腹腔镜肛提肌外腹会阴联合切除术治疗低位直肠癌的护理观察

Nursing care of extralevator abdominoperineal excision under laparoscope for low rectal cancer

目的总结腹腔镜肛提肌外腹会阴联合切除术治疗低位直肠癌护理方法，以提高护理抗风险能力和护理质量。方法以2014年本院收治的42例低位直肠癌患者为研究对象，将其随机分为对照组与观察组，每组21例，对照组给予常规的腹腔镜辅助下腹会阴联合切除术（APR），观察组术前给予心理疏导及情景教育：使用人体模拟讲解这类手术的优点、手术方法及术后恢复等事项；以真人作模拟示范预防术后并发症的方法，如防血栓、防感染（肺部和伤口感染）、减轻伤口疼痛方法、引流管的放置（变换体位、床上活动注意引流管的放置、防止引流管扭曲、脱落及注意事项）和营养支持及造口的观察护理方法等。结果对照组发生并发症为42．86％（其中盆底疝9．52％、尿潴留4．76％、会阴伤口14．29％、肺部感染9．52％、栓塞4．76％），观察组为14．29％（其中盆底疝4．76％、尿潴留0．00％、会阴伤口4．76％、肺部感染4．76％、栓塞0．00％），差异有统计学意义（x2=4．232，P〈0．05），对照组住院天数为（15．3±2．3）d，观察组为（12．3±1．2）d，t=5．301，P〈0．05。结论术前教育是提高患者及其家属的认知能力，减少、消除心理压力，术后督促、协助、指导患者使用已掌握预防并发症的方法能有效降低腹腔镜辅助下肛提肌外腹会阴联合切除术术后并发症发生率，提高患者的生活质量及降低其经济负担，值的临床重视与推广。

Objective To summarize the nursing methods of extralevator abdominoperineal excision under laparoscope for low rectal cancer and to increase the anti-risk ability of nursing care and improve nursing quality. Methods 42 patients with low rectal cancer treated at our hospital in 2014 were selected as study objects and were randomly divided into a control group and an observation group, 21 for each group. The control group received laparoscopic assisted abdominoperineal resection （APR） and the observation group was given laparoscopic extralevator abdominoperineal resection （ELAPE）. And before operation, the observation group was given psychological consultation and situational education. Results The incidence of complications was 42.86% in the control group and 14.29% in the observation group, with a statistical difference （ X 2 =4.232, P 〈 0.05 ） . The hospital stay was （ 15.3±2.3 ） d and （ 12.3±1.2 ） d in the observation group, t=5.301, P 〈 0.05. Conclusions Preoperative education can improve the patients and their family members＇ cognition ability and reduce psychological pressure. Good postoperative nursing care can effectively reduce postoperative complications and improve the patient＇s quality of life.