肠镜腹腔镜辅助肛门成型治疗中高位先天性肛门闭锁的手术配合

刘笑天; 王煜; 潘守东; 吴新雁; 韩丁; 刁美; 李颀; 张震; 王男; 李龙

doi:10.16766/j.cnki.issn.1674-4152.001894

肠镜腹腔镜辅助肛门成型治疗中高位先天性肛门闭锁的手术配合

doi: 10.16766/j.cnki.issn.1674-4152.001894

刘笑天¹,
王煜¹,
潘守东¹,
吴新雁¹,
韩丁¹,
刁美²,
李颀²,
张震²,
王男^1, ,,
李龙²

1.
首都儿科研究所附属儿童医院麻醉科，北京 100020
2.
首都儿科研究所附属儿童医院普外科，北京 100020

基金项目:

国家科学自然基金 81700451

北京市医院管理中心科研培育计划项目 PX2020054

详细信息

通讯作者:
王男，E-mail：798337795@qq.com

中图分类号: R657.1 R473.6
计量
- 文章访问数: 128
- HTML全文浏览量: 55
- PDF下载量: 1
- 被引次数: 0
出版历程
- 收稿日期: 2020-07-28
- 网络出版日期: 2022-02-16

Nursing cooperation of endoscopic and laparoscopic treatment of middle and high congenital anal atresia

1.
Department of Anesthesiology, the Children's Hospital affiliated to Capital Institute of Pediatrics, Beijing 100020, China

摘要

摘要: 目的总结肠镜、腹腔镜辅助肛门成型术在治疗中高位先天性肛门闭锁手术护理配合方法，为该手术提供标准化的手术护理配合流程。方法回顾性分析首都儿科研究所附属儿童医院2019年11月—2020年6月行肠镜腹腔镜辅助肛门成形术治疗中高位先天性肛门闭锁16例，所有患者均在肠镜下定位直肠尿道瘘，环形切开直肠盲端瘘口周围黏膜，并在腹腔镜下游离直肠，最后行直肠肛门吻合。总结手术配合过程和护理要点。结果 16例患儿均顺利完成手术，肠镜时长中位数为45.0(29.5，60.0)min，手术总时长中位数为188.5(167.5，211.3)min，术中出血量约5~10 mL。术后恢复良好，术后住院中位时间为5.5 d, 术后复查逆行膀胱造影均无尿道憩室、尿道瘘及尿道狭窄等并发症的发生。结论肠镜腹腔镜辅助肛门成型治疗中高位先天性肛门闭锁是安全可行的，具有创伤小，定位准确、并发症少等优点。手术护士专业技术的正规培训、充分做好术前准备、术中做好体温保护措施、动态实时监测生命体征、无菌操作严格、仪器设备的有效管理、规范的手术体位安置、熟练掌握配合技术及良好的医护患沟通是手术成功的关键。
- 先天性肛门闭锁 /
- 肠镜辅助腹腔镜肛门成型术 /
- 手术配合
Abstract: Objective This study aimed to summarise the nursing cooperation methods of endoscopic and laparoscopic anorectoplasty in the treatment of high anorectal malformation (ARM) and to provide a standardised operation of nursing cooperation. Methods A retrospective analysis was performed in 16 cases of high ARM who underwent endoscopic and laparoscopic anorectoplasty in Capital Institute of Pediatrics from November 2019 to June 2020. All patients had rectal urethral fistula; rectum mucosa around fistula was dissected by endoscopy, and the rectum was mobilised by laparoscopy. The operation cooperation process and nursing key points were summarised. Results The procedure was successfully performed in all patients. The median endoscopic time was 45.0(29.5, 60.0) min. The median total operative time was 188.5(167.5, 211.3) min, and the intraoperative blood loss was approximately 5-10 mL. Postoperative recovery was uneventful; the median postoperative hospitalisation time was 5.5 days, and postoperative re-examination of VCU showed no occurrence of complications such as urethral diverticulum, urethral leakage and urethral stricture. Conclusion Endoscopic and laparoscopic anorectoplasty is safe and feasible in the treatment of middle and high ARM, which has the advantages of less trauma, accurate positioning and few complications. Regular training of surgical nurses' professional skills, full preparation before operation, thermal retardation during operation, monitoring of vital signs, strict aseptic operation, effective management of instruments and equipment, standardised placement of surgical positions, skilled coordination techniques and adequate doctor-patient communication are the key to the success of surgery.
- Anorectal malformation /
- Endoscopic and laparoscopic anorectoplasty /
- Operation cooperation

HTML全文

图 1 手术人员和设备位置

下载: 全尺寸图片幻灯片

图 2 肛管固定方法

下载: 全尺寸图片幻灯片

图 3 肛周敷料粘贴方法

下载: 全尺寸图片幻灯片

参考文献(15)

[1]	刘佳林, 吴璇昭, 李龙, 等. 腹腔镜辅助下高位肛门闭锁肛门成形术的学习曲线[J]. 中华实用儿科临床杂志, 2016, 31(12): 940-942. doi: 10.3760/cma.j.issn.2095-428X.2016.12.017
[2]	刁美, 李龙, 叶茂, 等. 新生儿一期经脐单切口腹腔镜肛门成形术22例分析[J]. 中华小儿外科杂志, 2017, 38(9): 653-659. doi: 10.3760/cma.j.issn.0253-3006.2017.09.003
[3]	张金山, 李龙, 刁美, 等. 经脐单切口腹腔镜辅助肛门成形术治疗小儿中高位肛门闭锁[J]. 中国微创外科杂志, 2016, 16(5): 424-427. doi: 10.3969/j.issn.1009-6604.2016.05.011
[4]	LU C G, HOU G J, LIU C Y, et al. Single-stage transanal endorectal pull-through procedure for correction of Hirschsprung disease in neonates and nonneonates: A multicenter study[J]. Pediatr Surg, 2017, 52(7): 1102-1107. doi: 10.1016/j.jpedsurg.2017.01.061
[5]	何婷婷, 许开瑜, 叶玲, 等. 漫画手册的制订及其在患儿术前访视中的应用[J]. 护理学杂志, 2016, 31(22): 41-42. doi: 10.3870/j.issn.1001-4152.2016.22.041
[6]	杜菲, 叶枫林, 韩凤清, 等. 形象化健康教育方案对胸腔镜下肺癌根治术患者术后恢复的影响[J]. 中华全科医学, 2018, 16(4): 603-605, 629. https://www.cnki.com.cn/Article/CJFDTOTAL-SYQY201804029.htm
[7]	刘伟, 王占文, 仲丽静, 等. 手助腹腔镜在胃贲门癌根治术中的手术配合[J]. 河北医药, 2018, 40(22): 3501-3504. doi: 10.3969/j.issn.1002-7386.2018.22.038
[8]	吴玲萍. 品管圈活动在控制手术室院内感染及提高护士技能中的应用[J]. 中华全科医学, 2017, 15(1): 170-172. https://www.cnki.com.cn/Article/CJFDTOTAL-SYQY201701052.htm
[9]	曾彦超, 易凤琼, 喻琼, 等. 达芬奇机器人联合腹腔镜食管癌根治术的手术护理配合[J]. 海南医学, 2017, 28(16): 2736-2738. doi: 10.3969/j.issn.1003-6350.2017.16.055
[10]	王瑞. 1例小儿腹腔镜下经脐阑尾造口术行可控顺行灌肠的手术配合[J]. 当代护士(中旬刊), 2019, 26(2): 164-166. https://www.cnki.com.cn/Article/CJFDTOTAL-DDHS201902082.htm
[11]	郭莉, 何丽, 陈肖敏, 等. 手术室护理实践指南[M]. 北京: 人民卫生出版社, 2018: 117-118.
[12]	崔宇杨, 王曾妍, 何婷婷. 先天性肛门闭锁患儿行达芬奇机器人辅助肛门成形术的手术配合[J]. 现代临床护理, 2019, 18(11): 54-57. doi: 10.3969/j.issn.1671-8283.2019.11.009
[13]	王娜娜, 师堂旺, 韩梅, 等. 急性下肢缺血性疾病截肢术后的临床护理[J]. 中华全科医学, 2017, 15(9): 1623-1625. https://www.cnki.com.cn/Article/CJFDTOTAL-SYQY201709054.htm
[14]	曾凤美, 吴春柳, 饶芬, 等. 微创前后节联合手术治疗白内障合并玻璃体视网膜病变的护理研究[J]. 中华全科医学, 2018, 16(3): 498-500. https://www.cnki.com.cn/Article/CJFDTOTAL-SYQY201803049.htm
[15]	陈凤英, 王月美. 小儿腹腔镜下先天性高位肛门闭锁肛门成形手术配合[J]. 医疗装备, 2016, 29(14): 152-153. doi: 10.3969/j.issn.1002-2376.2016.14.118