腹腔镜胆囊切除术围手术期的护理

目的探讨腹腔镜胆囊切除术的围手术期护理方法。方法回顾性分析2007年1月-2009年8月,738例胆囊结石、胆囊息肉者施行腹腔镜胆囊切除术的临床资料,总结围手术期的护理措施和并发症的观察与护理。术前对患者进行全面的身体评估、做好健康指导及心理护理。术后患者回病房后给予常规护理,严密监测循环、呼吸系统,密切观察腹部体征及全身情况。同时给予饮食、活动和出院指导,预防并发症。结果 738例腹腔镜胆囊切除术,术中因1例胆总管损伤中转行横断胆管端-端吻合、T管引流术;5例出血、经腹腔镜探查胆囊周围严重粘连而中转开腹行胆囊切除术,其余手术顺利完成。术后发现2例胆总管损伤,9例腹腔出血,3例戳洞处出血,5例胆漏,21例肩部疼痛,经及时治疗与护理,全组病例均痊愈出院。结论虽然经腹腔镜胆囊切除术创伤小、痛苦少、术后恢复快,但也存在着一定的风险和并发症。只有科学、周密地做好围术期的治疗和护理,才是手术成功的重要保证。

Perioperative Nursing of Laparoscopic Cholecystectomy

Objective To explore the perioperative nursing of laparoscopic cholecystectomy.Methods The clinical data of 738 cases of gallstones or gallbladder polyps undergoing laparoscopic cholecystectomy from Jan.2007 to Aug.2009 were analyzed retrospectively.The perioperative care measures and complications treatment were summarized.All patients underwent a full preoperative medical assessment,health guidance and mental health care,and postoperative routine nursing.The circulation,respiratory,abdominal signs and general condition were close monitored.And the guidance on diet,exercise and discharge were performed to prevent from the complications.Results In all 738 cases undergoing laparoscopic cholecystectomy,1 case was with intraoperative bile duct injury and converted to biliary tract end to end anastomosis and T-tube drainage;5 cases were with bleeding around the gallbladder and severe adhesions confirmed by laparoscopy,and converted to laparotomy for cholecystectomy;2 cases with bile duct injury;9 cases with abdominal hemorrhage,3 cases with hemorrhage of poke holes,5 cases with bile leakage,and 21 cases with shoulder pain.All patients were cured by timely treatment and care.Conclusion The laparoscopic cholecystectomy is a minimally invasive keyhole surgical method with the features of minimal invasion,less pain,rapid recovery,and certain risks and complications.The scientific and close perioperative treatment and care is keys to successful surgery.