胆管疾病的经胆道镜微波治疗与个体化护理配合.docVIP

胆管疾病的经胆道镜微波治疗与个体化护理配合 　　【摘要】 目的：探讨胆管疾病经胆道镜微波治疗的方法与护理措施的改进。方法：胆道镜微波治疗胆管疾病 　　71例（包括胆管狭窄及胆管息肉、胆管息肉样病变、胆管壁肿瘤），同时在微波治疗前后采取针对性护理措施以保证治疗的顺利实施：（1）术前对患者心理疏导，介绍治疗的微创性，消除恐惧，有T管者作引流管护理，根据医嘱作必要的冲洗等；（2）镜检前常规做窦道与胆管表面黏膜麻醉；（3）对胆管狭窄将微波功率调至50～90 W，多方位放射状切开狭窄口使其扩大；对胆管息肉、胆管息肉样病变及胆管肿瘤先取活检，调节微波功率至90～110 W，直视下烧灼，使病变局部发白炭化；（4）术后T管妥善固定，观察T管内胆汁色泽、每日流量、有无出血，指导患者与家属对T管的保护。结果：（1）所有患者均如期接受胆道镜治疗及随访，依从性良好；（2）狭窄胆管微波治疗33例次，术后复查T管造影均有好转，胆管息肉及息肉样病变、胆管壁肿瘤治疗44例次，所有胆管壁病变均消失或基本消失，胆道镜复查或影像学检查未见复发；（3）术中未发生患者不配合终止治疗情况，术中无出血、窦道穿孔等并发症，胆道镜使用后无损坏；（4）所有患者术后T管均保护良好，无继发出血，胆汁流出通畅。结论：术前加强心理疏导，术中正确调节微波功率，精准操作，术后加强对T管的保护及采取个体化护理措施，应用微波技术经胆道镜治疗胆管疾病将会取得较为理想的治疗效果。 　　【关键词】 微波技术； 胆道镜； 护理技术； 胆管疾病 　　【Abstract】 Objective：To investigate the treatment method and improvement of nursing measures of microwave technique under choledochoscope for biliary tract diseases.Method：Targeted nursing measures was implemented on 71 patients with biliary tract diseases（including the bile duct stricture and bile duct polypi，bile duct polypoid lesions and bile duct wall tumor） who underwent microwave technique under choledochoscope before and after the treatment：（1）subjects were intervened with psychological guidance to introduce the benefits about the treatment to relieve fear before the operation.In addition，patients with T-tubes accepted nursing measures about tube draining and catheter irrigation according orders.（2）Mucosal surface anesthesia on antrum and bile duct was conducted routinely before microscopy.（3）The power of microwave for treatment of bile duct stricture was 50 to 90 W.The stricture sites were enlarged by multi-points coagulation and rad cauterization to char or gasify the membrane-like hyperplastic tissues.For treatment of polypi of bile duct and biliary tumor，which first underwent biopsies to rule out canceration，the power of microwave was generally 90 to 110 W.During the operation，the radiation head was usually inserted into polypi foci to make local tissue white-looking and charring then.（4）T-tube was fixed well aft