腹腔镜胃底折叠术联合袖状胃切除术治疗肥胖合并胃食管反流病患者围手术期的护理体会

Peri operative nursing experience of Laparoscopic fundoplication with sleeve gastrectomy for obese patients with gastroesophageal reflux disease

目的观察及探讨腹腔镜胃底折叠术联合袖状胃切除术治疗肥胖合并胃食管反流病患者围术期护理效果,并提出合理的护理方案。方法回顾性分析2014年2月至2018年4月在新疆维吾尔自治区人民医院住院并行腹腔镜胃底折叠术联合胃袖状切除术手术治疗的35例肥胖合并胃食管反流病患者的临床资料,并对围手术期全面护理经验进行总结。结果35例患者均顺利完成手术,经过精心全面的围手术期护理,均获得良好的治疗效果,术后35例患者均达到良好的减重效果,且胃食管反流症状均完全缓解,其中5例患者术后出现浅表切口感染,给予换药处理后痊愈出院,其中25例合并糖尿病和/或糖耐量异常,18例合并高血压,术后3个月血糖和血压均恢复正常,无吻合口瘘、吻合口梗阻及吞咽困难等严重并发症的发生。结论腹腔镜胃底折叠术联合袖状胃切除术疗效肯定,可达到抗反流减重双重目的,辅以精心全面的围手术期护理及个体化饮食指导,是术后达到减重效果及防治胃食管反流病发生发展的重要保障。

Objective To observe and explore the perioperative nursing effect of Laparoscopic fundoplication with sleeve gastrectomy in the treatment of obese patients with gastroesophageal reflux disease,and to put forward a reasonable nursing plan.Methods from February 2014 to April 2018,35 obese patients with gastroesophageal reflux disease who were hospitalized in the people's Hospital of Xinjiang Uygur Autonomous Region and underwent Laparoscopic fundoplication with sleeve gastrectomy were analyzed retrospectively.Results The 35 patients were operated successfully.After careful and comprehensive perioperative nursing,they all achieved good therapeutic effect.After operation,35 patients all achieved good weight loss effect and gastroesophageal reflux symptoms were completely relieved.5 patients developed superficial incision infection after operation and were cured after dressing change.25 patients were complicated with abnormal glucose tolerance,18 patients complicated with hypertension,and were discharged Blood glucose and blood pressure returned to normal in the last 3 months,and no serious complications such as anastomotic leakage,anastomotic obstruction and dysphagia occurred.Conclusion Laparoscopic fundoplication with sleeve gastrectomy has a positive effect,which can achieve the dual purpose of anti reflux and weight loss.It is an important barrier to achieve weight reduction effect and prevent the occurrence and development of gastroesophageal reflux disease after operation with careful and comprehensive perioperative nursing and individualized diet guidance.