Nursing Observation and Intervention of Extrahepatic Bile Duct Stones with Gallstones Treated with Electronic Duodenoscopic Sphincterotomy Combined with Laparoscopic Cholecystectomy_West China Medical Journal

Authors：

 ZHOUJie , LIJin-long

The First Surgical Ward, the Fourth People's Hospital of Sichuan Province, Chengdu, Sichuan 610016, P. R. China;

Corresponding?author：

Keywords：

Electronic duodenoscopic sphincterotomy; Laparoscopic chole cystectomy; Observation and intervention of postoperative nursing

DOI：

10.7507/1002-0179.20150323

Video：

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Objective To investigate the importance of nursing observation and intervention for extrahepatic bile duct stones with gallbladder stones treated by electronic duodenoscopic sphincterotomy (EST) combined with laparoscopic cholecystectomy (LC). Methods From July 2011 to February 2014, 157 patients with extrahepatic bile duct stones with gallbladder stones underwent EST and LC at the same time in our department. Combined with the surgery characteristics, we focused on the close observation and nursing of postoperative complications and drainage tubes for patients' timely recovery. Results One patient with duodenal diverticulum papilla did not complete EST and LC surgery, which was then transformed to LC, bile duct incision and choledochoscopy with T tube drainage. All the remaining 156 patients completed endoscopic retrograde cholangio-pancreatography and LC with a completion rate of 99.36%. Under close observation and careful nursing care, this group of patients did not have duodenum perforation, bile leakage or other complications. No patient died. Seven to thirteen days after hospitalization, all the patients were cured and discharged from the hospital. Conclusion For patients undergoing EST and LC at the same time, observation and timely intervention are very important in reducing serious complications, improving the quality of surgery, enhancing patients' comfort, and promoting postoperative recovery.

Citation： ZHOUJie, LIJin-long. Nursing Observation and Intervention of Extrahepatic Bile Duct Stones with Gallstones Treated with Electronic Duodenoscopic Sphincterotomy Combined with Laparoscopic Cholecystectomy. West China Medical Journal, 2015, 30(6): 1123-1126. doi: 10.7507/1002-0179.20150323 Copy

1.	羅云藩, 鄧予, 景英朝, 等. 腹腔鏡膽囊切除術聯合十二指腸鏡乳頭切開術治療膽石癥[J]. 右江民族醫學院學報, 2005, 27(3):350-351.
2.	李金龍, 李榮祥, 何平, 等. LC聯合EST在膽囊結石伴肝外膽管結石中的應用[J]. 肝膽外科雜志, 2005, 13(6):458-459.
3.	黃業鳳. 腹腔鏡膽囊切除術后并發癥發生的原因分析及護理干預[C]//中華護理學會第8屆全國造口、傷口、失禁護理學術交流會議, 全國外科護理學術交流會議, 全國神經內、外科護理學術交流會議論文集. 廣州:中華護理學會, 2011:240-242.
4.	龔霞玲. 腹腔鏡膽囊切除術并發癥觀察護理[J]. 中國民族民間醫藥, 2013, 22(14):159.
5.	何平, 李金龍, 張乙川, 等. 肝膽手術后膽漏的原因、預防和治療[J]. 吉林醫學, 2010, 31(22):3628-3630.
6.	王偉. 腹腔鏡膽囊切除術后并發癥的觀察及護理[J]. 中國現代藥物應用, 2014, 8(14):193-194.
7.	溫秀英. 淺談腹腔鏡膽囊切除術(LC)的圍手術期的護理[J]. 健康必讀, 2012, 11(7):459.
8.	楊建鋒, 張嘯, 張筱鳳. 內鏡下逆行胰膽管造影并發十二指腸穿孔15例診治分析[J]. 中華胃腸外科雜志, 2012, 15(7):682-686.
9.	蔣艷, 單雪蓮, 毛鑫群. ERCP術后并發十二指腸穿孔的早期觀察和護理[J]. 護士進修雜志, 2009, 24(19):1782-1783.
10.	周潔, 李金龍, 張乙川, 等. 重視內鏡逆行胰膽管造影術圍手術期的護理[J]. 中外醫學研究, 2013, 11(35):89-90.
11.	李金龍, 張福鑫, 李勁, 等. 介入栓塞治療在EST術后大出血中的應用[J]. 中華消化內鏡雜志, 2009, 26(10):543-544.
12.	張嘯, 錢禮. 內鏡下乳頭切開術的近期并發癥[J]. 中華消化內鏡雜志, 1996, 13(5):290-292.
13.	王書智, 葉志霞, 胡冰, 等. 止血夾與藥物聯用預防乳頭括約肌大切開術后出血的效果觀察[J]. 解放軍護理雜志, 2006, 23(4):51-52.
14.	黃永德, 胡團敏, 張成華, 等. ERCP聯合LC治療膽囊結石合并膽總管結石的臨床價值[J]. 現代消化及介入診療, 2011, 16(5):332-334.
15.	董建花. 鼻膽管引流術后的護理[J]. 中國醫藥指南, 2014, 12(27):292-293.
16.	梁和業, 喬秀麗, 王曉豐, 等. ERCP后即時LC在治療膽囊結石合并膽總管結石中的應用價值[J]. 胃腸病學和肝病學雜志, 2013, 22(7):704-705.
17.	陳彩芳, 蔡秋鳳. 雙鏡聯合治療肝外膽道結石的護理體會[J]. 實用臨床醫藥雜志, 2014, 18(4):85-86.

1. 羅云藩, 鄧予, 景英朝, 等. 腹腔鏡膽囊切除術聯合十二指腸鏡乳頭切開術治療膽石癥[J]. 右江民族醫學院學報, 2005, 27(3):350-351.
2. 李金龍, 李榮祥, 何平, 等. LC聯合EST在膽囊結石伴肝外膽管結石中的應用[J]. 肝膽外科雜志, 2005, 13(6):458-459.
3. 黃業鳳. 腹腔鏡膽囊切除術后并發癥發生的原因分析及護理干預[C]//中華護理學會第8屆全國造口、傷口、失禁護理學術交流會議, 全國外科護理學術交流會議, 全國神經內、外科護理學術交流會議論文集. 廣州:中華護理學會, 2011:240-242.
4. 龔霞玲. 腹腔鏡膽囊切除術并發癥觀察護理[J]. 中國民族民間醫藥, 2013, 22(14):159.
5. 何平, 李金龍, 張乙川, 等. 肝膽手術后膽漏的原因、預防和治療[J]. 吉林醫學, 2010, 31(22):3628-3630.
6. 王偉. 腹腔鏡膽囊切除術后并發癥的觀察及護理[J]. 中國現代藥物應用, 2014, 8(14):193-194.
7. 溫秀英. 淺談腹腔鏡膽囊切除術(LC)的圍手術期的護理[J]. 健康必讀, 2012, 11(7):459.
8. 楊建鋒, 張嘯, 張筱鳳. 內鏡下逆行胰膽管造影并發十二指腸穿孔15例診治分析[J]. 中華胃腸外科雜志, 2012, 15(7):682-686.
9. 蔣艷, 單雪蓮, 毛鑫群. ERCP術后并發十二指腸穿孔的早期觀察和護理[J]. 護士進修雜志, 2009, 24(19):1782-1783.
10. 周潔, 李金龍, 張乙川, 等. 重視內鏡逆行胰膽管造影術圍手術期的護理[J]. 中外醫學研究, 2013, 11(35):89-90.
11. 李金龍, 張福鑫, 李勁, 等. 介入栓塞治療在EST術后大出血中的應用[J]. 中華消化內鏡雜志, 2009, 26(10):543-544.
12. 張嘯, 錢禮. 內鏡下乳頭切開術的近期并發癥[J]. 中華消化內鏡雜志, 1996, 13(5):290-292.
13. 王書智, 葉志霞, 胡冰, 等. 止血夾與藥物聯用預防乳頭括約肌大切開術后出血的效果觀察[J]. 解放軍護理雜志, 2006, 23(4):51-52.
14. 黃永德, 胡團敏, 張成華, 等. ERCP聯合LC治療膽囊結石合并膽總管結石的臨床價值[J]. 現代消化及介入診療, 2011, 16(5):332-334.
15. 董建花. 鼻膽管引流術后的護理[J]. 中國醫藥指南, 2014, 12(27):292-293.
16. 梁和業, 喬秀麗, 王曉豐, 等. ERCP后即時LC在治療膽囊結石合并膽總管結石中的應用價值[J]. 胃腸病學和肝病學雜志, 2013, 22(7):704-705.
17. 陳彩芳, 蔡秋鳳. 雙鏡聯合治療肝外膽道結石的護理體會[J]. 實用臨床醫藥雜志, 2014, 18(4):85-86.

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West China Medical Journal

Nursing Observation and Intervention of Extrahepatic Bile Duct Stones with Gallstones Treated with Electronic Duodenoscopic Sphincterotomy Combined with Laparoscopic Cholecystectomy

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