腹腔镜胆囊切除术患者的围手术期护理

目的腹腔镜胆囊切除术(LC)以其手术创口小、患者痛苦少、出血少、恢复快、感染概率小、住院时间短、腹部不留明显瘢痕、术后肠粘连少等优点,近年来成为胆囊切除术的主要术式,据文献报道胆囊切除术中,LC已占到95%以上。因为LC与开腹手术差别很大,因而二者的护理措施也不尽相同。通过总结腹腔镜胆囊切除术的术前、术中、术后护理经验,达到认识如何加强围手术护理才能保证手术成功。方法收集湖南省浏阳市人民医院普外科自2004年1月至2008年12月患者中选择LC手术患者46例,以总结和发现LC围手术期护理要点、重点及原则。总结术前、术中和术后的各项护理经验。结果本组病例均痊愈出院,术中放置腹腔引流管者12例。主要的并发症包括不同程度的恶心、呕吐,共15例,胆漏2例,腹腔内出血1例。术后住院3～4d出院。结论LC术是近年来外科微创手术中开展较广泛新技术之一,主要特点是创伤小、瘢痕小、康复快,受到患者的欢迎。随着老年化社会的到来,中老年人行LC术越来越多见。老年人常合并有内科疾病,为疾病的治疗和护理带来挑战,且由于内镜下手术操作空间有限,直观性不强,故术后并发症的观察及护理尤其重要。严格掌握术前适应证,熟悉该手术的特点,加强术后并发症的观察和及时处理是患者康复的保障。

The Nursing of Perioperative Patients Treated by Laparoscopic Cholecystectomy

Objective Laparoscopic cholecystectomy （LC） for its small wound surgery, the patient less pain, less bleeding, faster recovery, the small probability of infection, hospital a short time, the abdomen without leaving obvious scars after intestinal adhesion fewer advantages, in recent years, Cholecystectomy to become the main method, it has been reported in the literature cholecystectomy, LC has accounted for more than 95 percent. Because LC and open surgery vary greatly, so the two measures of care also vary. The adoption of laparoscopic cholecystectomy summarize the preoperative, intraoperative and postoperative care experience, to understand how to enhance peri-operative care in order to ensure successful operation. Methods Collection of general surgery in our hospital fi＇om January 2004 to December 2008 in select patients patients LC 46 cases, to sum up and found LC Peri-operative nursing points, the focus and principles. Summary of before, during and after the nursing experience. Results The patients were cured and discharged. Of peritoneal drainage tube placed in those 12 cases. The main complications, including varying degrees of nausea, vomiting, a total of 15 cases, bile leakage two cases, one case of abdominal bleeding. After hospital discharge three to four days. Conclusion LC of minimally invasive surgery in recent years, more extensive surgery in one of the new technology, is the main characteristics of small wounds, scars of small, fast recovery, patients are welcome. With the arrival of aging society, the elderly in line with growing LC. The elderly often associated with internal diseases, diseases of the treatment and care challenges, and endoscopic surgical operation due to limited space, the visual is not strong, the postoperative complications of observation and care is especially important. Strict control of the former indications, and is familiar with the characteristics of the operation, the strengthening of postoperative complications and timely treatment is observed in patients with protection.