Background The technique of intersphincteric resection of tumors combined with coloanal anastomosis has been used to avoid permanent colostomy for patients with a rectal cancer located 〈5 cm from the anal verge. This...Background The technique of intersphincteric resection of tumors combined with coloanal anastomosis has been used to avoid permanent colostomy for patients with a rectal cancer located 〈5 cm from the anal verge. This study aimed at assessing the preservation of continence function of the residual rectum and the clinical prognosis of patients with lower rectal cancer after intersphincteric resection using a prolapsing technique. Methods This study included patients with the following inclusion criteria： （1） pathological evidence of rectal cancer and the tumors within distal margins located 5 cm or less from the anus by preoperative endoscopic examination; （2） no evidence by MRI of infiltration of either the external sphincter, puborectalis or the levator muscle; （3） the patients are eligible for intersphincteric resection and lower coloanal anastomosis with a preoperative biopsy showing the tumors with well-to-moderate differentiation. From January 2000 to June 2004, 23 patients with low rectal cancer were included in this study. We used the standard abdominoperineal approach to perform radical resection of tumors with excision of the mesorectum and total or part of the internal sphincters. The patients were followed for assessment of the function of the residual rectum and of cancer recurrence after the operations. Results The median tumor distance from the anal margin was 4.5 （range 3.5-5.0） cm and the mean distal surgical margin 1.6 （range 1.0-2.0） cm. Cancer was classified into Stage Ⅰ （30.4%）, Stage Ⅱ （47.8%）, and Stage Ⅲ （21.7%） according to the TNM classification. Two patients developed anastomotic fistula after the surgical resection and 2 patients （8.7%） developed later stages of anastomotic stricture at the site of coloanal anastomosis. The median follow-up period was 31.5 months （range 12-54） and 2 patients （8.7%） developed local recurrence. Three deaths were associated with distal organ metastasis. Twenty patients （87.0%） have maintained compete展开更多
The aim of this study was to validate the advantages of the intrafascial nerve-sparing technique compared with the interfascial nerve-sparing technique in extraperitoneal laparoscopic radical prostatectomy. From March...The aim of this study was to validate the advantages of the intrafascial nerve-sparing technique compared with the interfascial nerve-sparing technique in extraperitoneal laparoscopic radical prostatectomy. From March 2010 to August 2011, 65 patients with localized prostate cancer （PCa） underwent bilateral intrafascial nerve-sparing extraperitoneal laparoscopic radical prostatectomy. These patients were matched in a 1.2 ratio to 130 patients with localized PCa who had undergone bilateral interfascial nerve-sparing extraperitoneal laparoscopic radical prostatectomy between January 2008 and August 2011. Operative data and oncological and functional results of both groups were compared. There was no difference in operative data, pathological stages and overall rates of positive surgical margins between the groups. There were 9 and 13 patients lost to follow-up in the intrafascial group and interfascial group, respectively. The intrafascial technique provided earlier recovery of continence at both 3 and 6 months than the interfascial technique. Equal results in terms of continence were found in both groups at 12 months. Better rates of potency at 6 months and 12 months were found in younger patients （age 65 years） and overall patients who had undergone the intrafascial nerve-sparing extraperitoneal laparoscopic radical prostatectomy. Biochemical progression-free survival rates I year postoperatively were similar in both groups. Using strict indications, compared with the interfascial nerve-sparing technique, the intrafascial technique provided similar operative outcomes and short-term oncological results, quicker recovery of continence and better potency. The intrafascial nerve-sparing technique is recommended as a preferred approach for young PCa patients who are clinical stages cT1 to cT2a and have normal preoperative potency.展开更多
Wound ostomy continence nurses(WOC nurses),developed as an important part of clinical nurse specialists play an indispensable role in the management of ostomy,all kinds of chronic wounds and incontinent dermatitis.How...Wound ostomy continence nurses(WOC nurses),developed as an important part of clinical nurse specialists play an indispensable role in the management of ostomy,all kinds of chronic wounds and incontinent dermatitis.However,there exists a gap compared with developed countries and regions.This paper provides an overview of WOC nurses in China including origin and development,training and accreditation system,roles,values and management,in order to provide references for the development of WOC nurses in China.展开更多
Pelvic floor muscle exercise(PFME)is the most common con servative manageme nt for urinary incon tine nee(Ul)after radical prostatectomy(RP).However,whether the PFME guided by a therapist(G-PFME)can contribute to the ...Pelvic floor muscle exercise(PFME)is the most common con servative manageme nt for urinary incon tine nee(Ul)after radical prostatectomy(RP).However,whether the PFME guided by a therapist(G-PFME)can contribute to the recovery of urinary continenee for patients after RP is still controversial.We performed this meta-analysis to investigate the effectiveness of G-PFME on Ul after RP and to explore whether the additional preoperative G-PFME is superior to postoperative G-PFME alone.Literature search was con ducted on Cochra ne Library,Embase,Web of Scie nee,and PubMed,to obtai n all re leva nt randomized controlled trials published before March 1,2018.Outcome data were pooled and an a lyzed with Review Man ager 5.3 to compare the conti nence rates of G-PFME with control and to compare additional preoperative G-PFME with postoperative G-PFME.Twenty-two articles with 2647 patients were included.The conti nence rates of G?PFME were all superior to con trol at d iff ere nt follow-up time points,with the odds ratio(OR)(95%confidence interval[Cl])of 2.79(1.53-5.07),2.80(1.87-4.19),2.93(1.19-7.22),4.11(2.24-7.55),and 2.41(1.33-4.36)at 1 mon th,3 months,4 months,6 months,and 12 months after surgery,respectively.However,there was no difference between additional preoperative G-PFME and postoperative G-PFME,with the OR(95%Cl)of 1.70(0.56-5.11)and 1.35(0.41-4.40)at 1 month and 3 months after RP,respectively.G-PFME could improve the recovery of urinary continence at both early and Iong-term stages.Starting the PFME preoperatively might not produce extra benefits for patients at early stage,compared with postoperative PFME.展开更多
文摘Background The technique of intersphincteric resection of tumors combined with coloanal anastomosis has been used to avoid permanent colostomy for patients with a rectal cancer located 〈5 cm from the anal verge. This study aimed at assessing the preservation of continence function of the residual rectum and the clinical prognosis of patients with lower rectal cancer after intersphincteric resection using a prolapsing technique. Methods This study included patients with the following inclusion criteria： （1） pathological evidence of rectal cancer and the tumors within distal margins located 5 cm or less from the anus by preoperative endoscopic examination; （2） no evidence by MRI of infiltration of either the external sphincter, puborectalis or the levator muscle; （3） the patients are eligible for intersphincteric resection and lower coloanal anastomosis with a preoperative biopsy showing the tumors with well-to-moderate differentiation. From January 2000 to June 2004, 23 patients with low rectal cancer were included in this study. We used the standard abdominoperineal approach to perform radical resection of tumors with excision of the mesorectum and total or part of the internal sphincters. The patients were followed for assessment of the function of the residual rectum and of cancer recurrence after the operations. Results The median tumor distance from the anal margin was 4.5 （range 3.5-5.0） cm and the mean distal surgical margin 1.6 （range 1.0-2.0） cm. Cancer was classified into Stage Ⅰ （30.4%）, Stage Ⅱ （47.8%）, and Stage Ⅲ （21.7%） according to the TNM classification. Two patients developed anastomotic fistula after the surgical resection and 2 patients （8.7%） developed later stages of anastomotic stricture at the site of coloanal anastomosis. The median follow-up period was 31.5 months （range 12-54） and 2 patients （8.7%） developed local recurrence. Three deaths were associated with distal organ metastasis. Twenty patients （87.0%） have maintained compete
文摘The aim of this study was to validate the advantages of the intrafascial nerve-sparing technique compared with the interfascial nerve-sparing technique in extraperitoneal laparoscopic radical prostatectomy. From March 2010 to August 2011, 65 patients with localized prostate cancer （PCa） underwent bilateral intrafascial nerve-sparing extraperitoneal laparoscopic radical prostatectomy. These patients were matched in a 1.2 ratio to 130 patients with localized PCa who had undergone bilateral interfascial nerve-sparing extraperitoneal laparoscopic radical prostatectomy between January 2008 and August 2011. Operative data and oncological and functional results of both groups were compared. There was no difference in operative data, pathological stages and overall rates of positive surgical margins between the groups. There were 9 and 13 patients lost to follow-up in the intrafascial group and interfascial group, respectively. The intrafascial technique provided earlier recovery of continence at both 3 and 6 months than the interfascial technique. Equal results in terms of continence were found in both groups at 12 months. Better rates of potency at 6 months and 12 months were found in younger patients （age 65 years） and overall patients who had undergone the intrafascial nerve-sparing extraperitoneal laparoscopic radical prostatectomy. Biochemical progression-free survival rates I year postoperatively were similar in both groups. Using strict indications, compared with the interfascial nerve-sparing technique, the intrafascial technique provided similar operative outcomes and short-term oncological results, quicker recovery of continence and better potency. The intrafascial nerve-sparing technique is recommended as a preferred approach for young PCa patients who are clinical stages cT1 to cT2a and have normal preoperative potency.
文摘Wound ostomy continence nurses(WOC nurses),developed as an important part of clinical nurse specialists play an indispensable role in the management of ostomy,all kinds of chronic wounds and incontinent dermatitis.However,there exists a gap compared with developed countries and regions.This paper provides an overview of WOC nurses in China including origin and development,training and accreditation system,roles,values and management,in order to provide references for the development of WOC nurses in China.
基金a grant from the Natural Science Foundation of China(No.71573097).
文摘Pelvic floor muscle exercise(PFME)is the most common con servative manageme nt for urinary incon tine nee(Ul)after radical prostatectomy(RP).However,whether the PFME guided by a therapist(G-PFME)can contribute to the recovery of urinary continenee for patients after RP is still controversial.We performed this meta-analysis to investigate the effectiveness of G-PFME on Ul after RP and to explore whether the additional preoperative G-PFME is superior to postoperative G-PFME alone.Literature search was con ducted on Cochra ne Library,Embase,Web of Scie nee,and PubMed,to obtai n all re leva nt randomized controlled trials published before March 1,2018.Outcome data were pooled and an a lyzed with Review Man ager 5.3 to compare the conti nence rates of G-PFME with control and to compare additional preoperative G-PFME with postoperative G-PFME.Twenty-two articles with 2647 patients were included.The conti nence rates of G?PFME were all superior to con trol at d iff ere nt follow-up time points,with the odds ratio(OR)(95%confidence interval[Cl])of 2.79(1.53-5.07),2.80(1.87-4.19),2.93(1.19-7.22),4.11(2.24-7.55),and 2.41(1.33-4.36)at 1 mon th,3 months,4 months,6 months,and 12 months after surgery,respectively.However,there was no difference between additional preoperative G-PFME and postoperative G-PFME,with the OR(95%Cl)of 1.70(0.56-5.11)and 1.35(0.41-4.40)at 1 month and 3 months after RP,respectively.G-PFME could improve the recovery of urinary continence at both early and Iong-term stages.Starting the PFME preoperatively might not produce extra benefits for patients at early stage,compared with postoperative PFME.
