腹腔镜下肾部分切除术后早期出血原因分析及护理体会

Analysis and nursing experience of early hemorrhage after laparoscopic partial nephrectomy

为研究腹腔镜下肾部分切除术后早期出血原因及护理体会,文章回顾性分析2019年2月—2021年2月在南京医科大学第一附属医院行腹腔镜下肾部分切除术的患者300例,分析其临床资料。将术后早期出血的患者作为出血组,将未出血的患者作为未出血组,对比两组术后住院时间,术后第1天引流量,手术时间,R,E,N,A,L评分,术中出血量,统计术后并发症发生率。结果表明:300例行腹腔镜下肾部分切除术的患者中,有26例(8.67%)发生术后早期出血,两组年龄、性别、体质量指数、肿瘤位置、临床分期、肿瘤直径、热缺血时间等均无统计学差异(P>0.05);两组术后住院时间,术后第1天引流量,手术时间,R,E,N,A,L评分,未出血组术中出血量低于出血组,有统计学差异(P<0.05);未出血组术后并发症发生率(2.70%)低于出血组(15.38%)(P<0.05)。研究表明,术后早期出血是腹腔镜下肾部分切除术的主要并发症,可采用选择性肾动脉栓塞术止血,可有效止血、有效保护肾功能,值得临床借鉴。

To study the causes and management of early hemorrhage after laparoscopic partial nephrectomy,retrospectiveanalysis was conducted on 300 cases of patients o underwent laparoscopic partial nephrectomy in The First Affiliated Hospital from February 2019 to February wh2021,and their clinical data were analyzed.Patients with bleeding were taken as the bleeding group,and patients without bleeding were taken as the non-bleeding group.The postoperative hospital stay,postoperative drainage volume on the 1st day,operative time,R,E,N,A,L scores,intraoperativeblood loss,serum c reatinine and blood urea nitrogen levels before and 24 h after surgery were compared between the two groups,and theincidence of postoperative complications was statistically analyzed.Among the 300 patientswho underwent laparoscopic partial nephrectomy,26 cases(8.67%)suffered from early postoperative hemorrhage.There were no significant differences in age,sex,body mass index,tumor location,clinical stage,tumor diameter and hot ischemia time between the two groups(P>0.05).There were no significant differences in postoperative hospital stay,postoperative drainage volume on the 1st day,operative time,R,E,N,A,L scores.The amountof intraoperative blo od loss in the observation group was lower than that in the control group,with statistical difference(P<0.05).Theserum creatinine and blood urea nitrogen levels 24 h after operation in the non-bleeding group were lower than those in the bleeding group(P<0.05).The incidence of postoperative complications in the observationgroup was 2.70% lower than that in the control group(15.38%)(P<0.05).Early postoperative he morrhage is the main complication of laparoscopic partial nephrectomy,selective renal artery embolization can be used tostop bleeding,can effectively stop bleeding,effectively protect renal function,which is worthy of clinical reference.