微创治疗胆总管结石的护理对策  

Nursing countermeasures for choledocholithiasis by minimally invasive surgery

作　　者：吴兆琴[1] 金晓灵[1] WU Zhaoqin;JIN Xiaoling(Hepatobiliary and Pancreatic Center,Zhongda Hospital Affiliated to Southeast University,Nanjing,Jiangsu,210009)

机构地区：[1]东南大学附属中大医院肝胆胰中心,江苏南京210009

出　　处：《实用临床医药杂志》2020年第16期112-114,共3页Journal of Clinical Medicine in Practice

摘　　要：目的探讨行腹腔镜胆总管切开取石术(LCBDE)后Ⅰ期缝合的高龄患者存在的护理问题,并提出相应对策。方法回顾性分析接受LCBDE的高龄胆总管结石患者92例临床资料,其中行胆总管Ⅰ期缝合35例,放置T管引流57例,探讨Ⅰ期缝合的护理问题。结果高龄患者术后置T管导致胆汁大量丢失,引起水电解质及酸碱平衡紊乱,脂类及蛋白质营养物质吸收不良;T管不便携带,固定T管处易发生牵拉疼痛,易发生肺部感染和下肢静脉血栓等并发症。胆总管Ⅰ期缝合相对安全且效果确切,高龄患者相关并发症较少,但需要注意其适应证,并防止术后胆漏的发生。结论行腹腔镜胆管切开取石术后Ⅰ期缝合的高龄患者术后给予相关护理干预,可以达到让患者快速康复的目的。Objective To explore the nursing problems and the corresponding countermeasures of senile patients with primary closure of laparoscopic common bile duct exploration(LCBDE).Methods The clinical data of 92 senile patients with common bile duct stones undergoing LCBDE was retrospectively analyzed.Out of these patients,35 cases received primary closure of the common bile duct and 57 patients were given T-tube drainage.The nursing problems of primary suture were analyzed.Results Postoperative T tube placement in elderly patients caused massive loss of bile,resulting in the unbalance of water,electrolyte and acid-base,and poor absorption of lipids and protein nutrients.T tubes were inconvenient to carry,it was easy to occur traction pain at the fixed T tubes,and pulmonary infection as well as venous thrombosis of lower limbs.The primary suture of common bile duct is relatively safe and has an accurate effect,and can cause less complications,but its indications should be focused and postoperative biliary leakage should be prevented.Conclusion The nursing intervention can achieve the goal of rapid recovery for patients with primary suture after laparoscopic choledocholithotomy.

关 键 词：腹腔镜 胆总管结石 胆管切开取石术 高龄患者 

分 类 号：R364.2[医药卫生—病理学]