达芬奇机器人联合腹腔镜食管癌根治术的手术护理配合

Surgical nursing cooperation of da Vinci robot combined with laparoscopy for radical esophagectomy

目的总结达芬奇机器人联合腹腔镜辅助食管癌根治术的手术室护理配合方法,为该手术提供标准化的手术护理配合流程。方法回顾性分析2016年3~12月在我院开展的达芬奇机器人联合腹腔镜食管癌根治术26例患者的临床资料。所有患者在全机器人下完成胸部食管的游离,在腹腔镜下完成腹部胃的游离,最后将管胃通过食管床提至左颈部吻合。结果 26例手术均成功完成,25例手术过程顺利,有1例胸腔粘连严重转胸腔镜分离粘连后继续机器人完成胸部手术。手术时间(4.1±1.5)h,麻醉时间(5.5±1.7)h,出血量(110±52)m L,清扫淋巴结(18±4)个,术后住院时间(13±5)d,术中及术后均无手术护理并发症。结论应用达芬奇机器人联合腹腔镜食管癌根治术安全可行,具有创伤小、并发症少等优点。手术护士专业技术的正规培训、充分的术前准备、仪器设备的有效管理、规范的手术体位安置、良好的医护患沟通是确保手术顺利进行和成功的关键。

Objective To summarize the nursing cooperation of da Vinci robot combined with laparoscopy for radical resection of esophageal carcinoma, also to provide a standardized pipeline of nursing cooperation. Methods The clinical data of 26 patients, who admitted to our hospital and underwent da Vinci robot combined with laparoscopy for esophagectomy from March 2016 to December 2016, were retrospectively analyzed. All patients underwent complete dissection of the thoracic esophagus under the whole da Vinci robot system, and the abdomen stomach was dissociated under laparoscopy. Finally, the tubular stomach was lifted through the esophageal bed to the left cervical anastomosis.Results Twenty-six cases of surgery were successfully completed, of which twenty-five were smooth, and one of severe chest adhesions underwent thoracoscopic separation of adhesions chest surgery. The average operation time, anesthesia time, blood loss, number of lymph node dissection, postoperative hospital stay were（4.1 ± 1.5） h,（5.5 ± 1.7） h,（110±52） m L,（18±4）,（13±5） d, respectively. No complications were found during the operation and after the operation.Conclusion The application of Da Vinci robot combined with laparoscopic radical operation of esophageal carcinoma is safe and feasible, with the advantages of less trauma and less complication. Professional and technical training of nurses, adequate preoperative preparation, effective management of equipment, standardized surgical placement, good medical care communication are the key to ensure the smooth and success of the operation.