内镜下逆行性胰胆管造影及十二指肠乳头切开取石术护理.docVIP

内镜下逆行性胰胆管造影及十二指肠乳头切开取石术护理【摘要】 目的 探讨内镜下逆行性胰胆管造影及十二指肠乳头切开取石术的术中配合及术后护理要点。方法 对80 例胆总管结石患者进行逆行性胰胆管造影探查及十二指肠乳头切开取石术。结果 80 例患者成功完成手术，术后1例并发出血,经全面观察、及时抢救护理,均痊愈出院。1 例因术后呕吐致鼻胆管脱落，6例术后发生高淀粉酶血症,经积极的对症处理后均治愈,无一例因护理不当发生并发症。结论 内镜下逆行性胰胆管造影及十二指肠乳头切开取石术在术前、术中、术后都有很多影响因素,而有效护理对于提高手术效率及成功率、减少术后并发症有重要的作用。? 【关键词】 内镜逆行性胰胆管造影；胆总管结石；护理 ?? 【Abstract】 Objective To investigate the effect of endoscopic retrograde cholangiopancreatography and duodenal papilla lithotomy operative cooperation and postoperative nursing points. Methods 80 cases of common bile duct stones in patients undergoing retrograde cholangiopancreatography exploration and duodenal papilla lithotomy. Results 80 patients successfully completed the operation, after operation in 1 cases complicated with bleeding through observation, timely, comprehensive nursing, they were cured. 1 cases because of postoperative vomiting induced by nasal bile duct loss, 6 case of postoperative hyperamylasemia, positive after symptomatic treatment were cured, no case of complications due to improper care. Conclusion A lot of factors can impact Endoscopic retrograde cholangiopancreatography and duodenal papilla lithotomy。Effective nursing play a important role inimproving efficiency and success rate of the operation，and induceing complications。? 【Key words】 endoscopic retrograde cholangiopancreatography; Common bile duct stonesi; nursing care 内镜下逆行性胰胆管造影(ERCP)及十二指肠乳头切开(EST) 取石术对于胆总管结石是较为成熟的治疗方法,而且是首选方法。2010年6月至2011年6月我院共对80例胆总管结石患者进行ERCP 检查和治疗,作为我院ERCP 治疗的助理护士,综合了我们的临床护理经验并结合ERCP 医疗及护理理论知识,对这80 例患者资料进行了分组和整理,现将护理体会报告如下。? 1 临床资料? 1.1 一般资料 80 例患者中,均为我院消化内科胆总管结石患者，其中男42例,女38 例;年龄15～71岁,平均48 岁,术前超声检查提示结石直径0. 6～2.0 cm;数目1 枚64 例,2 枚85 例,≥3 枚11 例。既往有11 例患者患胆囊结石并行胆囊切除术,有胆道手术史6 例。? 1.2 方法 患者取左侧卧位或左前俯卧位,将十二指肠镜插入十二指肠降部,寻找十二指肠乳头,直接观察十二指肠乳头形态,再经活检管道插入造影导管,注入40 %泛影葡胺造影,及通过X 线影像观测、胆囊、胆管、肝管有无病变［1］。在X线下明确胆管结石的大小、部位、数量,切开乳头,用取石篮、取石气囊取石后置入鼻胆管引流。对结石量多或年龄大的患者可分次取石。? 1.3 结果 80例患者均成功实施EST 切开取石,其中74例一次成功, 6例2次成功，操作成功率100%。78例行乳头切开术患者,其中