腹腔镜辅助行内镜粘膜下剥离术治疗胃间质的手术配合-现代临床医学.docVIP

内镜下黏膜剥离术治疗消化道黏膜下肿瘤的护理配合 姜 琳,孙晓滨,任春蓉,高羚芯,董 璨,杨 梅,唐 宇 (四川省成都巿第三人民医院 消化内镜室,四川 成都 610031） 【摘要】 目的：总结内镜下黏膜剥离术（endoscopic submucosal dissection，ESD）治疗消化道黏膜下肿瘤（submucosal tumor, SMT）的护理配合方法，以提高ESD术的成功率及减少术中及术后并发症的发生。方法：我院2011年3月至2015年12月对63例SMT患者行ESD术，术前对患者行心理护理，备齐术中器械，术中密切配合医生进行护理操作，术后做好健康教育预防并发症的发生。结果：63例患者48例（76.19％）成功剥离，15例改用腹腔镜完整切除病灶。术中穿孔19 例（30.15％），10例经胃镜下金属夹成功封闭创面，9例改腹腔镜修补穿孔创面，术中出血配合使用热活检钳、电凝、金属夹治疗。51例术后随访观察1～3年，均未复发。结论：ESD技术的发展使消化道SMT能通过内镜进行完整的切除，护理人员术前、术中及术后的密切配合，熟练操作器械并正确使用是保证ESD手术成功的关键。 【关键词 【中图分类号】R473.6【文献标识码】B DOI:10.11851/j.issn.1673-1557.2017.04.0 Nursing cooperation of endoscopic submucosal dissection in treatment of submucosal tumor of digestive tract JIANG Lin, SUN Xiaobin, REN Chunrong, GAO Lingxin, DONG Can, YANG Mei, TANG Yu (Digestive Endoscopy Room, Chengdu Third People’s Hospital, Chengdu, Sichuan 610031,China) 【Abstract】 Objective: To summarize nursing cooperation methods of endoscopic submucosal dissection (ESD)in the treatment of submucosal tumor (SMT)of digestive tract in our hospital in order to improve the success rate of ESD and reduce intraoperative and postoperative complications. Methods: From March 2011 to December 2015, 63 SMT patients underwent ESD in our hospital. Before operation, psychological care was given to every patient; during operation, surgical equipment was well prepared, and close nursing cooperation with doctors was performed; after operation, health education was conducted to prevent complications. Results: Of 63 patients, 48 cases (76.19%) of SMT were successfully removed, and 15 cases underwent laparoscopic complete resection of lesion. During operation, perforation occurred in 19 cases (30.15%); the wound surface was successfully closed by metal clips under gastroscope in 10 cases, and 9 cases had wound surface repaired by laparoscopy. The intraoperative bleeding was treated by using thermal biopsy forceps, electrocoagulation and metal clips. 51 cases were followed up for 1-3 years without recurrence. Conclu