直肠癌前切除术后并发吻合口瘘的预防与护理_李岩详解.doc

直肠癌前切除术后并发吻合口瘘的预防与护理 新乡医学院第一附属医院普外二科 李岩 王国英 杨晓明 453100 【摘要】 目的:探讨减少直肠癌前切除术后吻合口瘘的发生及促进吻合口瘘愈 合的护理策略。方法: 对 2006 年 1 月至 2011 年 10 月实施的直肠癌前切除术患者采用综合护理方法：手术前进行充分的肠道准备、营养补充和预防感染，术后保持胃肠减压管和骶前引流管的通畅、放置肛门排气管和适当扩肛以减轻吻合口的张力、充分的营养支持和温馨的心理护理,并将实施该方法以来的护理效果与实施前的相同病例进行比较。结果: 我院自 2006 年 1 月开始严格对实施直肠癌前切除术的患者进行综合护理方法以来，在 2006 年 1 月至 2011 年 10 月的 5 年间共做直肠癌前切除术 286 例，仅发生吻合口瘘 16 例,与 A 组比较，吻合口瘘的发生率显著降低，患者满意度大大提高，吻合口瘘愈合时间显著降低，医疗纠纷明显减少。结论:对实施直肠癌前切除术的患者进行综合护理方法，能够有效的降低吻合口瘘的发生率和提高吻合口瘘的治愈率。 【关键词】 直肠癌前切除术，吻合口瘘，预防和护理 Preventing and Nursing Anastomosis Fistula after Dixon Operation 【Abstract】 Objective To explore a scientific nursing method to reduce the risk of anastomosis fistula and improve the cure of anastomosis fistula after Dixon operation. Methods Apply synthesized nursing methods for the patients who had Dixon operation from Jan, 2003 to Oct, 2008: Having adequate bowel preparation, nutritional supplements and infection prevention before operation, keeping the gastrointestinal decompression tube and presacral drainage tube unobstructed, placing an archo-exhauster and fairly broadening the archos to reduce the tension on stoma, with adequate nutritional support and warmth mental nursing before Dixon operation. Compare the scientific nursing efforts with the same case without using it. Results Since the strictly implement of the scientific nursing anastomosis fistula after Dixon operation, among 286 Dixon operation cases in our hospital from Jan, 2003, 16 was complicated with anastomosis fistula, which was significantly reduced comparing with group A. It greatly improved the patients’ satisfaction, reduced the cure time of anastomosis fistula, and cut down medical tangles. Conclusion Synthesized nursing methods for the patients after Dixon operation can reduce the incidence rate and improve the cure rate of anastomosis fistula efficiently. 【Key words】 Dixon operation, anastomosis fistula, nursing purpose 直肠癌是消化道常见的恶性肿瘤,居消化道癌症发病率的第二位，国内低位直肠癌占整个直肠癌发病比例约 65%~75%[1] 随着消化道吻合器的广