ObjectiveTo explore the clinicopathological features of pulmonary alveolar proteinosis (PAP).MethodsA total of 25 patients with PAP who were pathologically diagnosed in West China Hospital of Sichuan University from 2014 to 2018 were collected as the study subjects.ResultsThe 25 patients with PAP were 18–73 years old, with an average age of (42.52±15.79) years. There were 20 males and 5 females. The most common type was autoimmune PAP (15 cases), and secondary PAP (10 cases) were found in patients with pneumonia, tuberculosis, nephrotic syndrome, and pneumoconiosis. The common clinical symptoms of PAP were cough (24 cases), expectoration (20 cases), and progressive difficulty in breathing (11 cases of shortness of breath and 5 cases of dyspnea). The chest CT manifestations included double lung grinding (19 cases), grid-like changes (11 cases), and map-like changes (3 cases). Periodic acid-schiff (PAS) staining and post-digestion PAS staining double positive lipoprotein-like deposits was observed in lung biopsy (in the alveolar cavity) and/or alveolar lavage fluids.ConclusionsPAP has no characteristic clinical symptoms and a long diagnosis period. Clinicians should combine clinical signs, imaging features, and lung biopsy and/or alveolar lavage fluid PAS staining and post-digestion PAS staining to confirm the diagnosis.
ObjectiveTo understand the current situation of unplanned readmission of colorectal cancer patients within 30 days after discharge under the enhanced recovery after surgery (ERAS) mode, and to explore the influencing factors.MethodsFrom May 7, 2018 to May 29, 2020, 315 patients with colorectal cancer treated by Department of Gastrointestinal Surgery, West China Hospital, Sichuan University and managed by ERAS process during perioperative period were prospectively selected as the research objects. The general data, clinical disease data and discharge readiness of patients were obtained by questionnaire and electronic medical record. Telephone follow-up was used to find out whether the patient had unplanned readmission 30 days after discharge and logistic regression was used to analyze the influencing factors of unplanned readmission within 30 days after discharge.ResultsWithin 30 days after discharge, 37 patients were admitted to hospital again, the unplanned readmission rate was 11.7%. The primary cause of readmission was wound infection. Logistic regression analysis showed that the body mass decreased by more than 10% in recent half a year (OR=2.611, P=0.031), tumor location in rectum (OR=3.739, P=0.026), operative time ≤3 hours (OR=0.292, P=0.004), and discharge readiness (OR=0.967, P<0.001) were independent predictors of unplanned readmission.ConclusionsUnder the ERAS mode, the readmission rate of colorectal cancer patients within 30 days after discharge is not optimistic. Attention should be focused on patients with significant weight loss, rectal cancer, more than 3 hours of operative time, and low readiness for discharge. Among them, the patient’s body weight and discharge readiness are the factors that can be easily improved by clinical intervention. It can be considered as a new way to reduce the rate of unplanned readmission by improving the patients’ physical quality and carrying out discharge care program.
Objective To explore the related factors of postoperative pulmonary infection (PPI) in patients undergoing laparoscopic colorectal cancer surgery, and analyze the perioperative management strategy of pulmonary infection combined with the concept of enhanced recovery after surgery (ERAS). Methods Total of 687 patients who underwent laparoscopic colorectal cancer surgery in the colorectal cancer professional treatment group of Gastrointestinal Surgery Center of West China Hospital of Sichuan University from January 2017 to May 2019 were retrospectively included. According to the occurrence of PPI, all the included cases were divided into infection group (n=97) and non-infection group (n=590). The related factors and prevention strategies of PPI were analyzed. Results The rate of PPI among patients underwent laparoscopic resection in our study was 14.1% (97/687). Compared with the non-infection group, the proportions of patients with preoperative complications other than cardiopulmonary, receiving preoperative neoadjuvant radiotherapy and/or chemotherapy, preoperative Eastern Cooperative Oncology Group (ECOG) score 1–2, preoperative Nutrition Risk Screening 2002 (NRS2002) score 1–3, tumor located in the left colon and rectum, combined organ resection, operative time >3 h and postoperative TNM stage Ⅱ patients in the infection group were higher (P<0.05). However, the proportions of patients who used intraoperative lung protective ventilation strategy and incision infiltration anesthesia in the infection group were lower than those in the non-infection group (P<0.05). In the infection group, the proportions of patients who received regular sputum excretion, atomization therapy, balloon blowing/breathing training, stomatology nursing after operation and postoperative analgesia were all significantly lower than those of the non-infection group (P<0.05), whereas the proportions of patients receiving antibiotics and intravenous nutrition after operation were significantly higher than those in the non-infection group (P<0.05). Logistic regression analysis showed that low preoperative NRS2002 score, intraoperative protective ventilation strategy, postoperative respiratory training, and postoperative regular sputum excretion were the protective factors of PPI, while preoperative cardiopulmonary complications, preoperative neoadjuvant chemotherapy, tumor located in the left colon and rectum, late TNM staging and postoperative antibiotics were risk factors for pulmonary infection.Conclusions Preoperative cardiopulmonary complications, preoperative neoadjuvant chemotherapy, tumor location in the left colon and rectum, late TNM staging and postoperative antibiotics are risk factors for pulmonary infection in patients with laparoscopic colorectal cancer. Preoperative good nutritional status, intraoperative protective ventilation strategy, postoperative respiratory training and regular sputum excretion may reduce the incidence of PPI to a certain extent.
ObjectiveTo summarize research progress of quality of life in patients after colorectal cancer surgery.MethodsThe literatures about quality of life of patients with colorectal cancer surgery in recent years are reviewed.ResultsQuality of life had became an important criterion for evaluating the therapeutic effect and prognosis of cancer. At present, the assessment tools for the quality of life of colorectal cancer patients mainly included the universal scale [such as Short Form Health Survey (SF-36)], the applicable scales for cancer patients [such as European Organization for Research and Treatment of Cancer: quality of life questionaire-C30 (EORTC QLQ-C30) and European Organization for Research and Treatment of Cancer: quality of life questionaire-CR38 (EORTC QLQ-CR38)], and the special scales for stoma patients represented by City of Hope Quality of Life-Ostomy Questionnaire (COH-QOL-OQ), Stoma Quality Of Life (Stoma-QOL), Stoma Quality Of Life Scale (SQOLS), and so on. The short-term quality of life of colorectal cancer patients was lower at 1 month after operation and recovered at 3 months after operation. Five years after surgery, attention should also be paid to the long-term quality of life. Besides, postoperative quality of life of colorectal cancer patients was affected by age, occupational status, economy, preoperative physical activity level, psychological and social factor, personality, surgical method, co-morbidity, complication, stoma, and so on.ConclusionsUnderstand the longitudinal changes and influencing factors of patients’ quality of life after operation, grasp the time point of effective intervention, and select appropriate assessment tools are necessary for medical staff. It is of great significance to further optimize the clinical management pathway and improve the quality of life of patients with colorectal cancer after operation.
ObjectiveTo investigate the prevalence of early mobilization and it’s influencing factors in colorectal cancer patients who underwent enhanced recovery after surgery (ERAS) pathway. MethodsThe geneal data and perioperative data were collected through questionnaire survey and accessing to the hospital information system. The situation of early mobilization was investigated by bedside inquiry. Logistic regression was used to analyze the influencing factors of early mobilization in the patients with colorectal cancer. ResultsIn this study, 300 patients with colorectal cancer underwent ERAS were selected. Within 24 h after operation, 47 patients got out of bed, the early mobilization rate was 15.7%. Logistic regression results showed that the patients without preoperative complications (OR=2.726, P=0.019) and without preoperative nutritional risk (OR=3.621, P=0.013), and with operation time <3 h (OR=2.246, P=0.032) increased the probability of early mobilization, and preoperative low albumin decreased the probability of early mobilization (OR=0.364, P=0.007). ConclusionsEarly mobilization rate of patients with colorectal cancer in ERAS mode is low. Preoperative complications, preoperative albumin level, preoperative NRS2002 score, and operation time were important influencing factors. Active treatment of preoperative complications and improvement of preoperative nutritional status could make patients bear follow-up stress process with better physical condition, which helps to promote early mobilization.
【摘要】 目的 观察针刺法在治疗痔瘘术后疼痛的临床疗效。 方法 2009年1-6月，将符合纳入标准的93例痔瘘术后中度疼痛患者，随机分为治疗组49例与对照组44例。治疗组采用针刺治疗术后疼痛；对照组采用口服莫比可治疗术后疼痛，观察两组患者疼痛的消除程度。 结果 消除疼痛有效率治疗组为91.83%，对照组为68.18%，治疗组镇痛效果与对照组比较，差异有统计学意义（Plt;0.05）。 结论 痔瘘术后应用针刺法止痛效果好，有良好的临床应用前景。【Abstract】 Objective To determine the effect of acupuncture on the treatment of pain after hemorrhoids and fistula operation. Methods Ninety-three participants who suffered from moderate pain after hemorrhoids and fistula operation in the West China Hospital of Sichuan University from January to June 2008 were enrolled prospectively and randomly assigned into treatment group (n=49) and control group (n=44). The treatment group was treated with acupuncture for postoperative pain relief, whilst Mobic was given orally to the control group. Relief degrees of pain in both groups were observed. Results Efficient power of pain relief was significantly higher in the treatment group compared with the control group (91.83% vs. 68.18%,Plt;0.05). Conclusion Application procedure of acupuncture can significantly relieve postoperative pain after hemorrhoids and fistula operation, which has a good prospect in clinical application.
Objective To compare the clinical effect between alginate calcium dressing and radix yarn dressing after anal fistula surgery. Methods A survey of 128 patients with anal fistula from April to October 2008 were studied. Patients were divided into two groups using a simple random method: 64 cases in therapy group which were treated with alginate calcium dressing and 64 cases in control group which were treated with traditional radix yarn dressing. The difference of the wound recovery indexes between two groups was compared.Results With regard to age, gender, anal fistula type, the proportion of preoperative diabetes and the diameter of wound, there was no statistical significance between therapy group and control group (Pgt;0.05). The proportion of slight pain during dressing change in therapy group (45.32%, 29/64) was more than control group (25.00%, 16/64), which had statistical significance (Pgt;0.05). The incidence of skin allergy was significantly different between two groups (29.69% vs. 60.94%, P＜0.05). Also, the rotten tissue and the soakage disappears with a shorter period, which both had statistical significance 〔(8.60±2.37) d vs. (12.22±3.29) d， (16.96±5.83) d vs. (22.02±5.90) d〕， Plt;0.05.Conclusion With the shorten of inflammatory and increment stage of the wound recovery, alginate calcium dressing is an ideal material for the postoperative duration of surgery of anal fistula.
ObjectiveTo understand the current situation and factors affecting tube blockage (non-mechanical) during hyperthermic intraperitoneal chemotherapy (HIPEC). MethodsAccording to the inclusion and exclusion criteria, the patients with malignant tumors who underwent HIPEC in the Department of Gastroenterology of West China Hospital of Sichuan University from May 2019 to May 2021 were retrospectively gathered. The information about the patient and the occurrence of occlusion during HIPEC were obtained by consulting electronic medical records and perfusion records. The logistic regression analysis was performed to analyze the factors influencing non-mechanical tube blockage during HIPEC. ResultsA total of 240 patients with malignant tumors were gathered. During HIPEC, the non-mechanical tube blockage occurred in 88 patients with malignant tumors, with the incidence of 36.7%. The multivariate analysis results by logistic regression showed that the probabilities of non-mechanical tube blockage during HIPEC were higher in the patients with age≥65 years (OR=2.142, P=0.016), diabetes mellitus (OR=2.326, P=0.007), perfusion speed of 300–450 mL/min (OR=2.778, P=0.001), ascites (OR=2.192, P=0.020), and PCI ≥20 points (OR=4.380, P<0.001). ConclusionsPatients with malignant tumors treated with HIPEC are prone to non-mechanical tube blockage. The patients with middle-aged and elderly, diabetes, low perfusion speed, ascites, and high PCI score need to be of great concern, so as to prevent and deal with tube blockage in time.
Objective To compare the differences in evaluating readiness for hospital discharge between nurses and colorectal cancer (CRC) patients following enhanced recovery after surgery (ERAS) pathway. Methods A cross-sectional survey was conducted in Department of Gastrointestinal Surgery, West China Hospital, Sichuan University. Patient-reported Readiness for Hospital Discharge Scale (RHDS) and nurse-reported RHDS were delivered to 130 CRC patients and 40 nurses respectively. All patients were followed ERAS pathway during perioperative periods. The differences were compared in evaluating readiness for hospital discharge between nurses and CRC patients. Results This study investigated 130 CRC patients and 40 responsible nurses. The scores of RHDS from nurses and patients were 162.86±27.95 and 149.86±33.65 respectively. When evaluating whether patients were ready to go home after discharge, the consistency between nurses’ results and patients’ results was weak（κ=0.365, P<0.001）. Items in patients’ RHDS scoring ranking from high to low were expected support, coping ability, knowledge, and personal status. Items in nurses’ RHDS scoring ranking from high to low were expected support, knowledge, coping ability, and personal status. Besides the " social support” dimension, the scores of other 3 dimensions from nurses were significantly higher than those from patients (P<0.05). Conclusion There is a gap between the assessment of RHDS from nurses and patients, nurses overestimated patients’ discharge readiness level.
ObjectiveTo explore the correlation between readiness for hospital discharge and short-term quality of life among colorectal cancer (CRC) patients following enhanced recovery after surgery (ERAS) mode.MethodsSurveys of 127 CRC patients following ERAS mode were conducted in the West China Hospital of Sichuan University. The Readiness for Hospital Discharge Scale and EORTC QLQ-C30 Scale were issued at the discharge and 1 month after the operation, respectively.ResultsThe total score of RHDS was 149.43±33.25. The score of global quality of life was 66.80±18.84. Correlation analysis showed that the total score of RHDS was positively correlated with the score of global quality of life (r=0.220, P=0.013), and negatively correlated with the scores of fatigue, nausea and vomiting, pain, loss of appetite (r=–0.304, P=0.001; r=–0.189, P=0.033; r=–0.257, P=0.004; r=–0.254, P=0.004). The score of personal status dimension were positively correlated with the score of global quality of life and emotional function (r=0.213, P=0.016; r=0.197, P=0.027), and negatively correlated with scores of fatigue, pain and insomnia (r=–0.311, P=0.000; r=–0.264, P=0.003; r=–0.257, P=0.004). The score of knowledge dimension was negatively correlated with nausea and vomiting, pain and loss of appetite (r=–0.212, P=0.017; r=–0.182, P=0.040; r=–0.239, P=0.007). The score of coping ability dimension was positively correlated with the score of global quality of life and physical function (r=0.204, P=0.021; r=0.204, P=0.021), while negatively correlated with scores of fatigue, pain, insomnia and loss of appetite (r=–0.349, P=0.000; r=–0.240, P=0.007; r=–0.202, P=0.022; r=–0.201, P=0.024). The score of expected support was positively correlated with the score of global quality of life (r=0.220, P=0.013), and negatively correlated with scores of fatigue and loss of appetite (r=–0.249, P=0.005; r=–0.227, P=0.010).ConclusionsThe short term quality of life among CRC patients following ERAS keeps at upper middle level, and positively correlated with the readiness for hospital discharge. It is suggested that discharge preparation service is of great significance to improve the quality of life of patients.