胆总管术中胆道镜注水加压方法的护理临床经验  

Nursing clinical experience of pressurized water injection in choledochoscope method during common bile duct operation

作　　者：蒲成容[1] 杨璐[1] 刘艺[1] 张世巧[1] 熊良英[1] 魏雪萍 Pu Chengrong;Yang Lu;Liu Yi;Zhang Shiqiao;Xiong Liangying;Wei Xueping(Department of Hepatobiliary Surgery,the Sixth People's Hospital of Chengdu City,Sichuan Province,Sichuan Chengdu 610051)

机构地区：[1]四川省成都市第六人民医院肝胆外科,四川成都610051

出　　处：《中国社区医师》2020年第32期148-149,共2页Chinese Community Doctors

摘　　要：目的:探讨胆总管手术中胆道镜注水加压方法的护理操作技术。方法:2016年1月-2019年12月收治胆总管结石患者469例,均采用手术治疗。术中将胆道镜放在胆管下段位置,台下巡回护士左手捏紧接在胆道镜输液器孟非氏滴管上端的胶管上,右手用力挤压输液器孟非氏滴管,再放开左手,生理盐水快速充满孟非氏滴管,右手再用力挤压输液器孟非氏滴管,左右手动作反复交替进行;这时胆道因生理盐水压力作用,胆道管下段及Oddi括约肌被冲开,发现有哑铃状结构存在结石者则用取石网篮取出,胆道下段结石有嵌顿取石困难者则接胆道碎石仪。结果:胆道镜加压注水冲开胆总管下段及Oddi括约肌465例,见到Vater壶腹有哑铃状结构17例,其中有结石11例,均用网篮取出结石。未冲开胆总管下段及Oddi括约肌4例,术后证实下段狭窄。术后第2天出现上腹痛3例,1周后彩超和MRCP证实胆总管内残余结石,及时用十二指肠乳头括约肌切开术(EST)取出残石。结论:胆道术中使用胆道镜加压注水的方法对看清胆道下段有效,可进一步降低胆道术后残余结石发生率。Objective:To explore the nursing experience of pressurized water injection in choledochoscope method during common bile duct operation.Methods:From January 2016 to December 2019,469 cases of patients with choledocholithiasis were enrolled,all of them were treated with surgery.The choledochoscope was placed in the lower bile duct,the roving nurse pinched her left hand on the upper hose of the upper end of the Mengfei's dropper of the choledochoscope infusion device,squeezed the Mengfei's dropper of infusion set with the right hand,when putted up the left hand,0.9%of saline was rapidly filled with Mengfei's dropper,squeezed the Mengfei's dropper of infusion set with the right hand again,the left and right hand movements alternated repeatedly.At this time,due to the pressure of 0.9%of normal saline,the lower part of the bile duct and Oddi sphincter were washed away,those who found a dumbbell-shaped structure with stones could take it out with a stone-removing basket,biliary tract lithotripter for those with incarcerated stones in the lower biliary tract.Results:465 cases of stones in the lower part of the common bile duct and Oddi sphincter were washed away by pressurized water injection of choledochoscope,17 cases had dumbbell-shaped structure in ampulla,among them,11 cases of stones were removed with a basket.4 cases of stones in the lower part of the common bile duct and Oddi sphincter were not washed away,the stenosis of the lower segment was confirmed after operation.3 cases of upper abdominal pain occurred on the second day after operation,a week later,ultrasound and MRCP confirmed there were residual stones in the common bile duct,so EST was used to remove the remaining stones.Conclusion:The use of pressurized water injection in choledochoscope during common bile duct operation is effective in seeing the lower part of biliary tract,which can further reduce the incidence rate of residual stones after biliary tract operation.

关 键 词：胆道术中 胆道镜 加压注水 护理 

分 类 号：R473.6[医药卫生—护理学]