经肛型肠梗阻减压导管在急性左半结肠恶性梗阻中的应用效果及护理

Application Effect and Nursing of Transanal Decompression Catheter for Intestinal Obstruction in Acute left Colon Malignant Obstruction Patients

为探讨经肛型肠梗阻减压导管在急性左半结肠恶性梗阻中的应用效果,并分析总结护理对策,回顾2018年6月至2019年8月于我院行经肛型肠梗阻减压导管置入治疗的30例患者资料,就置管成功率、置管后引流情况、脱管情况、一期手术情况及术后并发症进行分析。结果显示,30例患者均成功置管。置管后冲洗液不滴3例,导管引流不畅2例,导管脱出1例。经积极导管护理,置管5~7d后,19例患者肠梗阻完全缓解,拔管后均行一期根治性切除吻合术,余11例患者肠梗阻未完全缓解,术日拔管并清洁肠道后8例行一期根治性切除吻合术,3例因为Dukes D期患者未能根治性切除,仅行肿瘤切除一期吻合术。术后未发生腹腔感染、吻合口漏,3例切口感染(均为术前肠梗阻未完全缓解者)。结果表明,对急性左半结肠恶性梗阻患者应用经肛型肠梗阻减压导管缓解梗阻症状安全可行,成功率高,而且对提高结直肠癌一期切除吻合率具有积极意义。良好的导管护理是保证引流通畅从而有效解除梗阻的关键。

To investigate the application effect of transanal intestinal obstruction decompression catheter(TIODC)for acute left colon malignant obstruction(ALCMO)patients,analyze and summarize the nursing countermeasures,author review the data of 30 patients treated with TIODC in author’s hospital(2018-06-2019-06),and their success rate of tube placement,drainage after tube placement,extubation,first stage operation and postoperative complications were retrospectively analyzed.As results,all 30 patients’tubes were all successfully placed.After catheterization,3 cases were not dripped,2 cases were not unobstructed,and 1 case was removed;Through active catheter nursing,19 patients with intestinal obstruction were completely relieved after 5-7 dof catheterization,after extubation,the first stage radical resection and anastomosis were performed,and the remaining 11 patients were not completely relieved,after extubation and cleaning,8 patients underwent radical resection and anastomosis;There were no abdominal infection,anastomotic leakage,and 3 cases of incision infection(all of them were not completely relieved before operation).The results show that it is safe and feasible to use TIODC to relieve obstruction symptoms in patients with ALCMO,and the success rate is high,and it is of positive significance to improve the anastomosis rate of primary resection of colorectal cancer.Good catheter care is the key to ensure smooth drainage and effective relief of obstruction.