People who have had hemorrhoids have been tortured by the anus, and if one day, because of cancer, you have to lose your anus, would you?
"Stoma people", is such a group of people who have lost the function of the anus, they need surgery to remove the lesion site to continue life because of serious diseases (such as tumors) in the colorectum, bladder and other parts, the doctor opens an opening in the abdomen, fixes the intestinal tube on the skin of the abdomen, wears a special stoma care device to collect excrement, and for the rest of their lives, they rely on "artificial anus" to live.
According to the late Professor Yu Dehong, the founder of modern Anorectal Surgery in China and the father of Chinese ostomy, it is estimated that about 100,000 new permanent enterostomy patients are added to the mainland every year, and the total number has exceeded 1 million, and it has shown an upward trend year by year.
In the past, due to the limitations of ostomy supplies, stoma patients were ashamed to see people every day because of their image, odor and other reasons. Nowadays, with the improvement of advanced stoma tools and new adjuvant treatment methods, the quality of life of stoma people has been greatly improved, and they have begun to regain dignity and self-confidence.
The "bag of dung" is not terrible, and it is painful to barely keep the anus
On September 28, at 2:30 p.m., peking university cancer hospital gastrointestinal tumor center ward 3 (colorectal oncology department) stoma ward.
Chen Ruifen, 55, had just completed her first postoperative ostomy treatment, dragging her weak body slowly to the door, leaning against a table, waiting for her husband who was paying the fee.
Half a month ago, because of the recurrence of rectal cancer, Chen Ruifen and his wife came to Beijing Cancer Hospital from Dazhou, Sichuan, 1600 kilometers away, where there is the earliest established colorectal cancer diagnosis and treatment specialty in the country, and in October 2015, the country's first stoma ward was established, where there are stoma clinics every Tuesday and Friday, and more than 80 numbers are hung up in an afternoon clinic.
The ostomy clinic of Peking University Cancer Hospital has to hang more than 80 numbers in one afternoon
"I was very healthy before, I liked to eat vegetables, I didn't eat much meat, I didn't eat spicy, I really didn't expect to get this disease." Chen Ruifen, who speaks Sichuan Mandarin, told reporters in a low voice that this was not her first encounter with rectal cancer, and that she had completed her first rectal cancer surgery in Chongqing in early 2017, and the doctor had reserved her anus at the time, but unfortunately recurred a year later, and she underwent a second operation in Beizhu on September 14.
Chen Ruifen has a daughter who makes her proud, after graduating with a master's degree, she worked as a doctor in the neurology department of a top three hospital in Chongqing. But more often, Chen Ruifen's face has been hanging on the sad face of being tormented by illness, two months ago there were 100 pounds of her, after a period of surgery and chemotherapy, lost weight to about 80 pounds, and can only eat liquid food, such as corn paste, lotus flour, etc., always hungry and panicked.
After being pumped twice in a row by rectal cancer, she couldn't figure it out and was not willing in her heart. Chen Ruifen is the eldest in the family, often worrying about various family affairs, sometimes the mental pressure is relatively large, she guessed, this may be the reason why cancer found her.
Although the first rectal cancer surgery Chen Ruifen was lucky to save the anus, but this time the recurrence was not spared, the doctor removed the anus according to the condition, made a stoma for her, and could only live with the "fecal bag" in the future, which made her full of regret and sadness.
Director Wu Aiwen of the Third Ward of the Gastrointestinal Tumor Center is out of the clinic
70 to 80% of patients have anterior rectal resection syndrome after preservation surgery, and some patients have very severe symptoms, such as a very large number of stools, reaching 20 to 30 times a day, these patients are very painful, it is difficult for the anus to control their own stool intentions, which is very affecting life and work. Professor Wu Aiwen, director of the third ward of the Gastrointestinal Tumor Center of Peking University Cancer Hospital, admitted that in fact, after the removal of the sphincter for a permanent intestinal stoma, the patient's quality of life may not be worse.
Rectal cancer patients do not protect the anus, not determined by subjective will, but determined by the position of the tumor. The doctor can only make a rough judgment before surgery, if the tumor grows too close to the anus, within 5 centimeters, when removing the tumor, the rectum and the connected anus need to be removed together.
There have been such rectal cancer patients, rather than do ostomy, insist on pleading with the doctor to keep the anus, the doctor had to keep the anus for him, but could not clean the intestinal lymph nodes before and after the lesion site, leaving hidden dangers, a year later the tumor metastasized through lymphatic spread, when he found the doctor again, it was useless.
Director Wu said that for some elderly patients or patients with various underlying diseases (diabetes, incontinence, etc.), preservation surgery is prone to anastomotic leakage or bleeding, which has a great impact on the patient's life, and it is not recommended to do preservation surgery. Today's new technology research and methods, such as preoperative new adjuvant therapy methods and the latest improved stoma care products, have been able to reduce patient complications and live like normal people.
Dr. Lili Song introduced how patients with permanent stomas face life:
From steel rings to "plasticine", stoma lifting helps patients regain their dignity
Once the stoma is done, the pouch and chassis are no longer indispensable. One-piece or two-piece? Open or closed pockets? Choosing a good choice of stoma supplies that suits them has become a problem that stoma people need to consider extra.
Gu Jin, a well-known colorectal cancer authority in the mainland, chairman of the former oncology branch of the Chinese Medical Association and president of Beijing Shougang Hospital, once said that stoma patients are mostly malignant tumor patients, and their urine and intestines are involuntarily excreted through the stoma after surgery, and such patients will need to paste a bag at the stoma to contain excrement after discharge. They not only experience the blow of the disease, but also suffer from the use of stomas to collect their own excrement, and most patients cannot withstand multiple blows psychologically, making their quality of life poor.
In the past, the pouch did not come with a filter, and the smell of excrement could leak out, causing a lingering odor on the body, or the pouch accidentally bulged, causing embarrassment in public. The damage to the image and the fear of odor caused by these bring great mental pressure to stoma people, limit their normal social interaction activities, and greatly reduce the quality of life.
Zhang Jie, an international stoma therapist, introduced the development history of stoma appliances
Zhang Jie, head nurse of the third ward of the Gastrointestinal Cancer Center of Peking University Cancer Hospital, is an international stoma therapist, and she introduced the "past life and present life" of ostomy supplies to reporters.
About 30 years ago, the earliest pouch was to use a steel ring or a kettle lid like something, outside a simple plastic bag, the patient's stoma diameter is completely different, the size of the steel ring can not change, so that most of the skin will be exposed, feces for a long time impregnated skin, bladder cancer patients will also appear urine impregnation, resulting in skin inflammation and damage.
If the patient cleans more timely, the inflammation may heal, but this inflammatory reaction will still be repeated, continuous damage and healing will cause pseudo-wart inflammatory hyperplasia, like a layer of scar-like, very black and thick inflammatory stratum corneum, then there will be itching, pain, wrinkled feeling, the patient does not feel a problem at first, but the discomfort behind continues to increase, and then slowly there is a feeling.
Later, there was a stickable pouch, cleaning is much more convenient, the patient can be cut into the right size, but the elderly cut the big cut is different, may cause waste, cut large may also appear the previous inflammatory response problem.
Now, the latest plastic chassis, without scissors scissors, can be opened by hand like plasticine, how big it needs to be, avoiding the inconvenience of carrying scissors, from the past simple to the current human needs, there has been a great improvement.
At the same time, in the past when wearing steel rings, patients have no dignity to speak of, as long as the stool does not flow out, it is very satisfied, and the adhesive, plastic stoma chassis that appears later is better sealed, the taste can be eliminated, and the ostomy person has no difference when getting along with others, and has more confidence and dignity to communicate with others.
Shanghai does not pay up to 2500 yuan for stoma pockets for non-outpatient patients in one year
At present, the cost of ostomy surgery can be reimbursed in a certain proportion throughout the country, but the scope of postoperative nursing supplies included in medical insurance payment is mainly in some first-tier cities or individual developed cities in the east, and most second- and third-tier cities have not yet provided medical insurance subsidies for ostomy care. According to the information revealed by Liu Peihua, the founder of the Ostomy Forum, in an interview with the media, the proportion of medical insurance is 75% to 85% in Beijing, 80% in Nanjing, 90% in Qingdao, and Shanghai pays up to 2500 yuan for outpatient pocket costs within a year.
Not an alien ET, a small number of people in China, a lack of norms "ostomy butler"
The ET we are familiar with, Chinese means alien, but in the field of medicine, et enterostomal Therapist, the stoma is mostly an inestomy.
According to Nurse Zhang Jie, ET is currently mainly managed by the Professional Committee of Ostomy, Wound and Incontinence of the Chinese Nursing Association. Ostomy therapists are nurses with certain professional qualities, after systematic specialized training and assessment, by the World Association of Ostomy Therapists (WCET) review and issue professional qualification certificates, is a group of nurses with a high degree of specialization. The current situation of ET work in mainland China is that general hospitals are mostly for various types of wound care, and tumor specialty hospitals are mostly for stoma care.
"Her skin is well cared for, and the wound may be slightly sensitive." Nurse Wang Xinjing, who had just finished the ostomy treatment for Chen Ruifen, explained the previous treatment process to the reporter, and then called the next patient to come in, and the perennial work made her have rich experience in all kinds of stoma and wound treatment.
China's ET stoma therapists vary greatly across the country, the degree of attention is also different, in the north, Shanghai and Guangzhou areas are relatively adequately equipped, and there is no ET place to ignore patient care, patients are difficult to have the correct awareness of stoma care.
"Nursing staff is not enough, some places are nurses to do nursing, some places doctors to do nursing, the level of nursing is uneven." Zhang Jie said for example, for example, the skin color around the stoma, blackness is actually abnormal, but most stoma patients only think that the epidermis is not broken, not shed is normal, this is because in many areas of ostomy professionals lack of understanding.
In 2017, 10 ostomy therapist training schools in mainland China trained more than 800 ostomy therapists, and it is expected that 150 new stoma therapists will be added by 2018. Surgeons pay much attention to ostomy surgery, but rarely pay attention to the patient's postoperative ostomy care, and the stoma therapist is a group of professionals who are specifically responsible for helping the patient's stoma care.
A stoma nurse at the Gastrointestinal Cancer Center of Peking University Cancer Hospital is at work
Zhang Jie has seen such patients, because of the lack of care, the stoma has necrosis, the entire necrosis of the intestinal tube will fall off, like a piece of rotten flesh, but if the intestinal tube does not completely fall into the abdominal cavity, the general hospital will not do emergency surgery, but there is a layer of mucosa on the stoma has gone, the skin to the center of the longer and deeper the formation of a hole, "finally into a small eye smaller than the little thumb, how can such a patient defecate?" ”
In fact, if there is early professional intervention, with a pouch, chassis and a belt to push out the retracted mucosa, 1 to 3 months after complete healing can be solved.
In the 1990s, there was no profession of ostomy nurse in the mainland. At that time, nurses cared for stoma people in a simple and straightforward way: a gauze was covered on the stoma, and when it was defecated, the dirt was wiped off, and then the gauze was covered. This primitive method of nursing not only keeps the anorectal nurses busy, but even worse, the patients who have had an ostomy can no longer live like normal people, and can only spend most of the day with the bed.
How to scientifically care for stoma patients has plagued nurses for many years. It was not until 2002, when Sun Yat-sen Medical University in Guangzhou opened the first stoma therapist school and invited international stoma therapists from Hong Kong to teach the first 23 students, and since then, the mainland has begun to have a career as an ostomy nurse.
At present, China's international stoma therapists, most of whom appear in a part-time state, are also the head nurses of various departments, but foreign countries are full-time ET, can go out of the clinic or consultation, in addition to the professional nursing that ET is responsible for, they are not responsible for clinical nursing, they have more time to do related research.
"Foreign stoma research is deeper than domestic, but the ability to deal with complications is not as good as China ET." Ms. Zhang Jie, who has visited hospitals in Japan, is not only gastroenterology, but in almost every ward, there is a small room reserved for stoma patients, equipped with free pouches, cleaning tissues and facilities, which impresses her.
The total number of enterostomy patients in mainland China has long exceeded 1 million, more and more people have begun to pay attention to such an unknown group, with the continuous improvement of colon cancer treatment effects and stoma tools, many intestinal ostomy patients can get long-term survival and live like normal people. But how to train more professional stoma therapists and help more stoma patients to live with the stoma correctly and friendly, there is still a long way to go.
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