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目的探讨腹腔镜中低位直肠癌患者行前切除双吻合器吻合术的围手术期护理。方法选取2009年1月至2015年12月间陆军总医院收治的103例行腹腔镜中低位直肠癌根治前切除双吻合器吻合术的直肠癌患者。采用统一的整体护理模式,做到术前四准备,即皮肤准备、心理准备、肠道准备及营养支持准备,术后四精准,即精准体位护理、精准疼痛护理、精准术后一般并发症护理及精准术后特殊并发症护理和术后饮食调节、出院护理指导的护理指导方案。统计所有患者的肛门恢复排气时间、住院时间、术后肿瘤病理分期、术后并发症及恢复情况,比较干预前后患者的焦虑、抑郁及生活自理能力情况。结果 103例患者术后肠蠕动肛门恢复排气时间为3~5d,住院时间平均为11d,术后随访时间为3~50个月,平均26个月,术后发生吻合口瘘3例(2.9%),2例经结肠腹部临时造口3个月后还纳愈合,1例保守治疗1个月后愈合。术后局部肿瘤复发4例(3.9%),其余患者预后良好,日常生活基本自理。103例患者术后SAS和SDS评分分别为(34.02±7.35)分和(40.33±6.48)分,均低于术前的(50.39±7.06)分和(53.33±6.84)分,差异均有统计学意义(均P<0.01),患者术后ADL评分为(27.98±5.65)分,高于术前的(23.50±6.31)分,差异有统计学意义(P<0.01)。结论实施整体化优质护理能够有效促进腹腔镜中低位直肠癌行前切除双吻合器吻合术患者康复,预防并发症发生,缓解不良情绪,提高生活质量。
Objective To investigate the perioperative nursing of patients undergoing laparoscopic surgery of low rectal cancer with anterior resection and double stapling anastomosis. Methods A total of 103 rectal cancer patients undergoing laparoscopic middle and low rectal cancer resection and double stapler anastomosis were enrolled in the Army General Hospital from January 2009 to December 2015. The use of a unified overall nursing model, so that the preoperative preparation of four, that is, skin preparation, psychological preparation, preparation for intestinal preparation and nutritional support, postoperative four precision, accurate postural care, precision pain care, precision postoperative complications care And precise postoperative complications of special care and postoperative dietary regulation, nursing guidance of nursing guidance program. Statistics of all patients anal discharge time, hospital stay, postoperative tumor pathological stage, postoperative complications and recovery, compared before and after intervention in patients with anxiety, depression and self-care ability. Results In 103 patients, the time of postoperative anal perforation was 3 to 5 days, the average length of hospital stay was 11 days, and the follow-up time was 3 to 50 months (average 26 months). Anastomotic fistula occurred in 3 cases (2.9 %). Two cases were still healed after 3 months of temporary colostomy. One case was cured after conservative treatment for 1 month. Local tumor recurrence in 4 cases (3.9%), the remaining patients with good prognosis, daily basic self-care. The postoperative SAS and SDS scores of the 103 patients were (34.02 ± 7.35) and (40.33 ± 6.48), respectively, which were lower than those of preoperative (50.39 ± 7.06) and (53.33 ± 6.84), respectively (P <0.01). The postoperative ADL score was (27.98 ± 5.65) points higher than the preoperative (23.50 ± 6.31) points, the difference was statistically significant (P <0.01). Conclusion The implementation of holistic quality nursing can effectively promote the rehabilitation of patients undergoing laparoscopic middle and low rectal cancer with double stapling anastomosis and prevent the occurrence of complications, relieve the negative emotions and improve the quality of life.