总结1例胆管癌患者行离体肝切除联合自体肝移植围手术期的护理体会。护理要点：术后1周目标导向精准静脉抗凝护理;利用劳尔比色卡动态观察引流液,主动预防和识别前哨出血;控制腹内压、做好术后24 h内液体管理,保证肝脏有效灌注,降低肝脏缺血和再灌注损伤;围手术期充分观察和预防小肝综合征发生;关注术后胃肠道功能恢复,实施分阶段营养方案。经过精心护理,患者术后第45天康复出院。
To summarize the perioperative nursing experience of one patient with cholangiocarcinoma undergoing ex vivo liver resection combined with autologous liver transplantation. Nursing points：goal-oriented precise venous anticoagulation nursing one week after operation,observing the drainage fluid dynamically by Raúl colorimetric card to actively prevent and identify sentinel bleeding,controlling intra-abdominal pressure and doing a good job in fluid management within 24 hours after operation to ensure effective liver perfusion and reduce liver ischemia and reperfusion injury,comprehensively preventing and observing the occurrence of small liver syndrome during perioperative period,paying attention to the recovery of gastrointestinal function after operation and implementing the staged nutrition program. After careful nursing,the patient was discharged 45 days after operation.
[1] 中国抗癌协会肝癌专业委员会转化治疗协作组. 肝癌转化治疗中国专家共识(2021版)[J]. 中国消化外科杂志,2021,20(6):600-616.
Liver Cancer Conversion Therapy Alliance of Liver Cancer Committee of Chinese Anti-Cancer Association. Chinese expert consensus on conversion therapy in hepatocellular carcinoma(2021 edition)[J]. Chin J Dig Surg,2021,20(6):600-616.
[2] 樊羿辰,邓满军,鄢靖欣,等. 离体肝切除联合自体肝移植的临床疗效及安全性评估的贝叶斯单臂荟萃分析[J]. 中华肝胆外科杂志,2022,28(7):547-554.
Fan YC,Deng MJ,Yan JX,et al.Clinical efficacy and safety of ex-vivo liver resection and liver auto-transplantation:a Bayesian single-arm Meta-analysis[J]. Chin J Hepatobiliary Surg,2022,28(7):547-554.
[3] Kato T,Hwang R,Liou P,et al.Ex vivo resection and autotransplantation for conventionally unresectable tumors-an 11-year single center experience[J]. Ann Surg,2020,272(5):766-772.
[4] 张博雅,吴迪. 自体肝移植现状及进展[J]. 中华器官移植杂志,2021,42(12):761-764.
Zhang BY,Wu D.Current status and progress of autologous liver transplantation[J]. Chin J Organ Transplant,2021,42(12):761-764.
[5] Brodsky JT,Turnbull AD.Arterial hemorrhage after pancreato-duodenectomy. The‘sentinel bleed’[J]. Arch Surg,1991,126(8):1037-1040.
[6] 徐晶,李杰,韩悦. 劳尔比色卡在引流液出血量观察中的应用[J]. 天津护理,2017,25(2):172.
Xu J,Li J,Han Y.Application of Raul colorimetric card in observation of bleeding volume of drainage fluid[J]. Tianjin J Nurs,2017,25(2):172.
[7] Zhang XL,Wang WJ,Wang WJ,et al.Effectiveness and safety of controlled venous pressure in liver surgery:a systematic review and network meta-analysis[J]. Biomed Res Int,2015, 2015:290234.
[8] 郝保兵,张峰. 活体肝移植小肝综合症的防治[J]. 肝胆外科杂志,2015,23(4):243-244.
Hao BB,Zhang F.Prevention and treatment of small liver syndrome in living donor liver transplantation[J]. J Hepatobiliary Surg,2015,23(4):243-244.
[9] 尹德成,彭强. 小肝综合症的发生机制与防治[J]. 中外医疗,2014,33(36):197-198.
Yin DC,Peng Q.Mechanism,prevention and treatment of small liver syndrome[J]. J Huanggang Polytech,2014,33(36):197-198.
[10] 王胤佳,李超,张睿,等. 肝移植术中液体管理对术后腹内高压发生的影响[J]. 中华器官移植杂志,2015,36(4):205-208.
Wang YJ,Li C,Zhang R,et al.Relationship between postoperative intra-abdominal hypertension and fluid management during liver transplantation[J]. Chin J Organ Transplant,2015,36(4):205-208.
