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Laparoscopic surgery of congenital bile duct cysts of Note

Date2013-08-27 21:55:25

The main symptoms of congenital bile duct cysts as abdominal pain, jaundice, abdominal mass, they are also occasionally found as part of the physical examination. Choledochal cyst, cholecystectomy, hepatic duct jejunum Roux-Y anastomosis is widely considered to be the preferred procedure, the surgical procedure is relatively complex, more difficult to complete laparoscopic endoscopic perioperative preparation with particularly important.
A preoperative care preparations
1, the psychological aspects
Since most of these patients are young children, children in this period the mother and family members as their all, they want security and trust, fear separation, fear of unfamiliar environments and characters. When the nurse approached wearing overalls will terrified. This period is also the stage of human life, fast movement and cognitive development, their own body and the external environment is full of boundless curiosity and interest.
For these characteristics, the children of parents should be actively involved in surgical care of children, in order to provide children with sensory Setting a therapeutic effect. Active play with the children together to increase children's safety and sense of trust, eliminate fear and unfamiliar children. Preoperative parental mood is contradictory, that is, that as soon as possible contact with their child's surgical pain, and worry about whether the success of the surgery and children with body blow to withstand surgery and its complications. Parents should be careful to communicate with the medical staff, surgical procedures, anesthesia, the effect may be achieved, the risk of surgery, complications may occur after the recovery process and learn more about the precautions to eliminate their anxiety.
2, preoperative antibiotics, inhibition of pancreatic secretion
Choledochal cyst patients with multiple biliary duct confluence with the exception, so with acute pancreatitis, preoperative use of antibiotics and other drugs Sandostatin both ease the suffering of children, but also to ensure the safety of surgery.
3, gastrointestinal preparation
Line of low-fat diet or fasting, preoperative fasting day gas-producing foods such as milk, soy products, preventing flatulence, revealing the impact of the operative field and postoperative recovery of gastrointestinal function. Preoperative indwelling stomach tube, after decompression helps avoid flatulence, prevent exposure of the operative field, reducing operating space laparoscopic surgery, in addition to the line due cholangioenterostomy, decompression surgery is necessary ; indwelling catheter is also provided for the surgical operating room; cleansing enema before surgery to prevent intraoperative anastomotic fecal contamination or spill into the abdominal cavity.
4, preoperative skin care
Range of skin preparation with open surgery, focusing on good clean umbilical hole. Wash thoroughly umbilical patients because surgical incision close to the first umbilical edge, easy to accumulate dirt and navel, if not thoroughly cleaned easily lead to wound infection.
Second, post-operative care
1 , vital signs monitoring
Due to the age of children is still small , so after receiving major surgery , are generally more frail , so make sure children after close observation of vital signs . Monitoring of respiratory rate and rhythm , laparoscopic surgery because of pneumoperitoneum with CO2 , CO2 diffusion into the blood , so that children are in a similar state of respiratory acidosis . Children need to breathe deeper , speeding up the discharge of residual autoregulation CO2, so the respiratory monitoring is very important. Children should go to the pillow supine, head to one side , keeping the airway open , bedside equipment suction, low flow (2 ~ 3 L / min), low density (PiO220% ~ 25%) oxygen to increase the oxygen partial pressure ( can be oxygen nasal cannula or mask type ) .
Monitoring of heart rate and blood pressure. Laparoscopic surgery , because artificial pneumoperitoneum cause increased intra-abdominal pressure , diaphragm elevation can cause hemodynamic changes affect cardiac function in children , therefore , monitoring of blood pressure and heart rate after surgery is very important. Infusion rate can not be too fast, pay attention to changes in urine , and prevent heart failure. In laparoscopic surgery , CO2 due to the long path length of surgery , children with physical exposure time , plus pneumoperitoneum used before the release of frozen liquefied , enabling rapid cooling of the body has a certain influence on the children , so special attention to suffering children warm, electric blankets available if necessary .
2 Postoperative complications
When patients back to the ward, the nurse should check whether the bleeding puncture Troca. After close observation of changes in blood pressure, pulse and body condition, short 50mL bloody fluid draining more rapid decline in hemoglobin should be wary of internal bleeding, after close observation of vital signs, abdominal signs of change, to detect and report physician. Note bile leakage occurs due to hepatic duct jejunum anastomosis dysraphism occurs, patients should be closely observed in patients without abdominal pain, bloating, muscle tension and rebound tenderness, fever. Always observe the drain of color, quantity, quality, as soon as possible to confirm whether bile leakage, so that as soon as the second surgery.
3, dietary guidance
After 2 to 3 days to be fasting, first, because the bowel is not restored, but also to reduce the stimulation of bile secretion, reduce the incidence of bile leakage. Flatus after children can eat liquid diet, avoid eating can lead to intestinal bloating milk and sweets, should be smaller meals, avoid eating too much time, cause gastrointestinal discomfort, and gradually transition to a low-fat food. Most children have a few picky eaters, food habits, you should try to respect their tastes, so that children early resumption of diet, and postoperative nutrition.