复杂肝内胆管结石病疗效及围手术期护理分析

A clinical nursing analysis of 153 cases surgical treatment with complicated intrahepatic cholelithiasis

目的：总结肝内胆管结石围手术期的护理要点、总结护理经验。方法：回顾性分析1998—2005年四川省人民医院收治复杂肝内胆管结石153例的临床、护理资料，对其术前全身及营养情况做详细评估，重点检查心肝、肺、肾及血液系统功能，做好心理护理；术后密切观察生命体征及病情变化，保证有效循环血量，防治低血压；保持各引流管通畅，加强基础护理及术后并发症的观察及护理。结果：该153例复杂肝内胆管结石患者均做了肝叶切除术，无1例手术死亡，153例中发生术后并发症37例（24．2％），围手术期死亡4例（2．62％），153例共81例获得0．5～10年随访，随访率53．0％，疗效优良率为77．8％，残石率为21．0％，结石复发率为8．7％。结论：做好围手术期的护理尤其是增强术后的护理观察，提高术后护理质量，巩固手术疗效和促进病人康复至关重要。肝段（叶）切除联合其他手术是治疗肝内胆管结石较为理想而有效的手术方式。

Objective To evaluate the effect of treatment and to conclude the nursing experience with for complicated intrapeutic cholelithiasis. Methods In this study, 153 patients suffering from intrahepatie bile duct stones underwent surgical treatment from 1998 to 2005. Operation modality, postoperative complication, residual stone and nursing data were evaluated. Resuhs Postoperative complications occurred in 37 cases （24. 2% ）, mortality in 2.62%, limited intrahepatic bile duct in 80. 4%. A follow up of 0. 5 to 10 years was achieved in 81 patients （53.0%）, with excellent or good result in 77. 8%, residual stone in 21.0%, and stone recurrence in 8.7%. Conclusion The combined hepatic resection and other operation is an ideal and effective surgical method to treat complicated intrahepatic cholelithiasis.