小儿腹股沟斜疝经腹手术的围手术期的护理

论文编号:HL167  论文字数:7764.页数:14

论文题目：小儿腹股沟斜疝经腹手术的围手术期护理
摘　要
 小儿腹股沟疝是一种常见病和多发病，以斜疝为常见。小儿腹股沟疝的发生多因腹膜鞘状突未闭而并非因肌肉薄弱。腹股沟疝的患儿年龄在3个月以上者，自愈机会很少。随着年龄的增长疝块增大，极易发生嵌顿，绞窄，一旦发生嵌顿，不仅累及肠管或卵巢、输卵管，尚可造成睾丸萎缩，影响成人后的生育，应及早手术。斜疝的手术原则是疝囊高位结扎和疝修补。腹腔镜手术是近十多年来运用到临床的一项新技术，正逐步得到临床的重视和普及。疝囊高位结扎治疗小儿腹股沟斜疝相对比较简单，不仅能取得与传统手术相同的效果，而且具有切口少、痛苦少、恢复快等特点。
目的
 探讨微型腹腔镜经腹手术治疗小儿腹股沟斜疝的临床应用价值及发展前景，得出进行科学系统的围手术护理，不仅能提高手术的有效性和安全性，也能使患儿取得最大限度的康复。
方法
 1999年12月~2009年12月共应用微型腹腔镜治疗小儿腹股沟斜疝101例，年龄1~13岁(5.64岁)，所有病例均行微型腹腔镜下疝囊高位结扎术。从术后复发率、手术时间、术后住院时间等方面回顾性分析。
结果
 本组应用微型腹腔镜治疗的101例腹股沟斜疝患儿均手术顺利，术后随访1周～2年，复发1例外，其余病例均症状消失，伤口不需缝合，未见明显手术疤痕，复发率为0.9901％；手术时间5～20分钟，平均13.29分钟；术后住院时间24～72小时，其中位数为48.00小时；2例出现并发症，但均得到及时的处理未引起不良后果。术中发现并处理对侧隐性疝14例。
结论
 微型腹腔镜治疗小儿腹股沟斜疝治疗效果确切，创伤小、复发率低、手术时间短、术后恢复快、并发症少、可同时发现并处理对侧隐性疝值得在临床应用推广，具有广阔的应用前景；科学系统的围手术护理，不仅能提高手术的有效性和安全性，也能使患儿取得最大限度的康复。
 
 关 键 词：腹股沟斜疝；经腹手术；围手术期护理
 
 研究类型：应用性研究
 
 Title: Indirect inguinal hernia after abdominal surgery Perioperative Nursing
research
ABSTRACT
Objective:
 To explore the therapeutic effects of microlaparoscopic treatment fo indirect inguinal hernia in children and its prospect of application.
Methods:
 101 children aged from 1 year to 13years(mean 5.64岁)were treated by microlaparoscopic surgery from January 1999 to December 2009,and all the patients received the operation of hernial sac high ligation.we analyzed the recurrence rate、operation time、length of staying in hospital(LOS)after operation、complications、surgical trauma and the rate of missed diagnosis retrospectively.
Results:
 All the 101 patients recovered except for one case recurred,and the recurrence rate was 0.9901%with a follow up from one week to two years postoperatively.The The incision didn''''t need suture and there was no obvious scar after operation;The operation time was from 5~20 minutes,and the mean time was 13.29minutes;The length of staying(LOS)was 24~72 hours,and the median was 48.00 hours;Complications were found in two cases,but they were dealed with in time and there was no bad consequence left.14 patients had concealed hernia and received the operation of hernial sac high ligation.
Conclusions:
 Microlaparoscopic treatment for indirect inguinal hernia in children is a simple,convenient,quick,safe and minimal injury procedure with little complications and it can find and deal with contralateral paten processus vaginalis(CPPV)at operation time.Especially it can avoid the failure of finding hernial sac when dealling with those who had received traditional operation and there were severe adherence in the inguina.So microlaparoscopic treatment for indirec inguinal hernia in children is worthy of being used widely and it has a good prospective.
Key words： microlaparoscope;child;indirect inguinal hernia;hernial sac high ligation.

目  录
 
摘　要 I
ABSTRACT I
目  录 III
1 绪论 1
1.1研究背景及意义 1
1.2目的及目标 1
1.3关键词定义 1
1.4文献回顾 2
2 研究设计 1
2.1研究对象 1
2.2一般资料 1
2.3研究方法 1
2.4研究步骤 1
2.5统计分析 1
3 研究结果 2
3.1年龄分布 2
3.2术中情况 2
3.3复发率 2
3.4手术创伤 3
3.5手术时间 3
4．讨论 4
4.1复发率 4
4.2手术创伤 4
4.3手术时间及术后住院时间 4
4.4护理 5
5 推论及建议 6
5.1 结论 6
5.2建议 6
致    谢 8
附   录 9
参考文献 10