经皮肝穿刺胆管引流术联合胆道支架植入治疗34例恶性梗阻性黄疸护理体会

目的 考察经皮肝穿刺胆管引流术(PTCD)联合胆道金属支架植入术治疗恶性梗阻性黄疸患者的护理疗效，归纳并探究治疗前后并发症的护理体会。 方法 回顾性分析肝胆外科2008年4月—2014年3月行PTCD联合胆道支架植入术的34例恶性梗阻性黄疸患者的护理。 结果 34例经皮肝穿刺胆管引流术(PTCD)联合胆道金属支架植入术全部成功，黄疸5 d内退净6例，黄疸2周内退净18例，2周内黄疸明显减轻7例。皮肤、巩膜黄染及皮肤瘙痒症状3～7 d消失，大小便颜色2～5 d恢复正常；血尿淀粉酶明显升高5例，经4～7 d应用生长抑素后治愈；局限性胆汁性腹膜炎4例，重新放置PTCD引流管后症状消失；引流管脱出2例，经及时处理后好转出院；夹管带管出院1例。所有患者均未出现穿孔、腹膜炎等其他严重并发症。 结论 PTCD结合胆道金属支架置入治疗恶性梗阻性黄疸患者效果良好、创伤小；合理、有效、优质的围手术期护理可促进手术成功及为良好预后提供重要保证。系统的个性化的护理方案以及切实有效的措施可为支架植入患者的恢复提供重要保障。同时，在临床护理过程中仍然需要不断探索及总结经验，使患者能更好地配合治疗并增加战胜疾病的信心，积极的心理状态可以促进患者康复。 

Nursing of PTCD with biliary stenting for malignant biliary obstruction: analysis of 34 cases

Objective To evaluate the care efficacy of percutaneous transhepatic biliary drainage(PTCD) combined with biliary stenting in patients with malignant obstructive jaundice,and to summarize the nursing experience in complications. Methods The nursing materials for 34 patients with malignant obstructive jaundice treated by PTCD combined with biliary stenting in our department between April,2008 and March,2014 were analyzed retrospectively. Results The surgery in all cases was successfully.The jaundice relieved exactly in 5 days in 6 cases;relieved exactly in 14 days in 18 cases;improved obviously in 14 days in 7 cases,among them,yellow skin and sclera,and skin pruritus faded away in 3 to 7 days,color of urination and defecation recovered in 2 to 5 days;elevated amylase level in blood and urine in 5 cases,recovered after somatostatin treatment of 4 to 7 days;localized biliary peritonitis in 4 cases,the symptoms disappeared after the replacement of PTCD catheter;accidental catheter detachment in 2 cases,coped timely;1 patient was discharged with a tube pinch.There was no perforation,peritonitis and other complications. Conclusions PTCD combined with biliary stenting for malignant obstructive jaundice was effective,with less invasive.The reasonable and effective perioperative nursing care can provide a good guarantee for the success of the procedure and patient prognosis.The systematic and personalized care programs as well as effective measures can provide important protection for stent implantation in patient recovery.