腹部无切口经肛门切除肿瘤腹腔镜低位直肠癌根治吻合器结肠造口的护理模式  

The nursing model of using colonic diversion to cure low rectal cancer under the help of laparoscope and anastomat without any abdomen incision

作　　者：陈彩玲[1] 杨梅[1] 李艳华[1] 王莉[1] 韩秀艳[1] 吕丹丹[1] 李世拥[1] 

机构地区：[1]北京军区总医院普通外科,北京市100700

出　　处：《护理实践与研究》2016年第2期70-72,共3页Nursing Practice and Research

基　　金：国家自然科学基金资助课题(81041025;81000189)

摘　　要：目的：探讨腹部无切口经肛门切除肿瘤的腹腔镜低位直肠癌根治吻合器腹部结肠造VI的三到位和六加强的护理模式。方法：对30例腹部无切口经肛门切除肿瘤的腹腔镜低位直肠癌根治吻合器腹部结肠造口患者，采用统一的整体护理模式，做到术前三到位，即皮肤护理，肠道护理，心理护理到位；术后做到六加强，即加强造口观察护理，加强营养护理，加强造口功能训练护理，加强会阴部观察护理，加强早期肠梗阻观察护理，加强出院康复指导护理。结果：30例患者术后2—3d肠蠕动恢复腹部结肠造口排气，4—5d开始进食，5～6d下床活动，术后平均住院9d，术后未发生与手术相关并发症。术后随访1～39个月，腹部结肠造口无坏死、狭窄、回缩等并发症，排便通畅，无局部肿瘤复发。结论：三到位和六加强的护理方法是促进腹部无切口经肛门切除肿瘤的腹腔镜低位直肠癌根治吻合器腹部结肠造口的快速康复、有效、可行的护理模式。Objective ： To explore the nursing model of three standards and six key steps when low rectal cancer patients are treated with colonic diversion un- der the help of laparoseope and anastomat and the tumor is cut by anus. Methods ： Apply universal comprehensive nursing model on 30 patients who were treated with colonic diversion under the help of laparoscope and anastomat and the tumor was cut by anus. The nursing model includes three preparation standards before the operation, including skin care, intestinal tract care, psychological preparation and six key steps after the operation, including intensive colonic diversion care, intensive nutrition care, intensive stoma function training, intensive perineum observation and care, intensive observation for early intestinal obstruction and intensive recovery guidance after hospital discharge. Results：Thirty patients can have normal optical cavity and the colon diversion can exhaust normally 2 to 3 days after the operation and begin to feed food 4 to 5 days after the operation and begin to get off the bed 5 to 6 days after the operation. The patients usually stay in hospital for 9 days after the operation and have no relevant complications. In the follow - up visit 1 to 39 months after the operation, the colon diversion has no complications like necrosis, narrowness and contractions and it can defecate normally without tumor occurrence. Conclusion ： The nursing model of three standards and six key steps is an effective and practical nursing model which can be used to cure the low rectal canc- er patients who can be treated with colonic diversion under the help of laparoscope and anastomat and the tumor is cut by anus.

关 键 词：直肠肿瘤 腹腔镜 造口术 护理干预 

分 类 号：R473.73[医药卫生—护理学]