腹腔镜下经括约肌间切除术的围手术期护理

目的 探讨腹腔镜下经括约肌间切除术（ISR）治疗超低位直肠癌的围术期有效护理方法.方法 选取2009年6月-2011年6月16例超低位直肠癌患者作为研究对象,所有患者均行经腹腔镜下ISR治疗,同时给予围手术期护理,观察护理效果.结果 16例患者经围术期精心护理均积极配合手术,无死亡病例,无吻合口瘘病例,未发生术后出血病例,所有患者恢复肛门排便后均有不同程度的肛门不适症状,患者主要包括坠胀感、患者急便感、患者肛门灼痛、患者排便不尽感等.出现肛周皮肤湿疹或溃烂11例,临床表现为大便稀、次数增多3～10次/d,经围术期精心护理,患者排便次数逐渐减少,控便时间逐渐延长,术后1年多数患者可获得满意的排便控制.术后患者1年肛门括约肌功能评估,A级患者8例,B级4例,C级3例,D级1例,患者功能良好率为93.75％.结论 围手术期护理对经腹腔镜下ISR治疗非常重要,应重视该期护理,以提高临床疗效.

Perioperative nursing of laparoscopic intersphincteric resection

Objective To explore the effective perioperative nursing method of the treatment of ultralow rectal cancer through laparoscopic intersphincteric resection （ISR）.Methods Sixteen patients with ultralow rectal cancer from June 2009 to June 2011 were chosen,and all patients received the laparoscopic ISR and the perioperative nursing,and the nursing effect was observed.Results All patients could actively cooperate with the operation through perioperative nursing,and the cases of death,anastomotic leakage and postoperative bleeding were not found.All patients had the different degree of anal discomfort symptoms including the bulge,fecal urgency,anal burning,endless defecate feeling after the recovery of the anus defecation.The cases of the perianal skin eczema or ulceration were 11 cases,and the clinical features included that the stool was watery and the number of stool was frequency （3-10 times/day） ; the number of stool was gradually reduced and the time of controlling stool was gradually increased through the perioperative nursing,and most patients obtained the satisfactory bowel control 1 years after operation.The assessment of anal sphincter function one year after operation showed that the cases of A,B,C,D grade were respectively 8,4,3,1 cases,and the good rate of function in patients was 93.75%.Conclusions Perioperative nursing is very important for the laparoscopic ISR,and the attention should be paid to the perioperative nursing so as to improve the clinical efficacy.