经内镜置入全覆膜自膨式可回收金属支架治疗肝移植后胆管吻合口狭窄患者的护理  

Nursing of endoscopic full-covered self-expanding removable metal stents implantation for bile duct anastomotic strictures after liver transplantation

作　　者：高秀珍[1] 郭忠华[2] 张诚[3] 杨玉龙[3] 李立[3] 

机构地区：[1]大连医科大学附属大连市中心医院消化内科,116033 [2]大连医科大学附属大连市中心医院胃肠外一科,116033 [3]大连大学附属中山医院胆道微创外科,116001

出　　处：《中国实用护理杂志》2017年第7期504-507,共4页Chinese Journal of Practical Nursing

摘　　要：目的探讨经内镜置入全覆膜自膨式可回收金属支架治疗肝移植术后胆管吻合口狭窄的护理要点。方法回顾性分析2013年1月至2015年7月应用全覆膜自膨式可回收金属支架治疗的9例肝移植术后胆管吻合151狭窄患者的临床资料，总结其护理过程。结果9例患者均成功置入并取出全覆膜自膨式可回收金属支架，术后未出现支架移位、急性胰腺炎、胆道出血、肠漏等并发症，金属支架取出后胆管吻合口狭窄均解除，随访10-32个月，未出现胆管吻合口狭窄相关症状和体征。结论全覆膜自膨式可回收金属支架治疗的肝移植术后胆管吻合15I狭窄患者，术前应介绍金属支架性能及治疗过程，提高患者依从性；熟悉内镜操作步骤、金属支架放置及取出方法，缩短手术操作时间；术后加强鼻胆管护理，注意金属支架放置及取出术后可能出现的并发症的观察，及时发现和治疗；加强金属支架放置及取出期间的延续护理。Objective To investigate the nursing points of endoscopic full-covered self-expanding removable metal stents （FCSERMS） implantation for bile duct anastomotic strictures after liver transplantation. Methods The clinical data of patients who were treated by endoscopic full-covered self- expanding removable metal stents implantation for bile duct anastomotic strictures after liver transplantation from January 2013 to July 2015 were retrospectively analyzed, and the nursing process were summarized. Results The group of 9 patients were successfully placed and removed with FCSERMS. There was no postoperative complication, such as stent migration, acute pancreatitis, biliary bleeding and intestinal leakage. All the bile duct strictures were relieved after FCSERMS removement. Followed up for 10-32 months, there was no symptom and sign of bile duct anastomotic stricture recurrent. Conclusions The key in nursing points of FCSERMS implantation for bile duct anastomotic strictures after liver transplantation are introducing the function of FCSERMS and therapeutic process to improve patient compliance, mastering the endoscopic operations, the placement and removal method of FCSERMS to short operation time, strengthening postoperative nasal bile duct care, paying attention to the observation, detection and treatment of postoperative complications after the metal stent placement and removement, as well as the continuing care during the period between placement and removment of FCSERMS.

关 键 词：肝移植 护理 胆管吻合口狭窄 内镜逆行胰胆管造影 可回收金属支架 

分 类 号：R473.6[医药卫生—护理学]