妇科NOTES手术与普通腹腔镜手术围手术期护理对比与效果分析

目的探讨妇科自然腔道内镜外科(natural orifice transluminal endoscopic surgery，NOTES)手术与普通腹腔镜手术护理方法的异同及效果。 方法回顾性分析北京协和医院妇科2017年期间实施的8例NOTES手术患者的临床资料，术前检查、术前和术后护理、出院指导方面，与普通腹腔镜手术围手术期护理进行比较，总结NOTES手术的护理要点。 结果NOTES手术在术前应排除阴道手术禁忌证，加强阴道消毒和肠道准备，重视患者心理护理，术后NOTES手术患者切口疼痛较普通腹腔镜手术患者轻，下床活动及排气早，护理上应重视阴道出血及留置阴道引流管的观察。术后只有1例患者在术后2个月时出现阴道出血量大于月经量2 d，考虑阴道后穹窿切口缝线吸收所致。 结论NOTES手术治疗妇科疾病具有手术创伤小、痛苦少、术后恢复快等优点，将是妇科手术发展的新方向，但现阶段仍在探索中，护理人员应根据NOTES手术的特点，制定相应的护理计划及措施，促进患者康复。

Comparison and effect analysis of perioperative nursing between gynecologic NOTES operation and laparoscopic operation

ObjectiveTo explore the similarities and differences of the nursing methods of gynecologic NOTES operation and common laparoscopic operation. MethodsThe clinical data of 8 cases of NOTES gynecologic surgery completed in Peking Union Medical College Hospital in 2017 were retrospectively analyzed. Preoperative examination, preoperative and postoperative care and discharge guidance were compared with these of common laparoscopic surgery. The nursing′s key points of NOTES operation were summarized. ResultsNOTES surgery should exclude all contraindications for vaginal operations, vaginal disinfection and bowel preparation should be emphasized. After operation, the pain of NOTES patients was lighter than that of ordinary laparoscopy, and the ambulation and anal exhaust were earlier. Vaginal bleeding and vaginal tube drainage should be observed carefully. In this study, only 1 patients experienced vaginal bleeding more than menstrual volume for 2 days in 2 months after operation, related to the absorption of the suture of vaginal fornix of the vagina. ConclusionsNOTES operation is a new direction for gynecologic surgery, but it is still in the exploratory stage. According to the characteristics of the NOTES operation, the nursing staff should formulate pertinent nursing measures to promote the recovery of the patients.