悬吊式与气腹式腹腔镜胆囊切除术护理配合的比较

Comparison between laparoendoscopic cholecystectomy with abdominal wall lift and pneumoperitoneum laparoscopic cholecystectomy

目的：比较气腹式腹腔镜与悬吊式腹腔镜胆囊切除术的护理方法及术中配合。方法选取2012年4月-2013年5月72例采用气腹式腹腔镜手术、76例悬吊式腹腔镜胆囊切除术患者的手术护理进行比较。对比两种术式平均手术时间、术中出血量、术后肩背疼痛发生率及医患满意度。结果气腹式手术患者术中出血量为（298．20±47．78）ml，悬吊式手术为（533．22±90．29）ml；气腹式手术术后患者肩背疼痛7例，悬吊式手术疼痛1例，两组比较差异均有统计学意义（t＝-5．144，χ2＝4．129；P＜0．05）。手术医生对气腹式手术满意度高于悬吊式手术，尤其在用物传递准确率及器械熟练度两项上比较差异有统计学意义（ t值分别为3．130，3．536；P＜0．05）。患者对气腹式手术与悬吊式手术总体满意度差异无统计学意义（t＝-1．925，P＞0．05），但悬吊式手术体位舒适性上要比气腹式手术高，差异有统计学意义（t＝-2．746，P＜0．05）。结论手术室护士应充分掌握气腹式腹腔镜手术和悬吊式手术操作特点才能提高手术护理质量。悬吊式手术作为最新的手术方式之一，手术组人员默契合作及共同努力是其成功的重要保证。

Objective To compare the nursing technique between laparoendoscopic surgery with abdominal wall lift （ LESC） and that with pneumoperitoneum laparoscopic cholecystectomy （ PLC） .Methods Data from 76 patients who underwent LESC and 72 patients who underwent PLC between April 2012 and May 2013 were collected .The operating time , estimated blood loss , shoulder and back pain rate , doctors and patients＇satisfaction were observed .Results The mean estimated blood loss was significantly more in the LESC group than that in the PLC group [（298.20 ±47.78） vs （533.22 ±90.29）ml;t=-5.144, P〈0.05）], while the shoulder and back pain rate of LESC group was significantly lower than that of PLC group （7 vs 1 cases;χ2 =4.129,P〈0.05）.The doctors＇satisfaction in PLC group was higher than that in LESC group （ P〈0.05）, especially in property transfer accuracy and instrument proficiency （ t=3.130,3.536,respectively;P〈0.05）.The patients＇satisfaction had no significant difference （t=-1.925,P＆gt;0.05）, while the posture comfort of patients in LESC group was higher than that in PLC group （t=-2.746,P〈0.05）.Conclusions Operation nurses should fully master the nursing technique and characters of LESC and PLC in order to improve the surgical nursing quality , and the doctor-nurse cooperation is the key for the success of LESC .