经电子十二指肠镜乳头括约肌切开联合腹腔镜胆囊切除术同期治疗肝外胆管结石伴胆囊结石的护理观察及干预  

Nursing Observation and Intervention of Extrahepatic Bile Duct Stones with Gallstones Treated with Electronic Duodenoscopic Sphincterotomy Combined with Laparoscopic Cholecystectomy

作　　者：周洁[1] 李金龙[1] 

机构地区：[1]四川省第四人民医院外一病区,成都610016

出　　处：《华西医学》2015年第6期1123-1126,共4页West China Medical Journal

摘　　要：目的 探讨护理观察和干预在经电子十二指肠镜乳头括约肌切开（EST）联合腹腔镜胆囊切除术（LC）治疗肝外胆管结石伴胆囊结石中的重要性。方法 对 2011 年 7 月－ 2014 年 2 月 157 例肝外胆管结石伴胆囊结石同期行 EST ＋ LC 患者，结合 EST＋LC 手术特点，着重在术后并发症和管道护理方面予以严密观察和及时干预，确保术后患者康复。结果 156 例患者同期完成了 EST＋LC，完成率为 99.36%；1 例患者因十二指肠乳头为憩室内乳头未完成 EST 而即时中转行 LC＋ 胆道切开胆道镜下取石 ＋T 管引流术。在护理人员的严密观察和精心护理下，患者均未出现十二指肠穿孔、胆漏等并发症，无 1 例死亡，住院 7 ～ 13 d 后均痊愈出院。结论 及时观察和干预是同期行 EST＋LC 术后减少严重并发症、提高手术质量、增强患者舒适度的重要保障，在促进患者术后恢复过程中起着积极的作用。Objective To investigate the importance of nursing observation and intervention for extrahepatic bile duct stones with gallbladder stones treated by electronic duodenoscopic sphincterotomy （EST） combined with laparoscopic cholecystectomy （LC）. Methods From July 2011 to February 2014, 157 patients with extrahepatic bile duct stones with gallbladder stones underwent EST and LC at the same time in our department. Combined with the surgery characteristics, we focused on the close observation and nursing of postoperative complications and drainage tubes for patients＇ timely recovery. Results One patient with duodenal diverticulum papilla did not complete EST and LC surgery, which was then transformed to LC, bile duct incision and choledochoscopy with T tube drainage. All the remaining 156 patients completed endoscopic retrograde cholangio-pancreatography and LC with a completion rate of 99.36%. Under close observation and careful nursing care, this group of patients did not have duodenum perforation, bile leakage or other complications. No patient died. Seven to thirteen days after hospitalization, all the patients were cured and discharged from the hospital. Conclusion For patients undergoing EST and LC at the same time, observation and timely intervention are very important in reducing serious complications, improving the quality of surgery, enhancing patients＇ comfort, and promoting postoperative recovery.

关 键 词：经电子十二指肠镜乳头括约肌切开术 腹腔镜胆囊切除术 术后护理观察和干预 

分 类 号：R473.6[医药卫生—护理学]