超声内镜引导下胆道引流术治疗恶性梗阻性黄疸患者的护理

Nursing care of patients undergoing endoscopic ultrasonography guided biliary drainage in the treatment of malignant obstructive jaundice

总结12例超声内镜引导下胆道引流术治疗恶性梗阻性黄疸患者的护理要点。所有患者均因行内镜下逆行胆胰管造影术胆管引流失败而改行超声内镜引导下胆道引流术,其中5例行经胃经肝内胆管穿刺造瘘术,7例行经十二指肠经肝外胆管穿刺造瘘术。护理要点:术前评估与合并疾病护理,心理支持,胃肠排空准备;术中心肺功能监护,手术操作配合;术后监护及出血、胆漏等并发症的观察及护理。12例患者住院10~16 d,2例术后发生并发症(16.67%),1例经胃经肝内胆管穿刺造瘘术患者发生胆漏、胆汁性腹膜炎及气腹,予内镜下全覆膜金属支架置入术、腹腔穿刺引流术及抗感染治疗后好转;1例经十二指肠经肝外胆管穿刺造瘘术患者发生消化道出血,予腹腔血管造影、栓塞止血治疗后好转。

This paper summarized nursing points for caring 12 cases undergoing endoscopic ultrasonography guid- ed biliary drainage（EUS-BD） in the treatment of malignant obstructive jaundice. All patients received EUS-BD after unsuccessful endoscopic retrograde cholangiopancreatography,including 5 patients undergoing EUS guided hepaticogastrostomy（EUS-HGS） and 7 patients undergoing EUS guided choledochoduodenostomy（EUS-CDS）. Nursing points included ：preoperative assessment,psychological care,preoperative gastrointestinal preparation,intraoperative cardiopul- monary function monitoring,collaboration in operation,postoperative monitoring,observation and nursing care for com- plications such as bleeding,bile leakage and the others. The average hospital stay was 10-16 d. Two patients developed complications（16.67%）. A patient undergoing EUS-HGS developed bile leakage,biliary peritonitis,and pneumoperitoneum after the procedure,but was successfully recovered by placement of a second fully covered self-ex- pendable metal stent in the primary metal stent,percutaneous abdominal drainage and antibiotic treatment. A patient undergoing EUS-CDS developed gastrointestinal bleeding,and was successfully treated with radiological intervention.