摘要
目的:探讨达芬奇机器人辅助下腹腔镜肾癌根治性切除(robot-assisted laparoscopic radical nephrectomy,RLRN)联合下腔静脉癌栓取出术预见性护理的疗效。方法:选取2014年9月至2020年12月浙江大学医学院附属第一医院肾癌伴癌栓患者12例,全面评估手术风险后拟行RLRN,并实施RLRN围手术期护理。RLRN围手术期护理重点是术前充分准备、多学科协作制定个体化护理方案,以患者为中心做好心理疏导;术中着重监测低体温、体外循环、压力性损伤风险;术后严密监测患者生命体征尤其重视尿量、引流液、肝肾功能、引流管、并发症的预见性护理。并分析术后并发症发生情况及住院时间,总结相关护理经验。结果:12例患者手术顺利,经过精心治疗与RLRN围手术期护理后全部康复出院。术后出现急性肝损伤1例,未发生出血、深静脉血栓、肺栓塞、肾衰竭、乳糜漏、腹腔镜相关并发症;术后住院时间7~24 d,平均住院时间14 d。结论:RLRN手术操作难度大,为患者制定RLRN围手术期管理方案、加强多学科合作、落实并发症的预见性护理有助于降低术后并发症的发生率,缩短术后住院时间及减少住院费用,加快患者的术后康复,提高患者围手术期的康复质量。
Objective:To explore the clinical experience and nursing methods of robot-assisted laparoscopic radical nephrectomy(RLRN)combined with removal of inferior vena cava tumor Thrombus.Methods:From September 2014 to December 2020,12 patients with renal cancer complicated with tumor embolism in the First Affiliated Hospital,Zhejiang University School of Medicine were selected to comprehensively evaluate the risk of surgery,plan to receive RLRN,and implement perioperative nursing of RLRN.The postoperative complications and hospitalization time were analyzed,and the relevant nursing experience was summed up.The significant measures of RLRN perioperative nursing were adequate preoperative preparation,multidisciplinary collaboration to develop individual nursing programs,patient-centered psychological counseling,intraoperative monitoring of hypothermia,cardiopulmonary bypass,stress injury risk.After surgery,patients'vital signs were closely monitored,especially urine volume,drainage fluid,liver and kidney function,drainage tube and predictive nursing of complications.Results:All 12 patients were discharged from hospital after individualized treatment and RLRN perioperative nursing.Postoperative acute liver function injury occurred in 1 case,without bleeding,deep vein thrombosis,pulmonary embolism,renal failure,chylous leakage or laparoscope related complications.Postoperative hospital stay was 7 to 24 days,with an average of 14 days.Conclusion:Perioperative nursing of RLRN can reduce the incidence of postoperative complications,reduce postoperative hospital stay and cost,which is conducive to the postoperative recovery of patients.
作者
吴沈雅
Wu Shenya(Department of Urology,the First Affiliated Hospital,Zhejiang University School of Medicine,Hangzhou 310003,Zhejiang,China)
出处
《加速康复外科杂志》
2021年第4期157-161,共5页
JOURNAL OF ENHANCED RECOVERY AFTER SURGERY
关键词
肾癌
癌栓
达芬奇机器人手术
围手术期
护理
Renal carcinoma
Tumor thrombus
Da Vinci robotic surgery
Perioperative period
Nursing
