内镜下放射状切开术治疗食管内镜黏膜下剥离术后狭窄的护理操作配合

Nursing cooperation for stenosis after esophageal endoscopic submucosal dissection in patients with endoscopic radial incision

目的观察内镜下放射状切开术(ERI)治疗食管内镜黏膜下剥离术(ESD)后狭窄的疗效,总结围术期护理及术中操作配合要点。方法收集11例食管ESD后狭窄患者的临床资料。比较患者手术前后狭窄处直径、吞咽困难评分,记录手术相关并发症的发生情况,分析围术期护理及术中操作配合对手术效果及安全性的影响。结果11例患者均完成ERI,平均狭窄长度为(2.72±1.48)cm,平均手术时间为(25.45±16.00)min,所有患者均未出现穿孔、出血等并发症。11例患者术前平均吞咽困难评分为(3.09±0.54)分,术后第5天降至(1.18±0.60)分,术后3、6个月降至(1.45±0.69)、(1.80±0.98)分,与术前比较,差异均有统计学意义(P<0.05)。11例患者术前、术后5 d及术后3、6个月时狭窄处直径依次为(0.34±0.14)、(1.26±0.19)、(1.16±0.22)、(1.14±0.20)cm,与术前比较差异均有统计学意义(P<0.05)。结论ERI用于食管ESD后狭窄的治疗是安全有效的,术中医护间的默契配合能提高手术安全性,围术期规范护理则能促进患者康复。

Objective To observe the efficacy of endoscopic radial incision(ERI)in the treatment of stenosis after esophageal endoscopic submucosal dissection(ESD),and to summarize the key points of perioperative nursing and intraoperative operation cooperation.Methods Clinical materials of 11 patients with stenosis after esophageal ESD were collected.The diameter of stenosis and dysphagia score were compared before and after operation in all the patients,the incidence condition of operation related complications was recorded,and the influence of perioperative nursing and intraoperative cooperation on the efficacy and safety of operation was analyzed.Results All the 11 patients completed ERI,the average stenosis length was(2.72±1.48)cm,the average operation time was(25.45±16.00)min,and no perforation,bleeding and other complications were observed in all the patients.The average dysphagia score of 11 patients was(3.09±0.54)points before operation,which decreased to(1.18±0.60)points on the fifth day after operation and(1.45±0.69)and(1.80±0.98)points at 3 and 6 months after operation,and there were significant differences when compared to the score before operation(P<0.05).The diameters of stenosis in 11 patients were(0.34±0.14),(1.26±0.19),(1.16±0.22)and(1.14±0.20)cm at the time points of before operation,5 days after operation,3 months and 6 months after operation,which showed significant differences when compared to diameter before operation(P<0.05).Conclusion ERI is safe and effective in the treatment of stenosis after esophageal ESD.The tacit cooperation between doctors and nurses can improve the safety of operation,and standardized perioperative nursing can promote the rehabilitation of patients.