    结论:这项研究为中低收入国家的儿科患者造口并发症提供了有用的见解。尽管患者相关因素和外科医生相关因素之间缺乏显著关联,和主要的造口并发症,需要进一步调查其他影响因素。建议改进数据收集方法和更大样本量的前瞻性研究,以增强对主要造口并发症的理解和优化护理。解决这项研究中发现的挑战可能会导致对儿科造口护理及其并发症的全面和量身定制的方法。
    BACKGROUND: Intestinal stomas are one of the most common parts of pediatric surgical care, and complications arising from it have significant impact on overall patient outcomes. However, data on major complications in low-middle-income countries remain limited. This pilot retrospective cohort study aimed to investigate the prevalence, types, and management of major stoma complications in pediatric patients at a tertiary government hospital in the Philippines.
    METHODS: Medical records of pediatric patients with major stoma complications classified as Clavien-Dindo III-V from June 2018 to June 2023 were reviewed. Patient-related factors (age, sex, diagnosis) and surgery-related factors (stoma type and location, surgeon expertise) were analyzed. Descriptive statistics characterized demographic profiles, while Chi-square and t tests analyzed categorical and continuous variables, respectively. Multivariable logistic regression evaluated independent associations with major stoma complications.
    RESULTS: Out of 1041 pediatric patients with stomas, 102 cases had major complications, representing a prevalence rate of 9.8%. Mortality directly attributed to stoma complications accounted for 1.3% of the total cases, or 14 deaths in 5 years. Neonates comprised a significant portion, primarily diagnosed with congenital conditions like anorectal malformation and Hirschsprung\'s disease. Ileostomies exhibited a higher incidence of major complications compared to other stoma types. Stomal prolapse and adhesive bowel obstruction are the most common reported stoma complications requiring surgical intervention while stoma revision is the most frequent corrective procedure. The median time from stoma creation to presentation of major complication was 14 months, with nearly half of the complications occurring within the first year. Only the presence of ileostomy had significant association with the development of major complications among the risk factors analyzed.
    CONCLUSIONS: This study provides useful insights into stoma complications in pediatric patients in a low-middle income country. Despite the lack of significant associations between the patient-related and surgeon-related factors, and major stoma complications, further investigation into other contributing factors is warranted. Improvements in data collection methods and prospective studies with larger sample sizes are recommended to enhance understanding and optimize care of major stoma complications. Addressing the challenges identified in this study could lead to a comprehensive and tailored approach to pediatric stoma care and their complications.
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  • 文章类型: Journal Article
    目的:外周动脉疾病(PAD)患者通常需要开放下肢血运重建(LER)治疗。PAD患者通常有其他合并症和相关疾病,影响手术结果。包括腹部气孔.这项工作的目的是研究气孔可能对术后结果和并发症的影响。
    方法:我们对全国再入院数据库进行了为期5年(2016-2020年)的分析。我们确定了所有接受开放式LER的成年患者。这些患者分为两组:造口和无造口。倾向评分匹配(1:1)用于控制人口统计学和合并症。检查了指数入院结果和再入院率。
    结果:确认了212,275例开放性LER患者。获得了3088名患者的匹配队列(1:1造口与无造口)。造口患者术后并发症发生率较高:急性出血后贫血(29.1%,P<0.01),急性肾损伤(21.4%,P<0.001),指数败血症(10.3%,P<0.001),和SSI指数(2.8%,P<0.001)。急性心肌梗死两组间差异无统计学意义。那些有气孔的人有更糟糕的结果:住院死亡率更高(4.7%,P<0.05),住院时间(中位数7天,P<0.001),总费用(中位数为108,037美元,P<0.001),长期护理机构出院(30.8%,P<0.001),出院到需要家庭保健的家中(30.1%,P<0.001),30天再入院率(23.2%,P<0.01),和30天再入院死亡率(6.1%,P<0.01)。
    结论:腹部并发造口与开放性LER术后发病率和死亡率增加相关。需要进一步的前瞻性研究来验证这些结果。
    OBJECTIVE: Patients with peripheral artery disease (PAD) often require treatment with open lower extremity revascularization (LER). Patients with PAD often have other comorbidities and associated conditions that affect procedural outcomes, including abdominal stomas. The aim of this work is to investigate the impact that stomas may have on postoperative outcomes and complications.
    METHODS: We performed a 5-year (2016-2020) analysis of the Nationwide Readmission Database. We identified all adult patients undergoing open LER. These patients were categorized into 2 groups: stoma and no-stoma. Propensity score matching (1:1) was used to control for demographics and comorbidities. Index admission outcomes and readmission rate were examined.
    RESULTS: 212,275 open LER patients were identified. A matched cohort of 3088 patients (1:1 stoma vs no-stoma) was obtained. Patients with stomas had higher rates of several postoperative complications: acute posthemorrhagic anemia (29.1%, P < 0.01), acute kidney injury (21.4%, P < 0.001), index sepsis (10.3%, P < 0.001), and index SSI (2.8%, P < 0.001). There were no significant statistical differences between the 2 groups for acute myocardial infarction. Those with stomas had worse outcomes: greater in-hospital mortality (4.7%, P < 0.05), length of stays (median 7 days, P < 0.001), total charges (median 108,037 dollars, P < 0.001), discharges to long-term care facilities (30.8%, P < 0.001), discharges to their own homes needing home health care (30.1%, P < 0.001), 30-day readmission rates (23.2%, P < 0.01), and 30-day readmission mortality (6.1%, P < 0.01).
    CONCLUSIONS: Concurrent abdominal stoma is associated with increased postoperative morbidity and mortality after open LER. Further prospective studies are needed to validate these results.
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  • 文章类型: Journal Article
    目的:已知充分的术前信息可以改善患者的预后。我们旨在评估接受肠造口形成的儿科患者和家庭的围手术期教育。
    方法:邀请英国儿科手术中心招募年龄在6-16岁的造口原位或在过去2年内逆转的患者。为潜在参与者发布了患者和父母问卷。
    结果:83名患者/父母二分体返回了问卷。中位年龄为11.5岁(范围4.1-17.8),其中48%(n=40)是选择性形成的。父母对他们围手术期的了解程度进行了评分(0较差,10高度知情)。与心理和社会影响相比,父母对手术问题和造口护理的了解更好(7.45vs6.11;p<0.0001)。54%的人报告了手术并发症,但与心理社会问题相比,将造口列为最糟糕的事情(24.4%)的患者要少得多:袋泄漏引起的困扰(90.8%;p<0.0001),自我意识(54.1%;p=0.0001),活动受限(40.2%;p=0.03)。
    结论:父母对医学和实践方面了解得很好,但对造口的心理和生活方式影响了解得较少。手术并发症对患者的影响不如对日常生活的影响重要。社会心理信息的增加将使家庭为有气孔的生活做好更好的准备。
    OBJECTIVE: Adequate preoperative information is known to improve patient outcomes. We aimed to evaluate perioperative education for paediatric patients and families undergoing intestinal stoma formation.
    METHODS: UK paediatric surgery centres were invited to recruit patients aged 6-16 years with a stoma in situ or reversed within the last 2 years. Patient and parent questionnaires were posted for potential participants.
    RESULTS: Eighty-three patient/parent dyads returned questionnaires. Median age was 11.5 years (range 4.1-17.8), with 48% (n = 40) formed electively. Parents rated how well-informed they felt perioperatively out of 10 (0 poorly, 10 highly informed). Parents were better informed about surgical issues and stoma care than psychological and social impacts (7.45 vs 6.11; p < 0.0001). 54% reported surgical complications but significantly fewer patients listed these amongst the worst things about having a stoma (24.4%) when compared with psychosocial issues: distress from bag leaks (90.8%; p < 0.0001), self-consciousness (54.1%; p = 0.0001), and restricted activity (40.2%; p = 0.03).
    CONCLUSIONS: Parents felt well-informed for medical and practical aspects but less well-informed of psychological and lifestyle impacts of having a stoma. Surgical complications were less important to patients than the impact on daily life. Increased psychosocial information would enable families to be better prepared for life with a stoma.
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  • 文章类型: Journal Article
    近几十年来,直肠癌的手术和治疗取得了重大进展。然而,仍然没有结肠吻合术技术在功能性和低发病率之间提供良好的折衷。本研究的目的是评估改良延迟结肠吻合术(mDCA)的安全性和有效性。在这项回顾性研究中,我们分析了19例接受mDCA治疗的患者的死亡率和功能结局,2021年9月至2023年6月在我们机构接受治疗的73例结直肠癌患者中。纳入标准是中直肠和低位直肠癌(距肛门边缘小于10厘米的肿瘤)。Clavien-DindoIII级或更高的并发症所代表的发病率估计为5.2%。只有一名患者出现无症状的吻合口漏(AL)A级。一名患者发生结肠残端缺血,在术后第5天回到OR。没有注意到树桩缩回。1例患者(5.2%)在术后90天出现吻合口狭窄,并接受了器械扩张治疗。围手术期死亡率为零。90天的平均StMarks失禁评分为13.2分。在3个月的随访中,15例患者(78.9%)有主要的低位前切除综合征(LARS),三人(15.7%)有轻微的LARS,1例患者(5.2%)无LARS.没有患者进行分流回肠造口术。mDCA,通过降低AL的速率,不需要分流回肠造口术,可能是传统的即时结肠吻合术(ICA)的有趣替代方法,用于癌症直肠切除术后恢复胃肠道。
    Surgery and management of rectal cancer have made significant progress in recent decades. However, there is still no coloanal anastomosis technique that offers a good compromise between functionality and low morbidity. The aim of this study is to evaluate the safety and efficiency of the modified delayed coloanal anastomosis (mDCA). In this retrospective study, we analyzed the morbi-mortality as well as functional outcomes of 19 patients treated with mDCA, out of 73 colorectal cancer patients treated at our institution from September 2021 to June 2023. The inclusion criteria were cancer of the mid and low rectum (tumor less than 10 cm from the anal verge). Morbidity represented by complications of Clavien-Dindo grade III or higher was estimated at 5.2%. Only one patient experienced an asymptomatic anastomotic leak (AL) grade A. Ischemia of the colonic stump occurred in one patient, taken back to the OR on the 5th postoperative day. No stump retraction was noted. Anastomotic stenosis appeared in one patient (5.2%) during the 90-day postoperative period, and was treated by instrumental dilation. Perioperative mortality was nil. The mean St Marks incontinence score at 90 days was 13.2 points. At the 3-month follow-up, 15 patients (78.9%) had major low anterior resection syndrome (LARS), three (15.7%) had minor LARS, and one patient (5.2%) had no LARS. None of the patients had a diversion loop ileostomy. The mDCA, by decreasing the rate of AL, without the need for diversion ileostomy, might be an interesting alternative to the conventional immediate coloanal anastomosis (ICA), for restoring the GI tract after proctectomy for cancer.
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  • 文章类型: Journal Article
    目的:探讨来自自我报告的生活质量的概况是否与接受,和兴趣,来自有造口的人的医疗保健专业人员的建议。
    方法:对来自英格兰的4487名结肠直肠癌造口患者的横断面全国调查数据进行二次分析。调查使用各种量表评估生活质量,收到并对各种形式的建议感兴趣,和身体活动。进行了三步潜在轮廓分析以确定轮廓的最佳数量。多项回归探讨了与档案成员关系相关的因素。一系列逻辑回归模型检查了个人资料成员资格是否与对建议的兴趣有关。
    结果:确定了五个概况;\“一贯良好的生活质量\”,\'功能问题\',“职能和财务问题”,\'生活质量低\'和\'支持但挣扎\'。与“一贯良好的生活质量”相比,“功能和财务问题”和“低生活质量”配置文件中的个人更有可能获得财务建议。与“一贯良好的生活质量”相比,所有其他档案更有可能报告需要一系列领域的建议,与“低生活质量”的关系最强。
    结论:研究结果表明,造口患者在生活质量方面不是同质的群体。生活质量问题简介的参与者报告说,他们希望在各个类别中提供更多建议,但研究结果表明,有探索如何针对特定群体进行调整或调整的空间。
    OBJECTIVE: To explore whether profiles derived from self-reported quality of life were associated with receipt of, and interest in, advice from a healthcare professional in people with a stoma.
    METHODS: Secondary analysis of cross-sectional national survey data from England of 4487 people with a stoma from colorectal cancer. The survey assessed quality of life using various scales, receipt and interest in various forms of advice, and physical activity. A three-step latent profile analysis was conducted to determine the optimum number of profiles. Multinomial regression explored factors associated with profile membership. A series of logistic regression models examined whether profile membership was associated with interest in advice.
    RESULTS: Five profiles were identified; \'consistently good quality of life\', \'functional issues\', \'functional and financial issues\', \'low quality of life\' and \'supported but struggling\'. Individuals in the \'functional and financial issues\' and \'low quality of life\' profiles were more likely to have received financial advice compared to the \'consistently good quality of life\' profile. When compared to the \'consistently good quality of life\' profile, all other profiles were more likely to report wanting advice across a range of areas, with the strongest associations in the \'low quality of life\' profile.
    CONCLUSIONS: Findings indicate that people with a stoma are not a homogenous group in terms of quality of life. Participants in profiles with quality of life concerns report wanting more advice across various categories but findings suggest there is scope to explore how this can be tailored or adapted to specific groups.
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  • 文章类型: Journal Article
    了解短肠综合征(SBS)患者及其护理人员的生活质量及其影响因素对于提高其幸福感至关重要。因此,本研究旨在全面了解SBS对患者及其护理人员的影响。以及其相关因素,通过综合现有证据。
    使用PubMed对文献进行了系统回顾,Embase数据库,CNKI,和ISPOR会议文件。手动搜索纳入的文章以识别任何其他相关研究。使用适当的JoannaBriggs研究所关键评估工具评估质量。
    本综述包括16项研究,包括15项观察性研究和1项随机对照试验。研究结果表明,在身体功能和心理领域方面,SBS患者的QoL低于普通人群。同时,护理人员在维持QoL方面遇到了挑战。发现SBS患者的QoL受多种因素的影响,例如治疗,年龄,性别,造口,和小肠长度。其中,治疗是通过外部干预可以有效改善的最值得注意的因素。
    虽然许多研究提供了对SBS患者及其护理人员所经历的QoL受损的见解,研究QoL决定因素的大样本定量调查仍然很少。关于照顾者的现有文献也明显不足。
    UNASSIGNED: Understanding the quality of life and the factors that influence it for patients with short bowel syndrome (SBS) and their caregivers is of utmost importance in order to enhance their well-being. Therefore, This study aimed to provide a comprehensive understanding of the impact of SBS on patients and their caregivers, as well as its associated factors, by synthesizing the available evidence.
    UNASSIGNED: A systematic review of the literature was done using PubMed, Embase databases, CNKI, and ISPOR conference papers. Included articles were manually searched to identify any other relevant studies. Quality was assessed using appropriate Joanna Briggs Institute critical appraisal tools.
    UNASSIGNED: This review included 16 studies, comprising 15 observational studies and 1 randomized controlled trial. The findings revealed that the QoL of patients with SBS was lower than that of the general population regarding physical functioning and psychological domain. Meanwhile, caregivers experienced challenges in maintaining their QoL. The QoL of SBS patients was found to be influenced by various factors such as treatment, age, sex, stoma, and small intestine length. Among them, the treatment is the most noteworthy factor that can be effectively improved through external interventions.
    UNASSIGNED: While numerous studies have provided insights into the compromised QoL experienced by individuals with SBS and their caregivers, there remains a scarcity of large-sample quantitative investigations examining the determinants of QoL. The existing body of literature on caregivers is also notably deficient.
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  • 文章类型: Journal Article
    背景前切除术(AR)后,最令人衰弱的并发症之一是在约64%的患者中发现的低位前切除综合征(LARS).LARS评分的严重程度与新辅助治疗显著相关,直肠手术的范围,吻合口漏引起的并发症,女性性别,年龄<64岁。在这项研究中,我们分析了各种临床因素对LARS以及生活质量(QoL)的影响.目的:评估接受直肠癌保留括约肌手术的患者肛门长期排便后LARS的发生率。QoL的变化,以及与LARS的关系和影响因素。方法一年前,在区域癌症中心接受AR的72名患者接受了训练有素的采访者的采访,并从档案中收集数据。使用的问卷是Wexner失禁评分,LARS马拉雅拉姆语问卷,和欧洲癌症研究与治疗组织(EORTC)QLQC30马拉雅拉姆语翻译。统计测量LARS评分用于将患者分为三个等级。使用χ2检验将得分与临床和社会因素进行关联比较。连续变量通过SpearmanRho检验进行比较。结果研究了患者的详细信息(男性:55.6%(40)和女性:44.4%(32))。50例患者接受了低位前切除术(LAR)。平均LARS评分为25.61,其中47.2%的患者具有严重的LARS评分。Wexner的平均得分为6.84。与手术类型的关系,方法(腹腔镜与开放),或新辅助治疗的类型没有发现有意义.根据FACT-C评估,较高的LARS评分不会影响整体QoL。失眠和腹泻症状评分显著恶化。对于接受吻合器吻合术的患者,疼痛评分更差。对于接受辅助化疗的患者,Wexner的评分更差。与低前切除术(LAR)相比,AR的角色功能评分更好。仅发现距肛门边缘的距离是LARS的重要原因,并且呈负相关。讨论在大多数患者中看到严重程度的LARS。没有发现可改变的危险因素显着影响LARS的机会。然而,LARS对QoL没有显著影响,手术类型也没有。所以可以为病人提供括约肌保存,但所有接受LAR的患者在手术前都应接受有关LARS风险的建议.
    Background After anterior resection (AR), one of the most debilitating complications is low anterior resection syndrome (LARS) seen in about 64% of patients. The severity of the LARS score was significantly correlated with neoadjuvant treatment, the extent of rectal surgery, complication by the anastomotic leak, female gender, and age < 64 years. In this study, we analyzed the impact of various clinical factors on LARS and also the various domains of quality of life (QoL). Purpose To assess the incidence of LARS in patients undergoing sphincter-sparing surgery for rectal cancer after the patient starts long-term defecating per anus, change in the QoL, and relation to LARS and factors affecting it. Methods One year before, 72 patients who had undergone AR in the Regional Cancer Centre were interviewed by a trained interviewer and data was collected from the file. The questionnaires used were the Wexner Incontinence score, LARS Malayalam Questionnaire, and European Organisation For Research and Treatment of Cancer (EORTC) QLQ C30 Malayalam translations. Statistical measures The LARS score was used to categorize patients into three grades. The scores were compared with clinical and social factors using the χ2 test for association. Continuous variables were compared by the Spearman Rho test. Results Details of patients were studied (male: 55.6% (40) and female: 44.4% (32)). Fifty patients underwent low anterior resection (LAR). The mean LARS score was 25.61, with 47.2% of patients having severe LARS score. The mean Wexner score was 6.84. The relation with type of surgery, approach (laparoscopic vs open), or type of neoadjuvant therapy was not found to be significant. A higher LARS score did not impact overall QoL as assessed by FACT-C. Insomnia and diarrhea symptoms scores were significantly worsened. The pain score was worse for those undergoing stapler anastomosis. Wexner\'s score was worse for those who had received adjuvant chemotherapy. Role functioning score was better for AR compared to low anterior resection (LAR). Only distance from the anal verge was found to be a significant cause of LARS and was negatively correlated. Discussion LARS of severe degrees were seen in most patients. No modifiable risk factors were significantly found to affect the chance of LARS. However, LARS did not have a significant impact on QoL, neither did the type of surgery. So sphincter preservation can be offered to the patients, but all patients undergoing LAR should be counseled well about the risk of LARS before surgery.
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  • 文章类型: Journal Article
    直肠癌几乎影响个人日常生活的方方面面。然而,在理解从诊断到康复的完整经验方面存在差距。因此,这项研究的目的是探索诊断为直肠癌的个体的治疗轨迹。采用解释性现象学方法,采用目的性抽样方法招募了7名参与者.数据是使用半结构化、以数字方式记录的深度采访,使用主题分析进行转录和分析。遵循可信度的四个维度标准建立了研究的严谨性,可靠性,可转移性和可确认性。参与者接受直肠癌治疗的经历中出现了四个突出的主题:发现内心的战斗;驾驭身体挑战;支持和征服峰会的锚。这些发现通过强调为考虑到直肠癌治疗的身体和心理情绪影响的个人提供全面和个性化治疗计划的重要性,为知识和实践做出了贡献。
    Rectal cancer affects almost every aspect of an individual\'s daily life. However, there are gaps in understanding the complete spectrum of experiences spanning from diagnosis to recovery. Therefore, the aim of this study was to explore the treatment trajectories of individuals diagnosed with rectal cancer. Adopting an interpretative phenomenological approach, seven participants were recruited using purposive sampling. Data were collected using semi-structured, in-depth interviews that were digitally recorded, transcribed and analysed using thematic analysis. Study rigour was established following the four-dimension criteria of credibility, dependability, transferability and confirmability. Four prominent themes emerged from the participants\' experiences of undergoing rectal cancer treatment: uncovering the inner battles; navigating the physical challenges; anchors of support and conquering the summit. These findings contribute to knowledge and practice by highlighting the importance of providing a comprehensive and individualised treatment plan for individuals that takes account of the physical and psycho-emotional implications of rectal cancer treatment.
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