内镜下切除上消化道黏膜下肿瘤的安全性护理

Nursing management in the endoscopic resection of upper gastrointestinal submucosal tumor

目的探讨上消化道黏膜下肿瘤(SMT)内镜下切除术中的安全性护理措施。方法回顾性分析117例上消化道黏膜下肿瘤行内镜下切除治疗的患者,对内镜下切除肿瘤术中护理方法进行总结。结果 117例患者均采用在内镜下完成黏膜下肿瘤切除术,其中采用挖除法71例,采用全层切除法32例,采用隧道法14例;一次完整切除率为95. 76%;所有术中出血病例均在内镜下成功止血,无术后迟发性出血病例;术中发现穿孔51例,占总例数的43. 6%,均在内镜下进行闭合,无转外科手术病例;术中发生气体并发症的有23例,占总例数的19. 7%,其中严重气腹15例,严重皮下肿4例,出现纵隔气肿2例,经处理后均改善;无术后严重感染病例。结论专业、规范的护理措施能够提高内镜切除上消化道黏膜下肿瘤手术的安全性,确保手术顺利进行。

Objective Tosummarize the nursing management in the endoscopic resection of upper gastrointestinal submucosal tumor （SMT）. Methods Theclinical data of 177 patients withendoscopic resection of upper gastrointestinal SMT was retrospectively analyzed. The perioperative nursing measures were also summarized. Results All 117 patients underwent endoscopic resection of upper gastrointestinal SMT, including 71 cases by endoscopic submucosal excavation, 32 cases by full-layer resection and 14 cases by submucosal tunnel dissection. The rate ofen-bloc resection was 95.76%. All cases of intraoperative hemorrhage were successfully stopped under endoscopy,and no cases of postoperative delayed hemorrhage were found. There were 51 cases of perforation, accounting for 43.6% of the total number of cases, all of which were closed under endoscopy without anycasesconversion to surgery. There were 23 cases of gas complications, accounting for 19.7% of the total cases, including 15 cases of severe pneumoperitoneum, 4 cases of severe subcutaneous swelling and 2 cases of pneumomediastinum. No severe postoperative infection was reported. Conclusion Professional and standardized nursing measures can improve the safety of endoscopic surgery for upper gastrointestinal submucosal tumors.