经肛内括约肌切除术联合经腹全直肠系膜切除术患者围术期护理

Perioperative Nursing for Patients with Combination of Transanal Interspincteric Resection and Trans-abdominal Total Mesorectal Excision

目的探讨超低位肿瘤患者经肛内括约肌切除术(intersphincteric resection,ISR)联合经腹全直肠系膜切除术(totalmesorectal excision,TME)的围术期护理。方法对34例无肛门外括约肌受侵的超低位直肠肿瘤患者实施经肛ISR联合经腹TME,术前加强心理护理及肠道准备,术后保持肛门清洁、调节饮食、指导坐浴和缩肛、提肛训练。结果 34例患者手术均获成功,无死亡病例,手术标本近、远切缘均无肿瘤细胞浸润;术后并发腹部切口感染2例,吻合口狭窄3例,吻合口裂开2例,直肠阴道瘘2例;术后患者肛门功能自我评价:满意27例,基本满意6例,不满意1例。结论围术期全面细致的护理及系统的缩肛、提肛训练,是经肛ISR联合经腹TME成功和改善术后排便功能的重要保证。

Objective To study the perioperative nursing of transanal intersphincteric resection（ISR） and transabdominal total mesorectal excision（TME） for anusretained ultra-low rectal tumors.Methods Thirty ultra-low rectal tumor patients without external anal sphincter involved undergoing the combination ISP and TME,were treated with psychological care before surgical procedures,bowel preparation,anus cleaning after surgery,diet adjustment,guided bath and anal shrink levator ani training.Results Of the 34 cases with successful surgeries,no perioperative deaths occurred and no tumor cell infiltration of cutting edge was detected in the near and far edges of the surgical specimens.There were 2 cases with abdominal wound infection,3 with postoperative anastomotic stenosis,2 with postoperative anastomotic rupture and 2 with rectovaginal fistula.The self-evaluation on postoperative anal function showed 27 cases with satisfaction,6 with adequate approval and 1 with dissatisfaction.Conclusion Intensive perioperative care combined with anal shrink and levator ani training guarantee a successful operation and improvement of postoperative bowel function.