评估在前列切除术期间产生阴性性尿路损伤的危险因素
Justin S Roskam1, Poya Pourghaderi1, Sara S Soliman1
1Department of Surgery, Morristown Medical Center, Morristown, NJ, USA.
The American surgeon
|June 1, 2023
概括
与开放式手术相比, laparoscopic proctectomy 显著减少了生殖尿路损伤 (GUIs). 显著的体重减轻和严重的全身疾病等因素会增加GUI风险,无论手术方法如何.
科学领域:
- 手术瘤学手术瘤学
- 泌尿器科 泌尿器科 泌尿器科 泌尿器科
- 患者安全 患者安全
背景情况:
- 生殖尿路损伤 (GUIs) 可以导致显著的术后功能障碍,延长恢复,并需要重新手术.
- 预防尿生殖器官的阴性损伤对于直肠手术后患者的最佳结果至关重要.
研究的目的:
- 为了比较腹腔镜和直肠癌的开放性分泌切除术之间的生殖尿路损伤 (GUIs) 的发生率.
- 确定与业内GUI相关的独立风险因素.
主要方法:
- 分析了来自2016-2019年ACS NSQIP向直肠切除数据库的2577名非转移性直肠癌患者.
- 使用单变量分析对腹腔镜和开放性分泌切除术之间的术后因素和GUI率进行比较.
- 多变量后勤回归用于确定内部操作GUI的独立风险因素.
主要成果:
- 开放性分泌切除术患者的术前并发症和GUI的发病率较高.
- 腹腔镜前切除与51.4%的GUI风险降低有关.
- 体重减轻 (>10%在6个月内) 和ASA类3状态是GUI的独立风险因素.
结论:
- 腹腔镜切除术与降低生殖尿路损伤的风险有关.
- 手术前的因素,如显著的体重减轻和严重的全身疾病 (ASA类3) 独立地增加GUI风险.
相关概念视频
Nursing Assessment of the Genitourinary System I: Health History
34
The genitourinary system is critical to maintaining fluid balance, waste elimination, and reproductive function. Nurses play a vital role in assessing this system, beginning with a thorough health history. This process involves gathering patient information, identifying risk factors, and recognizing symptoms of genitourinary disorders. Early detection is vital for timely interventions and management.1. Gathering Patient InformationA complete health history includes the patient’s personal,...
34
Nursing Assessment of the Genitourinary System II: Inspection and Palpation
147
The nursing assessment of the genitourinary (GU) system involves a systematic inspection and palpation to identify abnormalities in the kidneys, bladder, and surrounding structures.InspectionMouth: Inspect for signs of kidney dysfunction, such as stomatitis (inflammation of the mouth) and ammonia breath, which may occur in advanced kidney disease due to the buildup of urea, breaking down into ammonia.Skin: Check for pallor, which could indicate anemia caused by kidney disease. Look for...
147
Urinary Tract Calculi VI: Surgical Management
11
Procedures for Kidney StonesMedical intervention is necessary when kidney stones or renal calculi are too large to pass spontaneously (typically greater than 5 millimeters) when stones are accompanied by symptomatic infection (such as fever or pyelonephritis), when they impair kidney function, or when they cause persistent symptoms like severe pain, nausea, or urinary retention. Additionally, patients with only one kidney or those who cannot be treated with medical management also require...
11
Acute Kidney Injury IV: Diagnostic Studies and Prevention
41
Accurate diagnosis and effective prevention are critical in managing Acute Kidney Injury (AKI), which is linked to high mortality rates ranging from 10% to 80%. Timely recognition of at-risk patients and careful monitoring can significantly reduce the likelihood of kidney damage.Diagnostic Assessments:The diagnostic process starts with a comprehensive medical history to identify prerenal, intrarenal, and postrenal causes.Prerenal causes, such as dehydration, hypotension, or blood loss, should...
41
Urinary Tract Infection IV: Nursing Management
32
In managing urinary tract infections (UTIs) in nursing, a comprehensive assessment is essential. Begin by gathering subjective data, such as the patient’s complaints of dysuria (painful urination), urinary frequency, urgency, suprapubic pain, and any lower abdominal discomfort. This information can be complemented by questions regarding previous UTIs, sexual activity, and personal hygiene practices, which can provide insight into risk factors. Objective assessment should focus on signs...
32
Urinary Tract Calculi V: Nursing Management
14
AssessmentSubjective Data: Obtain a detailed health history, including any recent or chronic urinary tract infections, periods of immobilization, previous episodes of renal calculi, and medical conditions such as gout, benign prostatic hyperplasia, or hyperparathyroidism. Review the medication history for drugs that may influence stone formation, including allopurinol, analgesics, loop diuretics, or thiazide diuretics. Document the use of long-term indwelling catheters and any past surgical...
14


