紧急腹腔镜胆囊切除术转归及围手术期护理.docVIP

紧急腹腔镜胆囊切除术转归及围手术期护理 　　摘 要 目的：腹腔镜胆囊切除术是治疗胆囊结石首选措施，早期治疗和护理干预可减轻患者的痛苦。本研究的目的在于比较紧急和延迟腹腔镜手术治疗急性胆囊炎的可行性及安全性，并对护理措施进行讨论。方法：将55例紧急腹腔镜胆囊切除术患者分为两组，A组为发病后72小时内紧急手术患者，B组为发病72小时后延迟手术患者。结果：A组中转为开腹手术19.4%，B组26.3%（P=0.693）；平均手术时间（P=0.412）、总住院时间（P=0.626）、胆道损伤和手术后并发症，两组间差异比较无统计学意义。结论：紧急腹腔镜胆囊切除术安全，与延迟手术相比差异无统计学意义。 　　关键词 紧急腹腔镜胆囊切除术 中转开腹率 急性胆囊炎 护理 胆石症 　　Abstract Objective：Laparoscopic cholecystectomy is the preferred measure to cholecystolithiasis.Early treatment and nursing intervention can reduce the pain of patients.The purpose of this study is to compare the feasibility and safety of the immediate and delayed laparoscopic operation in the treatment of acute cholecystitis，and the nursing measures were discussed.Methods：55 cases of emergency laparoscopic cholecystectomy were divided into two groups.Group A patients was in emergency operation within 72 hours after onset.Group B patients was in emergency operation without 72 hours after onset.Results：We compared the two groups of indicators，such as the probability of conversion to open operation，average operation time，hospitalization time，biliary tract injury and complications after operation.The results found that the differences between these indices were not significant（P0.05）.Conclusion：Emergency laparoscopic cholecystectomy is safe and compared with delayed operation laparotomy operation was no significant difference. 　　Key words Emergency laparoscopic cholecystectomy；The probability of conversion to open operation；Acute cholecystitis；Nursing；Cholelithiasis 　　择期腹腔镜胆囊切除术是治疗症状性胆囊炎的重要手段[1]，急性胆囊炎采取紧急性腹腔镜胆囊切除可减轻患者痛苦，缩短住院时间，减少医疗费用。但是，急性胆囊炎紧急手术是否增加护理负担、中转为开腹手术机会是否增加，对患者围手术期症状和转归的影响值得研究[2]。随着实践经验的增多，急性胆囊炎实施早期紧急腹腔镜手术的报道不断涌现[3]。对于急性胆囊炎腹腔镜手术可根据手术时间分为早期手术（住院72小时内）和延迟手术（初期提供支持性干预，症状缓解后6～12周后行手术治疗）。本研究的目的在于比较紧急和延迟腹腔镜手术治疗急性胆囊炎的可行性及安全性，并对护理措施进行讨论。 　　资料与方法 　　2009-2010年收治以急性胆囊炎行腹腔镜胆囊切除术患者55例，入选标准：急性右上腹疼痛，体温37.8℃，白细胞计数11.0×109/L，Murphys征阳性，超声波检查提示急性胆囊炎。采集患者的手术前、手术中和手术后资料。 　　分组：急性胆囊炎患者分为两组：早期腹腔镜胆囊切除组（腹痛发生后72小时内）和延迟腹腔镜胆囊切除组（腹痛发生72小时后）。 　　观察及