ObjectiveTo contrastive the clinical results of intraperitoneal sigmoid colostomy and extraperitoneal sigmoid colostomy in abdominal perineal resection. MethodsThe clinical data of 172 patients who underwent abdominal perineal resection from March 2010 to March 2014 were retrospectively analyzed.Sixty cases were performed the intraperitoneal sigmoid colostomy (intraperitoneal group), seventy-six cases were performed the extraperitoneal sigmoid colostomy (extraperitoneal group), and thirty-six cases were performed the functional exercise after extraperitoneal sigmoid colostomy (functional exercise group). The operation situation, postoperative complications, and colostomy function of three groups of patients were compared. Results①Operation situation: The colostomy location selection, operative time, intraoperative blood loss, and postoperative hospital stay of the three groups had no statistically significant differences (P > 0.05). The postoperative first exhaust and defecate time of the intraperitoneal group and the functional exercise group were obviously earlier than the extraperitoneal group, the difference had statistical significance (P < 0.05).②The postoperative complications: The postoperative complications rates of the extraperitoneal group and functional exercise group were lower than the intraperitoneal group, had statistically significant difference (P < 0.05), the functional exercise group was lower than the extraperitoneal group, the difference had statistical significance (P < 0.05).③The colostomy function:The patient' proportion that > 30 s of appeared time of defecation signals in the extraperitoneal group was significantly higher than the intraperitoneal group, and the functional exercise group was higher than that in the extraperitoneal group, the difference were statistically significant (P < 0.05). The patient' proportion that > 2 min of autonomous control of defecation to discharge feces time after the bowel signal appears in the extraperitoneal group was significantly higher than the intraperitoneal group, and the functional exercise group was higher than that in the extraperitoneal group, the difference were statistically significant (P < 0.05). Conciusions The intraperitoneal sigmoid colostomy has less colostomy related complications than extraperitoneal sigmoid colostomy in abdominal perineal resection. The control, and defecate ability are better. Postoperative function exercise can further reduce the colostomy complications and improve the function of colostomy.
Objective To investigate the influence of preoperative enteral nutrition with dietary fiber on the nutritional status of patients with colon colostomy diaplasis, and discuss its safety. Methods Forty preoperative colon colostomy diaplasis patients from West China Hospital treated between September 2013 and June 2014 were randomly assigned into trial group and control group with 20 in each. The baseline of the two groups was the same (all P > 0.05). The trial group was given enteral nutrition with dietary fiber before operation for seven days, while control group was given homogenate diet with equal quantity of energy and nitrogen content for the same period of time. All patients were being tested for nutritional indexes on the day of admission and on the fifth day after surgery. Meanwhile, other indexes such as the first time of flatus and defecation, abdominal distension, bellyache, and other adverse reactions were recorded too. Results There was no statistical difference in nutritional indexes on the day of admission and on the fifth day after surgery between two groups (P > 0.05). Patients with dietary fiber had significantly higher incidence of abdominal distension than the control subjects (P < 0.05), but other adverse reactions had no statistical differences between the two groups (P > 0.05). No anastomotic leakage occurred in both the two groups. Patients with dietary fiber had significantly earlier time of flatus than the control group (P < 0.05). Patients with dietary fiber had significantly lower incidence of diarrhea than the control subjects (P < 0.05). Conclusions The study suggests that it is safe and feasible to use enteral nutrition with dietary fiber for preoperative colon colostomy diaplasis patients. Using dietary fiber is helpful for intestinal function recovery and reduction of the occurrence of adverse reactions after surgery.
ObjectiveTo understand the current status of oral frailty in older patients with colostomy, and analyze the factors affecting oral frailty. MethodsRetrospective analysis of older patients with colostomy who visited the gastroenterology outpatient department of Affiliated Provincial Hospital of Shandong First Medical University from May 2023 to December 2023 as research subjects. The questionnaire survey was conducted using the general data questionnaire, oral frailty index-8 (OFI-8), the edmonton frail scale (EFS), and the nutritional risk screening score 2002. According to the OFI-8 score, the patients were divided into oral frailty group and non-oral frailty group, and the two-classified logistic regression model was used for multi-factor analysis to explore the factors affecting the oral frailty of older patients. ResultsA total of 283 survey subjects were collected, and the incidence of oral frailty in older patients was 66.4% (188/283). Multi-factor analysis results show that old age [OR=1.181, 95% CI(1.015, 1.373), P=0.032], history of smoking [OR=2.721, 95%CI(1.122, 6.599), P=0.027], history of alcohol [OR=2.878, 95%CI(1.185, 6.991), P=0.020], dentures [OR=3.173, 95%CI(1.297, 7.759), P=0.011], postoperative oral diseases≥2 [OR=5.802, 95%CI(1.911, 17.615), P=0.002], nutritional risk [OR=2.744, 95%CI(1.033, 7.284), P=0.043], high EFS score [OR=1.823, 95% CI(1.309, 2.538), P<0.001], the type of stoma is permanent [OR=2.659, 95%CI(1.126, 6.275), P=0.026] is a risk factor for oral frailty in older patients with colostomy. ConclusionThe incidence of oral frailty in older patients with colostomy is relatively high. We should pay more attention to the patient's oral frailty, and implement precise intervention measures for high-risk factors to prevent the occurrence of oral frailty or improve the condition of oral frailty.