内镜黏膜下剥离术治疗直肠巨大扁平病变的护理体会

Nursing experience in endoscopic submucosal dissection of large flat rectal lesions

目的探讨采用内镜黏膜下剥离术(ESD)治疗直肠巨大扁平病变的护理配合体会。方法回顾分析2010年3月～2011年12月该科肠镜检查发现的25例直径>2cm的直肠扁平病变进行ESD切除治疗的病例资料,总结ESD术前、术中及术后护理方法。结果 25例患者均顺利完成ESD切除治疗,2例术后当晚出现便血,予经内镜对症处理后血止。随访期(1～24个月)内除1例手术创面出现增生肉芽肿外,其余全部瘢痕愈合,无1例复发。所随访的患者术后复查肠镜示创面愈合良好,无复发。结论随着ESD的不断开展及治疗器械和设备的不断改进,直肠巨大扁平病变可以得到1次、完整切除,充分体现"微创治疗"的优越性。护士在ESD过程中需要掌握各种配件的性能及熟练的操作,与医生配合默契,以保证手术顺利进行,减少并发症。

【Objective】To evaluate the nursing cooperative experience in endoscopic submucosal dissection （ESD） for the large flat rectal lesions.【Methods】25 cases of flat rectal lesions （larger than 2 cm） were resected with ESD technique from March 2010 to December 2011 in our hospital. The preoperative, intraoperative and postoperative nursing cooperative methods were retrospectively summarized.【Results】All 25 large flat rectal lesions were resected successfully with ESD technique. 2 cases with delayed bleeding were managed conservatively on colonoscopy. During the follow-up （1-24 monthes）, all the wound healed well without any recurrence, except one had hyperplastic granuloma in the wound.【Conclusions】With the development of ESD technique and improvement of ESD instruments, large flat rectal lesions can be resected completely in one piece, which fully embody the advantage of minimally invasive therapy. Endoscopic nursers must be familiar with various endoscopic accessories, cooperate very well with endoscopists, thus ensuring the operation going smoothly and decreasing the occurrence of the complications.