小切口微创胆总管探查术安全性及临床护理分析评估.docVIP

小切口微创胆总管探查术安全性及临床护理分析评估 　　【摘 要】目的：系统评价小切口胆总管探查术的安全性，总结临床护理经验。方法：采用随机对照方法，分别对120例小切口和100例传统切口行胆总管探查术的患者，就术中意外伤、术后并发症、残留结石、术后一般情况和护理资料等进行对比分析，并总结护理经验和措施.结果：术后下床活动时间以及住院、术后肛门排气和禁食等时间，小切口组（MCE组）均少于传统切口组（OCE组）；术后血浆管引流量，MCE组亦少于OCE组，两组的T管引流量统计无显著性差异；小切口组术中意外损伤发生率1.67%（2/120），术后结石残留率3.33%（4/120），结石复发率为5.00%（6/120）；传统切口组术中意外损伤发生率2.00%（2/100），术后结石残留率为3.00%（3/100），结石复发率为5.00%（5/100），统计显示两组无显著性差异（p0.05）；小切口组术后发生并发症8例，传统组8例，两组比较无统计学差异（p0.05）；术后MCE组临床恢复明显较OCE快，两组比较有统计学差异（p0.05）。结论：小切口胆道探查手术是一种安全、有效、预后良好、恢复时间快的手术方式，密切观察T管，血浆管引流，及早发现并发症的发生，及早处理是关键。 　　【关键词】胆道探查；小切口；意外损伤；结石残留；护理 　　[Abstract]objective： To evaluate the safety， feasibility ， curative effect and to conclude the nursing experience by mini-incision exploration of common bile duct. Methods In this study， 120 patients underwent min-incision exploration of common bile duct and 100 patients underwent open-incision exploration of common bile duct for suffering from bile duct stones and（or） gallstones from 2009 to 2010， and the iatrogentic bile duct injury， postoperative complication， residual stone， stone recurrence， therapeutic effect and nursing clinical data were evaluated with randomized contrast analysis. Results Time of operation， bleeding， volume of drain pipe， time of recover intestinal peristalsis and average days in hospital in the group of min-incision exploration（MCE）were less than that of open-incision exploration（OCE）. The iatrogentic bile duct injury occurred in 2 cases （1.67%，2/120）， residual stone in 4 cases （3.33%，4/120）， stone recurrence in 6 cases（5.00%，6/120） in the group of MCE， and occurred in 2 cases（2.0%， 2/100）， 3 cases（3.0%， 3/100）and 5 cases respectively in the group of OCE， there were less difference in the two groups. However， Postoperative complications occurred in the group of MCE and OCE was 8 cases（6.7%） and 8 cases（8.0%） respectively， and there was more difference in the two groups. Conclusion mini-incision exploration of common bile duct was a feasible and safe method resulting in fewer co