经皮肝穿刺胆管引流术联合胆道支架植入治疗34例恶性梗阻性黄疸护理体会

发布时间：2019-02-15 20:54

【摘要】：目的考察经皮肝穿刺胆管引流术(PTCD)联合胆道金属支架植入术治疗恶性梗阻性黄疸患者的护理疗效,归纳并探究治疗前后并发症的护理体会。方法回顾性分析肝胆外科2008年4月—2014年3月行PTCD联合胆道支架植入术的34例恶性梗阻性黄疸患者的护理。结果 34例经皮肝穿刺胆管引流术(PTCD)联合胆道金属支架植入术全部成功,黄疸5 d内退净6例,黄疸2周内退净18例,2周内黄疸明显减轻7例。皮肤、巩膜黄染及皮肤瘙痒症状3~7 d消失,大小便颜色2~5 d恢复正常;血尿淀粉酶明显升高5例,经4~7 d应用生长抑素后治愈;局限性胆汁性腹膜炎4例,重新放置PTCD引流管后症状消失;引流管脱出2例,经及时处理后好转出院;夹管带管出院1例。所有患者均未出现穿孔、腹膜炎等其他严重并发症。结论 PTCD结合胆道金属支架置入治疗恶性梗阻性黄疸患者效果良好、创伤小;合理、有效、优质的围手术期护理可促进手术成功及为良好预后提供重要保证。系统的个性化的护理方案以及切实有效的措施可为支架植入患者的恢复提供重要保障。同时,在临床护理过程中仍然需要不断探索及总结经验,使患者能更好地配合治疗并增加战胜疾病的信心,积极的心理状态可以促进患者康复。
[Abstract]:Objective to investigate the nursing effect of percutaneous transhepatic bile duct drainage (PTCD) combined with biliary metal stent implantation in patients with malignant obstructive jaundice, and to summarize and explore the nursing experience of complications before and after treatment. Methods the nursing care of 34 patients with malignant obstructive jaundice underwent PTCD combined with biliary stent implantation in hepatobiliary surgery from April 2008 to March 2014 was retrospectively analyzed. Results all 34 cases of percutaneous transhepatic bile duct drainage (PTCD) combined with biliary metal stent implantation were successful. Jaundice in 6 cases within 5 days, jaundice in 18 cases within 2 weeks, and jaundice in 7 cases within 2 weeks. The symptoms of skin, scleral yellow stain and pruritus disappeared in 3 and 7 days, and the color of urine returned to normal for 5 days, and the serum amylase increased significantly in 5 cases, which was cured by somatostatin for 4 days. In 4 cases of localized biliary peritonitis, the symptoms disappeared after re-placement of PTCD drainage tube, 2 cases with prolapse of drainage tube, and 1 case with clip tube and tube were discharged from hospital after timely treatment. No perforation, peritonitis and other serious complications were found in all patients. Conclusion PTCD combined with metallic biliary stent implantation in the treatment of malignant obstructive jaundice is effective, less traumatic, reasonable, effective and high quality perioperative nursing can promote the success of operation and provide important guarantee for good prognosis. Systematic individualized nursing program and effective measures can provide important protection for patients with stent implantation. At the same time, in the process of clinical nursing, we still need to explore and sum up the experience, so that the patients can cooperate better with the treatment and increase the confidence to overcome the disease. Positive psychological state can promote the recovery of the patients.
【作者单位】：蚌埠医学院第一附属医院肝胆外科;
【基金】：安徽省科技攻关项目(1501041155)
【分类号】：R473.73

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