32例经腹腔镜手术治疗胃切除术后胆囊结石患者的围手术期护理.docVIP

32例经腹腔镜手术治疗胃切除术后胆囊结石患者的围手术期护理 　　摘要：目的 探讨腹腔镜手术治疗胃切除术后胆囊结石患者的护理措施。方法 选择本院32例行腹腔镜手术治疗胃切除术后胆囊结石的患者，总结其围手术期护理措施。结果 32例患者均痊愈出院，术后无出血及切口感染，2例胆漏，经引流后痊愈。住院时间3～10（5±2）d。结论 对于腹腔镜手术治疗胃切除术后胆囊结石患者，加强心理护理和改善营养状况，进行充分的术前准备，密切观察患者术中、术后病情变化， 对提高手术成功率，促进患者早日康复起着重要作用。 　　关键词：腹腔镜；胃切除术后；胆囊结石；围手术期护理 　　Abstract：Objective To explore the nursing measures of laparoscopic operation in the treatment of gallstone patients after gastrectomy. Methods 32 gallstone patients in our hospital were selected after laparoscopic operation in the treatment of postgastrectomy and the nursing measures were summarized in their operation periods. Results 32 cases were cured and they were no abdominal hemorrhage and infection of incision. Two of the cases was bile leakage and then recovered after drainage. All of them were in hospital 3-10 days after operation. They were regularly followed up and they recovered well. Conclusion For the postgastrectomy gallstone patients in laparoscopic operation， it can strengthen the effective psychological nursing before operation， make adequate preoperative preparation and do close observation of patients during and after the operation and rehabilitation guidance， which play an important part in improving the success rate of operation， reducing the incidence of postoperative complications and promoting the patients recovery. 　　Key words：Laparoscopy； Gastrectomy； Gallstone； Peri-operation period nursing 　　胃切除术后会导致胆囊结石发病率增加，其发病率为14.5%～22.1%。高出正常人群10%[1]。其发病机制与术中迷走神经损伤、术后胆囊收缩素释放下降、术后体重快速下降等有关。腹腔镜下胆囊切除术（Laparoscopic cholecystectomy，LC），具有创伤小、恢复快的优点，现已成为治疗胆囊结石的首选术式。精心的围手术期护理是患者痊愈的关键。我院采用腹腔镜手术治疗胃切除术后胆囊结石患者32例，效果满意，现将护理体会总结如下。 　　1 资料与方法 　　1.1一般资料 选择2011年1月～2014年12月在本院行有胃切除病史的LC32例，其中男24例，女8例，年龄35～74（45±6）岁，其中全胃切除4例，远端胃大部切除毕Ⅰ式吻合[2]12例，毕Ⅱ式吻合8例，胃部分切除8例。胃疾病的分类：胃癌16例，胃溃疡伴严重并发症12例，胃恶性间质?A4例。LC术原因：单纯胆囊炎和并胆囊结石20例，胆囊息肉伴胆结石8例，胆囊结石伴胆总管结石4例。全组距前次胃部手术时间间隔为11个月～5年，平均（36±10）个月。20例既往胃恶性肿瘤术后患者，术前完善辅助检查，以排除肿瘤无复发转移。 　　1.2方法 所有患者均在全麻下行LC，手术时间35～65min（45±7）min。胆囊结石合并胆总管结石者4例先行ERCP下取胆总管结石，成功后行