Every colorectal surgeon during his or her career is faced with anastomotic leakage(AL); one of the most dreaded complications following any type of gastrointestinal anastomosis due to increased risk of morbidity, mor...Every colorectal surgeon during his or her career is faced with anastomotic leakage(AL); one of the most dreaded complications following any type of gastrointestinal anastomosis due to increased risk of morbidity, mortality, overall impact on functional and oncologic outcome and drainage on hospital resources. In order to understand and give an overview of the AL risk factors in laparoscopic colorectal surgery, we carried out a careful review of the existing literature on this topic and found several different definitions of AL which leads us to believe that the lack of a consensual, standard definition can partly explain the considerable variations in reported rates of AL in clinical studies. Colorectal leak rates have been found to vary depending on the anatomic location of the anastomosis with reported incidence rates ranging from 0 to 20%, while the laparoscopic approach to colorectal resections has not yet been associated with a significant reduction in AL incidence. As well, numerous risk factors, though identified, lack unanimous recognition amongst researchers. For example, the majority of papers describe the risk factors for left-sided anastomosis, the principal risk being male sex and lower anastomosis, while little data exists defining AL risk factors in a right colectomy. Also, gut microbioma is gaining an emerging role as potential risk factor for leakage.展开更多
Thirty per cent of all colorectal tumours develop in the rectum.The location of the rectum within the bony pelvis and its proximity to vital structures presents significant therapeutic challenges when considering neoa...Thirty per cent of all colorectal tumours develop in the rectum.The location of the rectum within the bony pelvis and its proximity to vital structures presents significant therapeutic challenges when considering neoadjuvant options and surgical interventions.Most patients with early rectal cancer can be adequately managed by surgery alone.However,a significant proportion of patients with rectal cancer present with locally advanced disease and will potentially benefit from down staging prior to surgery.Neoadjuvant therapy involves a variety of options including radiotherapy,chemotherapy used alone or in combination.Neoadjuvant radiotherapy in rectal cancer has been shown to be effective in reducing tumour burden in advance of curative surgery.The gold standard surgical rectal cancer management aims to achieve surgical removal of the tumour and all draining lymph nodes,within an intact mesorectal package,in order to minimise local recurrence.It is critically important that all rectal cancer cases are discussed at a multidisciplinary meeting represented by all relevant specialties.Pre-operative staging including CT thorax,abdomen,pelvis to assess for distal disease and magnetic resonance imaging to assess local involvement is essential.Staging radiology and MDT discussion are integral in identifying patients who require neoadjuvant radiotherapy.While Neoadjuvant radiotherapy is potentially beneficial it may also result in morbidity and thus should be reserved for those patients who are at a high risk of local failure,which includes patients with nodal involvement,extramural venous invasion and threatened circumferential margin.The aim of this review is to discuss the role of neoadjuvant radiotherapy in the management of rectal cancer.展开更多
目的:探讨多学科延续性护理在直肠癌造口患者中的应用效果。方法:选取2019年9月至2020年9月张家口市第一医院收治的130例直肠癌行永久性结肠造口术患者为研究对象。采用随机数字表法分为对照组与研究组,各65例。对照组予以常规护理,研...目的:探讨多学科延续性护理在直肠癌造口患者中的应用效果。方法:选取2019年9月至2020年9月张家口市第一医院收治的130例直肠癌行永久性结肠造口术患者为研究对象。采用随机数字表法分为对照组与研究组,各65例。对照组予以常规护理,研究组在常规护理的基础上实施多学科协作式延续性护理。干预3个月后,比较两组造口周围皮肤评分、并发症发生率、自我护理能力评分、心理状况评分、生活质量评分及护理满意度。结果:干预后,研究组造口周围皮肤变色、侵蚀、组织增生评分及造口周围皮肤总分均明显低于对照组(均P<0.05)。研究组粪水性皮炎及并发症总发生率均明显低于对照组(均P<0.05)。研究组自我护理能力各分量表自我技能、自护责任感、自我概念、自护知识评分及总分均明显高于对照组(均P<0.05)。研究组焦虑评分及抑郁评分均明显低于对照组(均P<0.05)。研究组生活质量问卷(Quality of Life Questionnaire Core 30,QLQ-C30)各分量表躯体功能、角色功能、认知功能、情绪功能、社会功能评分均明显高于对照组(均P<0.05)。研究组护理总满意率为92.31%,明显高于对照组的75.38%(P<0.05)。结论:直肠癌造口术后应用多学科协作式延续性护理能明显降低患者造口周围皮肤评分及并发症的发生率,提高患者的自我护理能力、生活质量、满意度。展开更多
文摘Every colorectal surgeon during his or her career is faced with anastomotic leakage(AL); one of the most dreaded complications following any type of gastrointestinal anastomosis due to increased risk of morbidity, mortality, overall impact on functional and oncologic outcome and drainage on hospital resources. In order to understand and give an overview of the AL risk factors in laparoscopic colorectal surgery, we carried out a careful review of the existing literature on this topic and found several different definitions of AL which leads us to believe that the lack of a consensual, standard definition can partly explain the considerable variations in reported rates of AL in clinical studies. Colorectal leak rates have been found to vary depending on the anatomic location of the anastomosis with reported incidence rates ranging from 0 to 20%, while the laparoscopic approach to colorectal resections has not yet been associated with a significant reduction in AL incidence. As well, numerous risk factors, though identified, lack unanimous recognition amongst researchers. For example, the majority of papers describe the risk factors for left-sided anastomosis, the principal risk being male sex and lower anastomosis, while little data exists defining AL risk factors in a right colectomy. Also, gut microbioma is gaining an emerging role as potential risk factor for leakage.
基金Supported by NBCRI,Symptomatic Breast Unit,University Hospital Galway
文摘Thirty per cent of all colorectal tumours develop in the rectum.The location of the rectum within the bony pelvis and its proximity to vital structures presents significant therapeutic challenges when considering neoadjuvant options and surgical interventions.Most patients with early rectal cancer can be adequately managed by surgery alone.However,a significant proportion of patients with rectal cancer present with locally advanced disease and will potentially benefit from down staging prior to surgery.Neoadjuvant therapy involves a variety of options including radiotherapy,chemotherapy used alone or in combination.Neoadjuvant radiotherapy in rectal cancer has been shown to be effective in reducing tumour burden in advance of curative surgery.The gold standard surgical rectal cancer management aims to achieve surgical removal of the tumour and all draining lymph nodes,within an intact mesorectal package,in order to minimise local recurrence.It is critically important that all rectal cancer cases are discussed at a multidisciplinary meeting represented by all relevant specialties.Pre-operative staging including CT thorax,abdomen,pelvis to assess for distal disease and magnetic resonance imaging to assess local involvement is essential.Staging radiology and MDT discussion are integral in identifying patients who require neoadjuvant radiotherapy.While Neoadjuvant radiotherapy is potentially beneficial it may also result in morbidity and thus should be reserved for those patients who are at a high risk of local failure,which includes patients with nodal involvement,extramural venous invasion and threatened circumferential margin.The aim of this review is to discuss the role of neoadjuvant radiotherapy in the management of rectal cancer.
文摘目的:探讨多学科延续性护理在直肠癌造口患者中的应用效果。方法:选取2019年9月至2020年9月张家口市第一医院收治的130例直肠癌行永久性结肠造口术患者为研究对象。采用随机数字表法分为对照组与研究组,各65例。对照组予以常规护理,研究组在常规护理的基础上实施多学科协作式延续性护理。干预3个月后,比较两组造口周围皮肤评分、并发症发生率、自我护理能力评分、心理状况评分、生活质量评分及护理满意度。结果:干预后,研究组造口周围皮肤变色、侵蚀、组织增生评分及造口周围皮肤总分均明显低于对照组(均P<0.05)。研究组粪水性皮炎及并发症总发生率均明显低于对照组(均P<0.05)。研究组自我护理能力各分量表自我技能、自护责任感、自我概念、自护知识评分及总分均明显高于对照组(均P<0.05)。研究组焦虑评分及抑郁评分均明显低于对照组(均P<0.05)。研究组生活质量问卷(Quality of Life Questionnaire Core 30,QLQ-C30)各分量表躯体功能、角色功能、认知功能、情绪功能、社会功能评分均明显高于对照组(均P<0.05)。研究组护理总满意率为92.31%,明显高于对照组的75.38%(P<0.05)。结论:直肠癌造口术后应用多学科协作式延续性护理能明显降低患者造口周围皮肤评分及并发症的发生率,提高患者的自我护理能力、生活质量、满意度。
