经尿道内镜粘膜下剥离术治疗非肌层浸润性膀胱肿瘤的护理

The nursing of transurethral endoscopic submucosal dissection for non-muscle invasive bladder tumor

目的:总结非肌层浸润性膀胱肿瘤行肿瘤粘膜下剥离术(BT-ESD)的护理经验。方法:收集分析2015年3月至2017年12月我科收治的32例行BT-ESD手术患者的临床资料,包括术前护理、术中配合、术后护理、并发症的观察、出院随访等。结果:32例患者术后均即刻行膀胱灌注药物治疗,保留时间0.5～1 h;术后平均住院时间4.53 d,总平均住院日11 d;有34%(11/32)的患者术后第1 d出现淡血性尿液,3%(1/32)的患者术后第3 d血尿较为严重;3%(1/32)的患者术后第2 d出现膀胱痉挛;3%(1/32)的患者术后当天膀胱灌注化疗后出现明显膀胱刺激症状;在术后长期随访中有6%(2/32)的患者出现尿道狭窄;无患者出现膀胱穿孔。其中有6%(2/32)的患者因术后病理示膀胱切缘癌累及,于术后1个月行二次电切;术后随访有6%(2/32)的患者分别于半年、1年后复发,行膀胱癌根治性切除+回肠代膀胱术。结论:膀胱肿瘤粘膜下剥离术(BT-ESD)治疗非肌层浸润性膀胱肿瘤是安全有效的,通过临床的精心护理,完善的出院随访,可以减少术后并发症的发生,降低膀胱肿瘤复发率,提高患者满意度。

Objective:To summarize the nursing experience of endoscopic submucosal dissection of bladder tumor(BT-ESD)for non-muscle invasive bladder tumor(NMIBC).Methods:The clinic data of 32 cases of NMIBC performed BT-ESD from March 2015 to December 2017 were collected and analyzed,including pre-operative nursing,operative cooperation,post-operative nursing,complications and follow-up.Results:In this study,32 patients were immediately given bladder perfusion after operation,with a retention time of 0.5-1h.The average postoperative hospital stay was 4.53 days,and the total average length of stay was 11 days.34%(11/32)of the patients had mild urine on the first day after operation.Hematuria was more serious in 3%(1/32)patients on the third day after surgery.Bladder spasm occurred in 3%(1/32)of patients the day after surgery.Bladder irritation was found in 3%(1/32)of patients after bladder perfusion chemotherapy on the day after surgery.Urethral stricture occurred in 6%(2/32)patients during postoperative long term follow-up,and no patient developed bladder perforation.Among them,6%(2/32)of the patients were involved in bladder resection margin cancer due to postoperative pathology,and the second electrotomy was performed 1 month after the surgery.6%(2/32)of the patients were followed up after surgery,and they relapsed 6 months later and 1 year later,respectively,for whom radical bladder resection and ileal bladder replacement were performed.Conclusion:BT-ESD is a safe and effective approach to treat NMIBC.Through careful clinical nursing and complete discharge follow-up,postoperative complications can be reduced,the recurrence rate of bladder tumor can be reduced,and patients'satisfaction can be improved.