肠镜腹腔镜辅助肛门成型治疗中高位先天性肛门闭锁的手术配合

Nursing cooperation of endoscopic and laparoscopic treatment of middle and high congenital anal atresia

目的总结肠镜、腹腔镜辅助肛门成型术在治疗中高位先天性肛门闭锁手术护理配合方法,为该手术提供标准化的手术护理配合流程。方法回顾性分析首都儿科研究所附属儿童医院2019年11月—2020年6月行肠镜腹腔镜辅助肛门成形术治疗中高位先天性肛门闭锁16例,所有患者均在肠镜下定位直肠尿道瘘,环形切开直肠盲端瘘口周围黏膜,并在腹腔镜下游离直肠,最后行直肠肛门吻合。总结手术配合过程和护理要点。结果 16例患儿均顺利完成手术,肠镜时长中位数为45.0(29.5,60.0)min,手术总时长中位数为188.5(167.5,211.3)min,术中出血量约5~10 mL。术后恢复良好,术后住院中位时间为5.5 d,术后复查逆行膀胱造影均无尿道憩室、尿道瘘及尿道狭窄等并发症的发生。结论肠镜腹腔镜辅助肛门成型治疗中高位先天性肛门闭锁是安全可行的,具有创伤小,定位准确、并发症少等优点。手术护士专业技术的正规培训、充分做好术前准备、术中做好体温保护措施、动态实时监测生命体征、无菌操作严格、仪器设备的有效管理、规范的手术体位安置、熟练掌握配合技术及良好的医护患沟通是手术成功的关键。

Objective This study aimed to summarise the nursing cooperation methods of endoscopic and laparoscopic anorectoplasty in the treatment of high anorectal malformation(ARM)and to provide a standardised operation of nursing cooperation.Methods A retrospective analysis was performed in 16 cases of high ARM who underwent endoscopic and laparoscopic anorectoplasty in Capital Institute of Pediatrics from November 2019 to June 2020.All patients had rectal urethral fistula;rectum mucosa around fistula was dissected by endoscopy,and the rectum was mobilised by laparoscopy.The operation cooperation process and nursing key points were summarised.Results The procedure was successfully performed in all patients.The median endoscopic time was 45.0(29.5,60.0)min.The median total operative time was 188.5(167.5,211.3)min,and the intraoperative blood loss was approximately 5-10 mL.Postoperative recovery was uneventful;the median postoperative hospitalisation time was 5.5 days,and postoperative re-examination of VCU showed no occurrence of complications such as urethral diverticulum,urethral leakage and urethral stricture.Conclusion Endoscopic and laparoscopic anorectoplasty is safe and feasible in the treatment of middle and high ARM,which has the advantages of less trauma,accurate positioning and few complications.Regular training of surgical nurses’professional skills,full preparation before operation,thermal retardation during operation,monitoring of vital signs,strict aseptic operation,effective management of instruments and equipment,standardised placement of surgical positions,skilled coordination techniques and adequate doctor-patient communication are the key to the success of surgery.