婴幼儿先天性胆总管囊肿自发性穿孔护理体会.docVIP

婴幼儿先天性胆总管囊肿自发性穿孔护理体会[摘要] 目的:探讨先天性胆总管囊肿自发性穿孔的护理经验。方法:回顾性分析11例婴幼儿先天性胆总管囊肿自发性穿孔患儿自发性穿孔的临床资料。结果:本组8例经术前腹腔穿刺确诊胆道自发性穿孔,其中5例经B超或CT诊断胆总管囊肿。3例行一期胆总管囊肿切除加胆道重建术(胆总管-空肠 R-Y吻合术);6 例行胆道外引流加腹腔引流术,2例行胆囊置管引流加腹腔引流术,3~6 个月后行胆总管囊肿切除加胆道重建术。11例患儿治疗后均恢复良好。结论:婴幼儿胆总管囊肿自发性穿孔容易误诊,掌握其临床特点、根据患儿具体情况选择合理的手术方式以及精心细致的护理是提高其治愈率的关键。 [关键词] 胆总管囊肿;腹膜炎;穿孔;护理 [中图分类号] R473.72[文献标识码]C [文章编号]1673-7210(2010)02(b)-091-02 Nursing for spontaneous perforation of choledochal cyst in infant XUE Jing (Department of Surgery,Kaifeng Children’s Hospital,He’nan Province, Kaifeng475000,China) [Abstract] Objective: To investigate the nursing experience for spontaneous perforation of congenital choledochal cyst in infants. Methods: The clinical data of 11 cases with spontaneous perforation of congenital choledochal cyst were analysed retrospectively. Results: The preoperative diagnosis was established by paracentesis in 8 patients. Abdominal sonography and CT found a cyst in 5 of the 8 cases reviewed. 3 different operative procedures were performed, choledochocyst excision Roux-Y choledocho-jejunostomy(3 cases), choledochotomy with T-tube drainage (6 cases),and cholecystostomy(2 cases) .Radical resection was performed in about 3-6 months after the initial operation. All patients recovered had got satisfactory therapeutic efficacy without any grave complication. Conclusion: The misdiagnosis of spontaneous perforation of congenital choledochal cyst in infants is more common,with understanding keys in the diagnosis and correct operation and meticulous care are important in improving the cure rate. [Key words] Choledochal cyst; Peritonitis; Perforated; Nursing 婴幼儿先天性胆总管囊肿自发性穿孔发病率低,误诊率高[1]。我院自1996年8月~2008年6月共收治11例婴幼儿先天性胆总管囊肿自发性穿孔患者,耐心细致的术前、术中和术后护理对患儿的恢复起到了重要作用,现将我们的护理经验总结报道如下: 1资料与方法 1.1一般资料 本组共11例,其中,男4例,女7例;手术时年龄2个月~3岁。平均1.6岁。临床表现以腹痛、腹胀、发热和呕吐为主,其中5例伴黄疸。病程6 h~10 d,平均4 d,有5例病程24 h。5例经B超和(或)CT诊断胆总管囊肿,8例经术前腹腔穿刺确诊胆道自发性穿孔。 1.2护理 1.2.1术前护理 1.2.1.1心理护理本组患者均是婴幼儿,术前护理常难以配合,很难从语言方面给予心理支持,因此护理人员