小儿上尿路多发结石微创手术护理.doc

小儿上尿路多发结石微创手术护理【摘要】 目的 探讨采用经皮肾镜、腹腔镜、输尿管镜等微创手术治疗小儿上尿路多发结石的护理要点。方法 回顾分析2003年5月至2009年12月采用三种微创技术治疗12例小儿上尿路多发结石,观察患儿的术前准备、术后护理及随访的手术效果。结果 5例经皮肾镜,4例经输尿管镜钬激光碎石,3例腹腔镜输尿管切开取石,结石清除率为75%,无并发症,随访无血尿、尿路感染、腰腹痛等。结论 结合小儿的生理特点,术前对患儿进行耐心细致的心理护理及充分的准备,术后做好饮食指导、管道护理及并发症的观察,小儿多发上尿路结石微创手术安全、可行、有效。 【关键词】尿石症;小儿;微创手术;护理 The nursing care of minimally invasive surgy for upper urinary tract lithiasis in infants LI Xiao-ling,CHEN Xiu-ling,SU Xia.The Third Affilliated Hospital Of Sun Yat-sen University,GuangZhou 510630,China 【Abstract】 Objective To discuss the nursing care of percutaneous nephroscopic lithotripsy(PCNL),laparoscopy and ureteroscopy for upper urinary tract lithiasis in infants.Methods From May 2003 to December 2009,12 infants of upper urinary tract lithiasis were treated by above three minimally invasive surgy.We observed preoperative preparation,postoperative care and the effect of surgery by follow-up.Results 5 infants treated by PCNL,4 infants treated by transureteroscopic holmium:YAG laser lithotripsy,3 infants treated by laparoscopic ureterolithtomy.The stone clearance rate was 75%.There was no complication,including hematuria,urinary tract infection and Lumbar pain,and so on.Conclusion Combination of physiological characteristics of infants,giving patient and careful mental nursing to infants,and well preparation before operation,and giving well diet guide,ducts nursing and conplication observing,minimally invasive surgy for upper urinary tract lithiasis in infants was safe,feasible and effective. 【Key words】Urinary alculus; Infant; Minimally invasive surgy; Nursing 尿路结石的终生患病率为5%~10%,小儿患者占1%~3%,随着现代影像技术进展使更多小儿病例得到确诊。经皮肾镜、输尿管镜、腹腔镜等微创器械的改进和发展,小儿结石微创治疗逐渐增加。我院自2003年5月至2009年12月采用三种微创技术治疗小儿上尿路多发结石,现将护理体会报告如下。 1 资料和方法 回顾从2003年5月至2009年12月对12例多发上尿路结石采用微创手术处理的小儿资料,排除有原发UPJ狭窄梗阻并结石的病例。男孩9例,女孩3例,年龄中位数3.5岁(6个月~13岁),最大结石直径6~40 mm(平均15 mm)。5例(41.7%)有腰部或腹部疼痛史,8例(66.7%)有间歇血尿。6例合并尿路感染,在术前一周开始口服抗生素。所有病例术前2 h静脉注射头孢类抗生素。 2 术前护理 2.1 术前检查的配合 所有病例经B超、腹部平片检查;其中8例行CT及