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Objective To investigate the feasibility of allogeneic platelet-rich plasma (PRP) for the treatment of skin injury around enterostomy. Methods The treatment process by PRP of 2 patients with skin injury around enterostomy was analyzed, and the PRP for each patient was tested with platelet count, bacteria and 5 growth factors. The clinical efficacy of enteral nutrition support therapy combined with allogeneic PRP was explored through analyzing treatment key points and literature review. Results After cleaning the skin around enterostomy, the patients were treated with PRP once daily for 5 days, adjusted to once every other day, and cure was achieved at 15 and 18 days, respectively. Conclusion Allogeneic PRP is a safe and effective treatment to promote skin injury around enterostomy regeneration in a short time, which can provide a new perspective for clinical.

This article describes an AIDS patient who was afraid of being discriminated against, and had no regular follow-up treatment, resulting in concurrent pneumocystis pneumonia and cytomegalovirus enteritis. The disease progressed and an artificial enterostomy was performed. Additionally, the patient's body mental image changed, resulting in anxiety, which prompted the author's motivation . From June 18 to July 13, 2021, direct care, observation, interactive methods to collect data, and using Gordon's eleven health function assessments, reveled, "activity intolerance", "body mental image dysfunction" and "anxiety" and other health problems. Intervention included, use of cross-team cooperative care during the nursing period, improving activity endurance through rehabilitation, providing patient with progress of rehabilitation using the exercise consciousness scale, giving enough privacy, and gradually allowing the patient to face up to and participate in stoma care. Through preferred static activities like listening to music and other entertainment methods to reduce anxiety, and assistance in seeking social support, assistance and placement, strengthen the social support system, and use the case management mechanism to allow patients to continue individualized care and still have something to rely on after discharge. [ABSTRACT FROM AUTHOR]

Objective·To investigate the level of stoma adaptation in patients with permanent enterostomy and its influencing factors.Methods·In this cross-sectional study, 260 patients with permanent enterostomy from North Campus in Hongkou and South Campus in Songjiang of Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine were recruited by convenience sampling approach from January to December, 2022. The level and the influencing factors of stoma adaptation were investigated by general information questionnaire, Chinese version of Ostomy Adjustment Inventory-20 (OAI-20), Hospital Anxiety and Depression Scale, Stoma Self-Efficacy Scale, Body Image Scale, and The Revised Dyadic Adjustment Scale. Statistical description used mean and standard deviation, frequency and percentage. T test, ANOVA, Spearman correlation and multiple linear regression analyses were preformed to explore the influencing factors of the level of stoma adaptation.Results·The mean score of OAI-20 was (42.28±11.47). One-way ANOVA results showed the effects of registered residence (P=0.001), monthly income (P=0.000) and the ostomy-related complications (P=0.000) on the OAI-20 score were statistically significant. Spearman correlation analysis results showed that the OAI-20 score was positively correlated with stoma self-efficacy and marital adjustment score (r=0.713, P=0.000; r=0.645, P=0.000), but negatively correlated with anxiety and depression and body image score (r=-0.391, P=0.000; r=-0.523, P=0.000). Four of the eleven variables, ostomy-related complications, anxiety, self-efficacy of ostomy caring and marital satisfaction, were selected by the multiple linear stepwise regression analysis, and could explain 59.8% of total variance (P=0.000).Conclusion·Most patients with permanent enterostomy have a low level of adaptation. Ostomy-related complications, anxiety, self-efficacy of ostomy caring and marital satisfaction are the main influencing factors of the level of stoma adaptation.

Objective·To investigate the level of stoma adaptation in patients with permanent enterostomy and its influencing factors. Methods·In this cross-sectional study, 260 patients with permanent enterostomy from North Campus in Hongkou and South Campus in Songjiang of Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine were recruited by convenience sampling approach from January to December, 2022. The level and the influencing factors of stoma adaptation were investigated by general information questionnaire, Chinese version of Ostomy Adjustment Inventory-20 (OAI-20), Hospital Anxiety and Depression Scale, Stoma Self-Efficacy Scale, Body Image Scale, and The Revised Dyadic Adjustment Scale. Statistical description used mean and standard deviation, frequency and percentage. T test, ANOVA, Spearman correlation and multiple linear regression analyses were preformed to explore the influencing factors of the level of stoma adaptation. Results·The mean score of OAI-20 was (42.28±11.47). One-way ANOVA results showed the effects of registered residence (P=0.001), monthly income (P=0.000) and the ostomy-related complications (P=0.000) on the OAI-20 score were statistically significant. Spearman correlation analysis results showed that the OAI-20 score was positively correlated with stoma self-efficacy and marital adjustment score (r=0.713, P=0.000; r=0.645, P=0.000), but negatively correlated with anxiety and depression and body image score (r= − 0.391, P=0.000; r=−0.523, P=0.000). Four of the eleven variables, ostomy-related complications, anxiety, self-efficacy of ostomy caring and marital satisfaction, were selected by the multiple linear stepwise regression analysis, and could explain 59.8% of total variance (P=0.000). Conclusion·Most patients with permanent enterostomy have a low level of adaptation. Ostomyrelated complications, anxiety, self-efficacy of ostomy caring and marital satisfaction are the main influencing factors of the level of stoma adaptation. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Clinical Nursing in Practice is the property of Journal of Clinical Nursing in Practice (Editorial Board, Shanghai Jiao Tong University Press) and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objective Using the visual analysis software VOSviewer to analyze the enterostomy nursing research on enterostomy nursing, and provide the research focus and research direction for the relevant researchers. Methods The Chinese Journal Full-text Database (CNKI), Wanfang Data Knowledge Service Platform, and VIP Chinese Science and Technology Periodical Database were retrieved, with the subject of “enterostomy nursing”, and the retrieval time was from 2017 to 2021. VOSviewer 1. 6. 17 softwarewas used to analyze the knowledge map of the retrieved literature, and visualize the research hotspots of enterostomy nursing in the past five years. Results A total of 3 480 related literatures were retrieved (1881 in Wanfang, 1081 in CNKI, 518 in VIP), and 1346 literatures were obtained after screening strictly according to the inclusion and exclusion criteria. From 2017 to 2021, the number of publications on enterostomy nursing showed an increasing trend year by year, and related research on enterostomy nursing had been paid attention by scholars. Conclusion The quality of life of patients with enterostomy is the focus of research, and continuous nursing and self-care have gradually become research hotspots. [ABSTRACT FROM AUTHOR]

Objective To investigate the intervention effect of acceptance and commitment therapy (ACT) on the stigma of rectal cancer patients with enterostomy. Methods Convenience sampling method was used to select 108rectal cancer patients with enterostomy in the hospital from August 2020to July 2021,and they were divided into the control group and the intervention group according to random number table method, with 54cases in each group. The control group received routine nursing, and the intervention group received ACT intervention on the basis of the control group. The scores of social impact scale (SIS) and stoma patient quality of life scale (Stoma-QOL) were compared between the two groups. Results There were no significant differences between the two groups in total SIS score and Stoma-QOL score before intervention (P>0.05) .After the intervention, the total score of SIS, score of each dimension and the score of Stoma-QOL in the two groups were significantly different (P<0.05) .After the intervention, the total SIS score and Stoma-QOL score of the intervention group were significantly different from those before the intervention (P<0.05) .Conclusion ACT can effectively reduce the level of stigma of rectal cancer patients with enterostomy, and improve their quality of life and self-awareness. [ABSTRACT FROM AUTHOR]

Objective To explore the risk factors of high-output stoma ( HOS ) after enterostomy in infants with necrotizing enterocolitis(NEC). Methods From July 1,2017 to June 30,2021,76 neonates undergoing enterostomy due to NEC were retrospectively reviewed. They were divided into two groups of HOS ( 푛 = 2S) and non-HOS( 푛 = 51) according to whether or not HOS occurred after enterostomy. General demographics, intraoperative findings and prognosis of two groups were compared. Univariate and multivariate Logistic regressions were utilized for examining the risk factors of HOS after enterostomy. Results Univariate analysis indicated that birth weight, gestational age, preoperative need for respiratory support, NEC stages and subtypes, corrected gestational age, operative weight and residual length of proximal enterostomy were the relevant occurring factors for postoperative HOS( 푃 < 0 .0S ). Logistic regression analysis showed that residual length of proximal enterostomy was an independent risk factor of HOS after enterostomy in NEC infants ( OR = 1. 220, 95% Cl: 1. 108 -1. 343,푃 < 0. 05). Receiver operating characteristic( ROC) curve was plotted with residual length of proximal enterostomy. Area under the curve was 0. 926 ( 95 % Cl :0. 849 - 1. 000,푃 < 0. 05 ) while the sensitivity and specificity were 92% and 74% . When residual length of proximal enterostomy was 86. 5 cm, the sensitivity and specificity were 84% and 96% of HOS, indicating that it was an excellent predictor for HOS in NEC infants. Conclusion HOS is prone to occur after enterostomy in NEC infants and residual length of proximal enterostomy is an independent risk factor and an excellent predictor for HOS in NEC infants after enterostomy. [ABSTRACT FROM AUTHOR]

Objective : To explore the interactions of depression and fatigue to quality of life in patients with colorectal cancer and their caregivers. Methods: Fifty-three patients with colorectal cancer who under went enterostomy within 6 months and their caregivers were selected. They were assessed with the Self-Rating Depression Scale (SDS), Fatigue Scale (FS-14) and 12-Item Short-Form Health Survey (SF-12). The two-level hierarchical linear models were established to complete the analysis of actor effects and partner effects with the physical and mental component summaries of SF-12 as the outcome variables respectively. Results: The FS-14 scores in patients and their caregivers had only actor effects on SF-12 scores on physical component summary (P < 0. 05), but no partner effects (P >0 . 05) . On mental component summary, the SDS and FS-14 scores in both patients and caregivers h ad actor effects on SF-12 scores (P < 0. 0 5), and the SDS scores had partner effects on SF-12 scores ( P < 0. 05) . Conclusion: It suggests that depression and fatigue in patients with colorectal cancer and their caregivers could affect each other's quality of life to some extent. [ABSTRACT FROM AUTHOR]

Objective To explore the risk factors of enterostomy in infants with Hirschsprung' s disease (HSCR) to facilitate timely evaluation of the condition and the clinical decision-making on the timing of intervention. Methods We retrospectively analyzed the data of 201 infants diagnosed with HSCR in our hospital between January, 2013 and January, 2019. Univariate analysis and multivariate logistic regression were used to analyze the clinical data and laboratory test results of the patients to identify the risk factors of enterostomy. Results The incidence of enterostomy was 22.4% in these infants. Multivariate logistic regression analysis showed that lowered serum albumin level (OR = 0. 737, 95% CI: 0. 633 - 0. 857, P = 0. 000), abnormal stool routine (OR = 10. 634, 95% CI: 3. 016-37. 502, P = 0. 000), procalcitonin (PCT) level >2 ng /mL (OR = 9. 954, 95% CI: 2. 517-39. 368, P = 0. 001), and right-sided HSCR (OR = 4. 307, 95% CI: 1. 417-13. 092, P = 0. 010) were risk factors for enterostomy in infants. Conclusion A lowed serum albumin level, abnormal stool routine, a PCT level > 2 ng /mL and right-sided HSCR are risk factors for enterostomy in infants with HSCR.

Copyright of Nursing of Integrated Traditional Chinese & Western Medicine is the property of Journal of Clinical Nursing in Practice (Editorial Board, Shanghai Jiao Tong University Press) and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objective To explore the practical effect of the newly continuous nursing mode constructed for patients with enterostomy. Methods With holistic care as the core concept, Omaha system as the theoretical framework, demand level theory and the forgetting curve principle as the reference basis, the model of continuous care for patients with intestinal stoma was established from five aspects : continuous care team, follow up form, follow up frequency, nursing content and nursing process. 128 cases patients who underwent enterostomy for colorectal cancer in the hospital from April to December 2017 were selected as the study subjects and randomly divided into the experimental group (n = 63) and the control group (n=65) through the random number table method. The experimental group implemented the extended care model established above, and the control group received routine discharge care. After 6 months of intervention, the practice effect was analyzed by means of cognitive behavior status (KBS) score, stomatal adaptability, stomatal self care ability, stomatal complication rate and discharge nursing satisfaction. Results The KBS scores of the experimental group before and after the intervention showed statistically significant differences (P < 0.05), and the stomatal adaptability and self care ability were significantly improved compared with those before the intervention (t = -16. 217, 29.287, P< 0.05). In the experimental group, the stoma adaptability, stoma self care ability and nursing service satisfaction were significantly higher than those in the control group, and the incidence of stoma complications was significantly lower than that in the control group, with statistically significant differences ( t = - 9.753, 6.648, - 9.357,X'= 12.098,P<0. 05). Conclusion The continuous nursing model constructed is scientific and practical, which effectively improves the health status of patients with enterostomy, reduces the incidence of complications, improves the stoma adaptability and self care ability, and improves the satisfaction of nursing. [ABSTRACT FROM AUTHOR]

Objective To explore the clinical safety and feasibility of enterostomy using running suture of dermis and seromuscular layer in laparoscopic-assisted radical resection for rectal carcinoma. Methods From May 1, 2017 to May 1, 2018, 46 patients who underwent laparoscopic-assisted radical resection for rectal carcinoma with enterostomy using running suture of dermis and seromuscular layer in Cancer Hospital, Chinese Academy of Medical Sciences were retrospectively enrolled in this study. Data regarding clinicopathologic characteristics, operation and postoperative outcomes, stoma-related complications and functions of stoma were collected and analyzed. Results All of the 46 patients successfully underwent this operation. Among them, 30 patients underwent laparoscopic-assisted abdominoperineal resection for rectal cancer with sigmoidostomy and 16 patients underwent laparoscopic-assisted low anterior resection for rectal cancer with loop ileostomy. The mean operation time was 115.3 minutes and intraoperative blood loss was 86.1 ml. The mean time for enterostomy was 14.1 minutes. The average time to flatus, time to fluid diet intake and length of hospital stay were 1.8 days, 2.9 days and 6.5 days, respectively. During the follow-up period, three patients suffered from stomal edema, two patients suffered from parastomal hernia, and two patients suffered from skin inflammation surrounding stoma. None of re-operation related stoma and severe mobility such as stomal stenosis, stomal necrosis, stomal prolapse, stomal retraction and stomal mucocutaneous separation occurred. Thirty-five patients recovered with satisfactory stomal function, two with middle function and one with poor function. Conclusion Enterostomy using running suture of dermis and seromuscular layer in laparoscopic-assisted radical resection for rectal carcinoma is a safe and feasible procedure with a satisfactory short-term effect. [ABSTRACT FROM AUTHOR]

Copyright of Chinese Journal of Clinical Healthcare is the property of Chinese Journal of Clinical Healthcare and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Ostomy-related complications are a prevalent postoperative problem for patients who receive an enterostomy. A previous study reported a 12% to 70% incidence rate for stoma-related complications. Purpose: This study aims to determine the incidence and predicting factors of ostomy-related complications in enterostomy patients at various time points after stoma creation. Methods: A retrospective chart review was conducted at a single institution. The participants in this study comprised patients entered in an ostomy case-management database who underwent enterostomy from January 2010 to October 2013. The patient demographics, revelant risk factors, stoma characteristics, and stomal and peristomal complications were documented by a wound ostomy and continence nurse. Results: A total of 264 patients were enrolled in this study (175 men and 89 women). The mean age of participants was 62.8 years. The incidence rate was 34.5% for early complications and 12.7% for late complications. Most stomal complications occurred within 1 month after surgery (48 of 264; 18.2%). The most common stomal complications that occurred within 10 days postoperative were: retraction, separation, and necrosis. Peristomal skin problems most frequently occurred within the first and the third postoperative months. Risk factors significantly associated with early complications were: stoma location, diameter, height, and peristomal skin condition (p < .05). A logistic regression analysis proved that stoma diameter (odds ratio [OR] = 3.12, p < .05) and height (OR = 4.17, p = .00) were effective in predicting the incidence of early complications. Conclusions / Implications for Practice: This research supports that the highest rate of stoma complications occurs within the first postoperative month and that stoma complications are associated with surgical factors. In the future, postoperative follow-up programs and preventive intervention may be implemented to decrease the occurrence of stoma complications. [ABSTRACT FROM AUTHOR]

Objective: To investigate the perceptions, attitudes, and surgical strategies of Chinese surgeons, toward stoma management. Methods: We conducted a nationwide, cross-sectional, questionnaire-based survey among individuals working at relevant departments in any tier of hospitals, including general surgery, gastrointestinal surgery, surgical oncology, emergency, and others, that was involved in managing enterostomies. We required that participants be senior surgeons who had participated in performing enterostomy surgery. The questionnaire consisted of five dimensions: personnel qualification and training, attitude toward ostomy complications, preoperative siting, the process of acquiring ostomy-related surgical skills, and awareness and adoption of relevant techniques. Descriptive statistical analysis was performed. Results: From July 2021 to July 2022, we sent 488 questionnaires through a WeChat link or two-dimensional barcode. We received 467 (95.7%) responses from 196 hospitals in 26 provinces. Among the respondents, 426 (91.2%) were from tertiary hospitals, the departments of which comprised general surgery (130, 27.8%), gastrointestinal surgery (210, 45.0%), surgical oncology (116, 24.8%), and other departments (11, 2.4%). Senior surgeons accounted for 311(66.6%) of the participants. We found that: (1) mentorship by senior surgeons was the primary source of knowledge about ostomies (83.3%, 389/467), followed by mentorship by others and surgical atlases (44.8%, 209/467), and self-education (42.0%, 196/467). (2) Concerns about correlations between complications and surgical procedures that were believed to be "closely" or "probably" related to complications (79.0%, 369/467) were expressed by 99.4% (464/467) of the surgeons. Stenosis and intestinal obstruction requiring unplanned surgery were not uncommon (61.0%, 285/467). Of the listed complications, 46.7% (218/467) were believed to be related to surgical procedures and 79.0% (369/467) avoidable. Only 58.7% (274/467) of surgeons had participated in training and discussion of stoma complications whereas 99.1% (463/467) believed that joint training and discussions between surgeons and enterostomal therapists were necessary. (3) The main reasons for creation of stomas that were not consistent with prior siting included: stoma site marked preoperatively not a suitable trocar site (56.1%, 262/467), defunctioning stoma marking according to standards for permanent stomas (50.7%, 237/467), and inappropriate marking (43.3%, 202/467). (4) The rate of awareness of relevant procedures was generally high; however, it was less than 75% for stoma creation by circular stapler (64.1%, 257/401) and parastomal drainage (44.1%, 177/401). Eversion suture of mucosa and supporting rods were utilized in 65.6% (263/401) and 56.4% (226/401), respectively. Peritoneum (or posterior rectus abdominis sheath) (68.3%, 274/401), anterior rectus abdominis sheath (54.4%, 218/401), and skin (80.6%, 323/401) were the most commonly used tissues for fixation and suture layers of defunctioning and permanent stomas. However, closure of subcutaneous tissue was controversial, suturing being advocated by 26.7% (107/401) and 32.7% (131/401) of surgeons, respectively. Complications were considered to depend mainly on technical skills rather than the amount of suturing by 81.5% (327/401) of the participating surgeons. Conclusions: The complications of stoma surgery are related to the awareness and technical skills of surgeons, indicating there are insufficient training, education, management, and research. Standardization of enterostomy technical strategies and stoma management are therefore imperative.

Stoma is a commonly used surgical procedure in clinic practice. However, for obese patients with thick abdominal wall, short and thickened mesentery, and for patients with intestinal obstruction and abdominal distension (difficult stoma), establishing a tension- free and well blood-supplied stoma is still a great challenge. Careful preoperative planning, including stoma location marking, careful consideration of all alternatives and attention to technical details, will help to make an optimal stoma under challenging conditions. For enterostomy of obese patients, the pullout intestine must be free of tension and must have sufficient blood supply, the structure of the abdominal wall should be incised vertically, and the intestine should be pulled out vertically as well. For enterostomy of patients with intestinal obstruction, the diameter of the stoma incision should not exceed 3 cm to avoid parastomal hernia, which commonly occurs after bowel retraction.

No consensus on standardized technique of enterostomy creation has been made meanwhile high heterogeneity of surgical procedure exists in 'stoma creation' chapters of textbooks or atlases of colorectal surgery. The present article reviews the anatomy of tendinous aponeurotic fibers which is crucial for abdominal wall tension and integrity. Through empirical practice we hypothesize a procedure of enterostomy creation basied on abdominal wall tension plus anchor suture for fascia fixation which could theoretically decrease short-term stoma complication rates and long-term parastomal hernia rates. Surgical techniques are as followed: (1) preoperative stoma site mark for de-functioning ileostomy should be positioned at the lateral border of rectus abdominis muscle (RAM) to decrease the difficulty of stoma reversal and for permanent colostomy should be placed overlying the RAM to promote adhesion; (2)Optimal circular removal or lineal opening of skin, and avoid dissection of subcutaneous tissue; (3) Lineal dissection of natural strong fascia (rectus sheath) at stoma site and blunt separation of muscular fibers. The tunnel of the fascia should be made with appropriate size without undue tension. To prevent the formation of dead space, additional suturing at fascia layer is unnecessary. (4) Anchor suture for fascia fixation at two ends of fascia opening could be considered to avoid delayed fascia disruption and parastomal hernia. (5) After pull-through of ileum or colon loop, 4-8 interrupted seromuscular sutures could be placed to attach loop to skin. For ileostomy, self-eversion of mucosa can be successful in vast majority of cases and a Brooke ileostomy is not necessary. The efficacy and safety of this procedure should be tested in future trials.

Objective: To investigate the efficacy and safety of diseased bowel resection and diversion enterostomy in the treatment of late severe complications of chronic radiation-induced late rectal injury (RLRI). Methods: Studies about comparison of diseased bowel resection and diversion enterostomy in the treatment of late severe complications of chronic RLRI were screened and retrieved from databases, including PubMed, EMBASE, Scopus, Web of Science, Cochrane Library, CNKI, VIP, CBM and Wanfang. The following terms in Chinese were used to search [Title/Abstract]: radiation-induced intestinal injury, radiation proctitis, surgery. The following English terms were used to search: Radiation-induced intestinal injury, Bowel injury from radiation, Radiation proctitis, Surgery, Colostomy. Literature inclusion criteria: (1) studies with control groups, published at home and abroad publicly, about the postoperative effects of diseased bowel resection vs. diversion enterostomy on RLRI patients with late severe complications; (2) the period of the study performed in the literatures must be clear; (3) patients at the preoperative diagnosis for RLRI with refractory bleeding, narrow, obstruction, perforation or fistula, etc.; (4) diseased bowel resection included Hartmann, Dixon, Bacon and Parks; diversion enterostomy included colostomy and ileostomy; (5) if the studies were published by the same institution or authors at the same time, the study with the biggest sample size was chosen; studies conducted in different time with different subjects were simultaneously included; (6) at least one prognostic indicator of the following parameters should be included: the improvement of symptoms, postoperative complications, mortality, and reversed stomas rate. The stoma reduction rate was defined as the ratio of successful closure of colostomy after diseased bowel resection and diversion enterostomy. The method of direct calculation or the method of convert into direct calculation were used for stoma reduction rate. Exclusion criteria: (1) a single-arm study without control group; (2) RLRI patients did not undergo diseased bowel resection or diversion enterostomy at the first time; (3) RLRI patients with distant metastasis; (4) the statistical method in the study was not appropriate; (5) the information was not complete, such as a lack of prognosis in the observational indexes. After screening literatures according to criteria, data retrieval and quality evaluation were carried out. Review Manager 5.3 software was used for Meta-analysis. Sensitivity analysis was used to exam the stability of results. Funnel diagram was used to analyze the bias of publication. Results: A total of 11 literatures were enrolled, including 426 RLRI patients with late severe complications, of whom 174 underwent diseased bowel resection (resection group) and 252 underwent diversion enterostomy (diversion group), respectively. Compared with diversion group, although resection group had a higher morbidity of complication (35.1% vs. 15.9%, OR=2.67, 95% CI: 1.58 to 4.53, P <0.001), but it was more advantageous in symptom improvement (94.2% vs. 64.1%, OR=6.19, 95% CI: 2.47 to 15.52, P <0.001) and stoma reductions (62.8% vs. 5.1%, OR=15.17, 95% CI: 1.21 to 189.74, P =0.030), and the differences were significant (both P <0.05). No significant difference in postoperative mortality was found between the two groups (10.1% vs. 18.8%, OR=0.74, 95% CI: 0.21 to 2.59, P =0.640). There were no obvious changes between the two groups after sensitivity analysis for the prognostic indicators (the symptoms improved, postoperative complications, mortality, and reversed stomas rate) compared with the meta-analysis results before exclusion, suggesting that the results were robust and credible. Funnel diagram analysis suggested a small published bias. Conclusions: Chronic RLRI patients with late severe complications undergoing diseased bowel resection have higher risk of complication, while their long-term mortality is comparable to those undergoing diversion enterostomy. Diseased bowel resection is better in postoperative improvement of symptoms and stoma reduction rate.

Copyright of Nursing of Integrated Traditional Chinese & Western Medicine is the property of Journal of Clinical Nursing in Practice (Editorial Board, Shanghai Jiao Tong University Press) and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Diversion colitis (DC) is a common non-specific inflammation of the malfunctioning bowel segment after diversion of feces. Although most patients develop DC during stoma, there are no obvious clinical symptoms, and a small number of patients show abdominal pain, mucus discharge and hematochezia. The erythema, diffuse particles and vascular texture blur are the most prominent endoscopic manifestations, and the lymphatic follicular hyperplasia is the most prominent pathological manifestations.Reconstruction of intestinal continuity is the best way to cure recanted colitis. In this review, we summarize and review the mechanism of occurrence, clinical features, diagnosis and treatment of DC, which will be helpful for the effective control and prevention of DC.

Objective: To compare the wound healing time, Surgical site infection (SSI) rate and other postoperative outcomes between the gunsight closure and purse-string closure technique in loop stoma closure. Methods: Between November 2013 and December 2017, a total of 143 patients who underwent gunsight stoma reversal were included in this multicenter prospective randomized controlled trial. The patients were randomized to undergo gunsight (gunsight group, n= 72) or purse-string closure technique (purse-string group, n= 71). The primary endpoint was wound healing time. The second endpoints were the incidence of SSI, morbidity, and patient satisfaction. Statistical analysis between groups was performed using the t -test, repeated measures analysis of variance, Mann-Whitney U test, χ(2) test or Fisher's exact test. Results: There were 45 males and 27 females with age of 67 (11) (M( Q(R) )) years in gunsight group, 42 males and 29 females with age of 65 (20) years in purse-string group. The body mass index, American Society of Anesthesiologist classification, comorbidities, primary diagnosis, the type of ostomy, intraoperative blood loss, perioperative complications, postoperative hospital stay, hospitalization cost, SSI rate and incisional hernia (stoma site) between the 2 groups were not significantly different ( P> 0.05). Although had a statistically longer operating time (80(10) minutes vs . 70(10) minutes, Z= -2.381, P= 0.017), patients who underwent gunsight procedure and a significantly shorter wound healing time (17(2) days vs . 25(4) days, Z= -10.199, P< 0.01), higher patient satisfaction score with regards to wound healing time (3(1) vs . 3(1), Z= -4.526, P< 0.01), and higher total patient satisfaction score (25(3) vs . 25(3), Z= -2.529, P= 0.011) compared with those who underwent purse-string procedure. Conclusions: The gunsight and purse-string techniques are effective procedures for stoma reversal and both have low SSI rate. The gunsight technique is associated with shorter wound healing time, higher levels of patient satisfaction compared with purse-string technique, and is recommended as the closure technique of choice.

Objective: To explore the method of relieving intestinal obstruction in patients with recurrent cervical cancer accompanied with intestinal obstruction after radical radiotherapy. Methods: The data of 10 recurrent cervical cancer patients accompanied with high risk weak constitution and intestinal obstruction after radical radiotherapy from May 2012 to May 2018 were retrospectively analyzed, including preoperative radiotherapy dose, physique and obstruction status, operation time, operation blood loss, postoperative digestive tract patency and diet. All of the 10 patients with cervical cancer recurrence accompanied with intestinal obstruction and disturbance of independent walking after radical radiotherapy. Results: The median fasting time of the 10 patients was 21 days, the median weight was 35.5 kg, the median body mass index (BMI) was 13.3 kg/m(2,) the median value of hemoglobin was 67 g/L, and the median value of platelet was 44×10(9) /L. All of the patients underwent enterostomy. the median operation time was 6.0 min and the median amount of bleeding was 5.0 ml. All of the patients defecated after operation, fed on the first day after operation, and were able to walk on their own 5 days after operation. Conclusions: Although the cervical cancer patients with recurrent intestinal obstruction after radical radiotherapy are extremely weak, some patients still have the opportunity to relieve intestinal obstruction if the treatment strategy and surgical method are appropriate.

Objective: To explore the effect of enterostomy on analgesic pattern in advanced digestive tract cancer. Methods: A retrospective cohort study was carried out, which was approved by the Ethics Committee of the Sixth Affiliated Hospital of Sun Yat-sen University (E2018026). Inclusion criteria were as follows: (1)age and gender were not limited; (2) all the gastrointestinal malignancies were confirmed histologically, and local recurrence or metastasis were confirmed by CT or MR; (3) numerical rating scale (NRS) ≥4 points, opioid analgesic drugs were required; (4) informed consents were signed by patients of their own. Exclusion criteria were as follows: (1) malignancies of early stage; (2) suspicious adverse mental states which might lead to poor administration compliance; (3) hypersensitivity or allergic reactions to opioids. Clinical data of patients with advanced gastrointestinal cancer receiving comprehensive treatment at the Medical Oncology Department of the Sixth Affiliated Hospital of Sun Yat-sen University from September 2016 to April 2017 were retrospectively collected. The patients were divided into the stoma group and the non-stoma group. The clinical findings of two groups were analyzed, including age, sex, ostomy status, pain location, presence or absence of intestinal obstruction, pain characteristics, selection of opioid analgesic agents, treatment of side effects of analgesics. Pain was assessed using brief pain inventory(BPI) table and NRS score. Strong opioids were prescribed for patients of NRS ≥4. Patients who were intolerant to opioids required opioid titration. The titration drugs included oral or IV morphine and oxycodone. After achievement of adequate pain control, long-acting opioids were administered, which included sustained-release morphine tablets, controlled release oxycodone and transdermal fentanyl. Criteria for pain relief included NRS≤3, breakthrough pain <3 times/day and duration of adequate pain control >3 days. The χ(2) test and the Wilcoxon signed rank sum test (nonparametric test) were used to analyze the clinical features of patients in the stoma and non-stomach groups. In order to find the factors associated with maintenance therapy and the use of laxatives, the variables were compared as well as in multivariate analysis with multiple regression models. For all the statistical tests, a value of P <0.05 in a two-tailed test was established as the alpha significance level. Result: A total of 123 patients were enrolled in this study, including 79 males (64.2%) and 44 females (35.8%) with a median age of 51 years. Fifty-two patients were in stoma group, including 30 (24.4%) of ileostomy and 22 (17.9%) of colostomy, and 71 patients were in non-stoma group. Pain of 40 (76.9%) patients in stoma group located in abdomenopelvic site while the pain of 44 (62.0%) patients in non-stoma group located in other sites. Compared with non-stoma group, cases in stoma group complained more abdominopelvic pain (73% vs. 62.0%, P <0.001).The median NRS pain score before treatment in the stoma group and the non-stoma group was 5.7 and 5.6, respectively, without statistically significant difference ( P =0.741). After analgesic management, the above scores reduced to 2.1 and 2.3, respectively, without statistically significant difference as well ( P =0.092). Analgesic treatment was effective in 111 cases (90.2%), including 49 cases (94.2%) in the stoma group, and 62 cases (87.3%) in the non-stoma group, and there was no statistically significant difference between the two groups ( P =0.202). There was more application of fentanyl transdermal patch [34.6%(18/52) vs. 9.8%(7/71)] in the stoma group, while more application of lactulose laxative [78.9%(56/71) vs. 61.5%(32/52)](χ(2)=10.023, P =0.002) in the non-stoma group. Multivariate analysis revealed that ostomy (OR=0.290, 95%CI: 0.102-0.824, P =0.009) and pain site (OR=5.691, 95%CI:1.709-18.948, P =0.005) were independent factors affecting the choice of the first line opioid sustained release agent. Of the 123 patients with maintaining analgesia, 98 had available data of laxative use, of whom 46 used laxatives to prevent or treat constipation, and the proportion of laxatives in stoma group (21.2%, 11/52) was significantly lower than that in non-stoma group (49.3%, 35/71) (χ(2)=6.957, P =0.008). Multivariate analysis of the application of laxative use showed that age (OR=0.281, 95% CI: 0.123-0.684, P =0.010) and ostomy (OR=2.621, 95% CI: 1.033-6.687, P =0.045) were independent factors affecting the use of lactulose laxatives. Conclusions: Enterostomy may affect the analgesic pattern in advanced digestive tract cancer. Patients with stoma are more likely to use fentanyl transdermal patches and younger patients with stoma do not need prophylactic use of laxatives.

Objective: To investigate the safety and efficacy of surgical treatment for chronic radiation intestinal injury. Methods: A descriptive cohort study was performed. Clinical data of 73 patients with definite radiation history and diagnosed clinically as chronic radiation intestinal injury, undergoing operation at Department of Colorectal Surgery, the Sixth Affiliated Hospital of Sun Yat-sen University from January 1, 2012 to February 28, 2019, were reviewed and analyzed retrospectively. Patients did not undergo operation or only received adhesiolysis were excluded. All the patients had preoperative examination and overall evaluation of the disease. According to severity of intestinal obstruction and patients' diet, corresponding nutritional support and conservative treatment were given. Surgical methods: The one-stage bowel resection and anastomosis was the first choice for surgical treatment of chronic radiation intestinal injury. Patients with poor nutritional condition were given enterostomy and postoperative enteral nutrition and second-stage stoma closure and intestinal anastomosis if nutritional condition improved. For those who were unable to perform stoma closure, a permanent stoma should be performed. Patients with severe abdominal adhesion which was difficult to separate, enterostomy or bypass surgery after adhesiolysis would be the surgical choice. For patients with tumor metastasis or recurrence, enterostomy or bypass surgery should be selected. Observation parameters: the overall and major (Clavien-Dindo grades III to V) postoperative complication within 30 days after surgery or during hospitalization; mortality within postoperative 30 days; postoperative hospital stay; time to postoperative recovery of enteral nutrition; time to removal of drainage tube. Results: Of the 73 patients who had been enrolled in this study, 10 were male and 63 were female with median age of 54 (range, 34-80) years. Preoperative evaluation showed that 61 patients had intestinal stenosis, 63 had intestinal obstruction, 11 had intestinal perforation, 20 had intestinal fistula, 3 had intestinal bleeding, and 6 had abdominal abscess, of whom 64(87.7%) patients had multiple complications. Tumor recurrence or metastasis was found in 15 patients. A total of 65(89.0%) patients received preoperative nutritional support, of whom 35 received total parenteral nutrition and 30 received partial parenteral nutrition. The median preoperative nutritional support duration was 8.5 (range, 6.0-16.2) days. The rate of one-stage intestine resection was 69.9% (51/73), and one-stage enterostomy was 23.3% (17/73). In the 51 patients undergoing bowel resection, the average length of resected bowel was (50.3±49.1) cm. Among the 45 patients with intestinal anastomosis, 4 underwent manual anastomosis and 41 underwent stapled anastomosis; 36 underwent side-to-side anastomosis, 5 underwent end-to-side anastomosis, and 4 underwent end-to-end anastomosis. Eighty postoperative complications occurred in 39 patients and the overall postoperative complication rate was 53.4% (39/73), including 39 moderate to severe complications (Clavien-Dindo grade III-V) in 20 patients (27.4%, 20/73) and postoperative anastomotic leakage in 2 patients (2.7%, 2/73). The mortality within postoperative 30 days was 2.7% (2/73); both patients died of abdominal infection, septic shock, and multiple organ failure caused by anastomotic leakage. The median postoperative hospital stay was 13 (11, 23) days, the postoperative enteral nutrition time was (7.2±6.9) days and the postoperative drainage tube removal time was (6.3±4.2) days. Conclusions: Surgical treatment, especially one-stage anastomosis, is safe and feasible for chronic radiation intestine injury. Defining the extent of bowel resection, rational selection of the anatomic position of the anastomosis and perioperative nutritional support treatment are the key to reduce postoperative complications.

Objective: To explore the clinical safety and feasibility of enterostomy using running suture of dermis and seromuscular layer in laparoscopic-assisted radical resection for rectal carcinoma. Methods: From May 1, 2017 to May 1, 2018, 46 patients who underwent laparoscopic-assisted radical resection for rectal carcinoma with enterostomy using running suture of dermis and seromuscular layer in Cancer Hospital, Chinese Academy of Medical Sciences were retrospectively enrolled in this study. Data regarding clinicopathologic characteristics, operation and postoperative outcomes, stoma-related complications and functions of stoma were collected and analyzed. Results: All of the 46 patients successfully underwent this operation. Among them, 30 patients underwent laparoscopic-assisted abdominoperineal resection for rectal cancer with sigmoidostomy and 16 patients underwent laparoscopic-assisted low anterior resection for rectal cancer with loop ileostomy. The mean operation time was 115.3 minutes and intraoperative blood loss was 86.1 ml. The mean time for enterostomy was 14.1 minutes. The average time to flatus, time to fluid diet intake and length of hospital stay were 1.8 days, 2.9 days and 6.5 days, respectively. During the follow-up period, three patients suffered from stomal edema, two patients suffered from parastomal hernia, and two patients suffered from skin inflammation surrounding stoma. None of re-operation related stoma and severe mobility such as stomal stenosis, stomal necrosis, stomal prolapse, stomal retraction and stomal mucocutaneous separation occurred. Thirty-five patients recovered with satisfactory stomal function, two with middle function and one with poor function. Conclusion: Enterostomy using running suture of dermis and seromuscular layer in laparoscopic-assisted radical resection for rectal carcinoma is a safe and feasible procedure with a satisfactory short-term effect.

Objective: To evaluate the application of intestinal stomas in mesenteric ischemia (MI) according to the concept of damage control surgery. Methods: Clinical data of 59 MI patients received intestinal stomas at Jinling Hospital, Nanjing University School of Medicine from January 2010 to June 2017 were analyzed retrospectively. There were 41 male and 18 female patients aging of (51±14) years (ranging from 20 to 86 years). All the patients were divided to two groups according to the degree of bowel ischemia: acute MI group (AMI, bowel necrosis, n =43) and chronic MI group (CMI, bowel stricture, n =16). The medium time from onset to consult of AMI was 7(12) days ( M ( Q(R) )) and the time of CMI was 80(51) days. After the resection of irreversible ischemic intestine, ostomy was carried out for all 59 patients. Patients received oral anticoagulation, enteral nutrition and succus entericus reinfusion therapy for about 6 months after discharge. Then definite surgery to restore digestive tract was preferred. Results: In AMI group, APACHEⅡ score in admission was (16±3). The length of infarcted intestine resected was (160±95) cm, normal bowel left was (220±106) cm. Twelve patients had complications during first post-operation period including sepsis ( n =8), acute renal failure ( n =4), acute respiratory distress syndrome ( n =4), short bowel syndrome ( n =4). 30-day mortality was 18.6%. Total 30 patients received operation to restore the continuity of intestinal tract after 202(42) days and APACHEⅡ score was 4±2. Two patients suffered from sepsis and were cured after anti-infection. In CMI group, APACHEⅡ score was 16±3 and NRS2002 score was more than 3. The length of infarcted intestine resected was (43±33) cm. All patients had restored the continuity of intestinal tract after 176 (47) days. No major complications occurred during the first and second post-operation period. Conclusions: According to damage control surgery, after early revascularization, patients with acute intestinal necrosis should be treated with infarcted bowel resection and stomas. Besides, second operation to restore the continuity of intestinal tract should be conducted after nutritional support for 6 months. Patients with ischemic enteropathy who cannot be corrected with severe malnutrition should achieve stomas during first operation.

A 60-year-old man demonstrated a bleeding tendency at enterostomy about 7 months after aortic arch replacement. Abdominal muscle hematoma and pelvic hematoma were also detected. He was diagnosed as having acquired hemophilia A based on prolonged APTT (65.9 sec), reduced FVIII activity (>1%), and the presence of FVIII inhibitor (19.5 BU/ml). Severe anemia was recognized. Recombinant activated factor FVIII (9.6 mg) was administered 25 times, combined with steroid pulse therapy. Usually postoperative acquired hemophilia is recognized in the immediate postoperative period or about 3 months later, while in this case, acquired hemophilia appeared 7 months postoperatively.

Objective: To explore the surgical methods and the clinical results of chronic radiation enteritis., Methods: Treatments were applied to forty-nine cases of chronic radiation enteritis complicated with intestinal obstruction, enterocutaneous fistula, intestinal stenosis, intestinal bleeding, severe proctocolitis and intestinal perforation, among whom 47 cases received an average of 2.8 +/- 2.1 operations. Twenty-six cases received resection of the injured segment with primary anastomosis, fourteen cases received intestinal resection and proximal enterostomy, among whom 6 ostomies were permanent, and another 8 cases received secondary ostomy closure. The injured intestinal segments were spared in 7 cases., Results: Forty-seven among 49 cases were cured (success rate, 96%) with no anastomotic leakage. Two patients died., Conclusions: Surgical complications of chronic radiation enteritis should be managed operatively. The operative method should be chosen according to the general condition of the patients and the complexity of the abdomen. Perioperative management and proper selection of intestinal segments for anastomosis are essential for the success.