I期尿道成形术治疗小儿尿道下裂护理.doc

I期尿道成形术治疗小儿尿道下裂护理【摘要】目的：探讨I期尿道成形术患儿围手术期的护理,减少并发症的发生，提高手术成功率。方法：对532例临床患儿的治疗护理回顾性总结。结果：532例中，治愈379例(71.2%)，发生尿瘘137例(25.8%)，其他并发症16例(3.0%)。结论：术前做好心理护理和术前准备，术后加强尿管护理，伤口和疼痛的观察护理，进食合理的饮食，保持大便通畅和皮肤完整，注重拔管后排尿的观察、指导，强调出院指导，能有效促进伤口愈合，提高手术成功率。 【关键词】尿道下裂；护理；观察 文章编号：1009-5519（2007）24-3656-02 中图分类号：R47 文献标识码：A Nursing care of one-stage urethroplasty in children with hypoadias XIAO Ling,Zhang Cheng-ying,HE Ying,et al. (Department of Uorlogy,Children’s Hospital,Chongqing University of Medical Sciences,Chongqing 400014,China) 【Abstract】Objective:to study the nursing care of perioperative peveod in children with hypospadias,so as to reduce the occurrence of complocation and improve the success rate of operation.Methods:A retrospective study was made in 532 sick children.Results:Of 532 cases of hypospadias,379 cases were cured accounting for 71.2%,137 cases developed urinary fistula account ofr 25.8%,16 cases had the other different complications account for 3.0%.Conclusion:Making the preoperative mental nuring and preparation well,strengthening the postoperative nursing care of urinary tube and wound as well as the observation of pain,taking rational diet,keeping stool unobstruction and skin integrigy,observing the condition of emiction after extubation carefully and enhancing the guidance after discharge could improve the success rate of this operation and promote the healing of wound effectively. 【Key words】Hhypospadias；Nursing caye；Observatio 先天性尿道下裂是小儿常见的尿道畸形，可位于海绵体部尿道的任何部位，伴有不同程度的阴茎下弯，尿道开口越靠后弯曲越严重，勃起时不能充分伸直，直接影响排尿和成年后性交生殖功能，其发生率约1/250～300[1]，为有利于患儿身心成长，主张学龄前完成手术矫正，手术技巧要求高，方式多种多样，治疗效果不尽理想。我科于1995年3月～2005年11月采用不同的外科皮瓣开展I期尿道成形术，取消膀胱造瘘，且近年来提早了手术年龄，缩短了治疗过程和住院时间，并配合合理的护理，有效促进手术的成功，减少尿瘘等并发症的发生，减轻了身体的创痛，取得较好效果。现将护理体会报道如下。 1 资料与方法 1.1 病例资料：本组532例，男，年龄1.5～17.9岁，平均6.0岁，中位年龄5.3岁。根据尿道开口位置分为4型，其中阴茎头及冠状沟型（Ⅰ型）105例，阴茎体型（Ⅱ型）251例，阴茎阴囊型（Ⅲ型）157例，会阴型（Ⅳ型）19例，均伴有不同程度的阴茎下曲，其中合并阴茎阴囊转位56例，隐睾33例。 1.2 外科皮瓣的选择：根据尿道下裂类型、阴茎下曲的程度、阴茎阴囊等处皮肤及尿道板发育情况，选择修复重建新尿道的外科皮瓣。（1）阴茎阴囊皮瓣+尿道板：适用