Medical device manufacturer

Focus on the production of staplers,
connectors, puncture and drainage bags, etc

The main symptoms of congenital choledochal cyst in children are abdominal pain, jaundice, abdominal mass, etc., and some of them are accidentally found by physical examination. Choledochal cyst resection, cholecystectomy and Roux-Y hepaticojejunostomy are recognized as the preferred surgical methods. The surgical operation is relatively complex, and it is more difficult to complete under laparoscopy. The preparation and cooperation in the perioperative period is particularly important.
1、 Preoperative nursing preparation
1. Psychological aspect
Because most of these patients are young children, children at this stage regard their mother and family members as everything. They are eager for safety and trust, worried about separation, and afraid of strange environments and people. When nurses in overalls approach, they will be frightened. This period is also a rapid stage of sports and cognitive development in people's life. They are full of infinite curiosity and interest in their own body and external environment. In view of these characteristics, parents should actively participate in the nursing of children during operation, so as to provide a therapeutic sensory activity environment for children. Actively play with children to increase their sense of safety and trust and eliminate their fear and strangeness. The mood of Kwai Fu's parents is also contradictory. They hope to see their children's pain as soon as possible and worry about the success or failure of the operation and whether the child's body can withstand the operation and its complications. Parents should carefully communicate with medical personnel to understand the operation process, anesthesia methods, possible effects, risk of operation, possible complications and precautions in the process of postoperative recovery, so as to eliminate their tension.
2. Preoperative anti infection and inhibition of pancreatic secretion
Most patients with choledochal cyst were complicated with abnormal confluence of choledochal duct and pancreatic duct. Therefore, they were complicated with acute pancreatitis. The preoperative use of antibiotics, Sandostatin and other drugs not only alleviated the pain of children, but also ensured the safety of operation.
3. Gastrointestinal preparation
Low fat diet or no diet, and fasting gas producing foods such as milk and bean products one day before operation to prevent intestinal flatulence, affect the exposure of operation field and the recovery of gastrointestinal function after operation. Preoperative indwelling of gastric tube after gastrointestinal decompression is helpful to avoid gastrointestinal flatulence, hinder the exposure of surgical field, and reduce the operation space of laparoscopic surgery. In addition, due to the need for biliary intestinal anastomosis, postoperative gastrointestinal decompression is also necessary; Indwelling catheter also provides operation space for operation; Clean enema before operation to prevent feces from polluting the anastomosis or overflowing into the abdominal cavity.
4. Preoperative skin care
The scope of skin preparation is the same as that of open surgery, focusing on the cleaning of umbilical hole. The patient's umbilicus needs to be thoroughly cleaned, because the first incision is close to the umbilicus edge, and the umbilicus is easy to accumulate dirt. If the cleaning is not thorough, it is easy to cause incision infection.
2、 Postoperative nursing
1. Vital signs monitoring
As the children are still young, they are generally weak after such a major operation, so they must closely observe their postoperative vital signs. The respiratory rate and rhythm were monitored. Due to CO2 pneumoperitoneum in laparoscopic surgery, CO2 diffused into the blood, making the children in a state similar to respiratory acidosis. Children need to discharge residual CO2 through self-regulation functions such as deepening and accelerating respiration, so the monitoring of respiration is very important. The child should lie on his back with his head tilted to one side to keep the respiratory tract unobstructed. A sputum aspirator is equipped beside the bed to inhale oxygen with low flow (2 ~ 3 L / min) and low concentration (pio220% ~ 25%) to improve the oxygen partial pressure (nasal catheter or mask oxygen inhalation can be used). Monitor heart rate and blood pressure. In laparoscopic surgery, the increase of intra-abdominal pressure caused by artificial pneumoperitoneum and the elevation of diaphragm can cause hemodynamic changes and affect children's cardiac function. Therefore, it is very important to monitor blood pressure and heart rate after operation. The infusion speed should not be too fast. Pay attention to the change of urine volume to prevent heart failure. In laparoscopic surgery, due to the long operation process and long exposure time of children's body, the CO2 used in pneumoperitoneum is frozen and liquefied before release, which can quickly cool the body and have a certain impact on children. Therefore, special attention should be paid to keeping children warm, and electric blankets can be used if necessary.
2. Observation of postoperative complications
When the patient returns to the ward after operation, the nurse should check whether there is bleeding at the troca puncture port. Closely observe the changes of blood pressure, pulse and general condition after operation. Drain more than 50ml of blood fluid in a short time and hemoglobin drops rapidly. Be alert to internal bleeding. Closely observe the changes of vital signs and abdominal signs after operation, find and report to the doctor in time. Pay attention to the occurrence of bile leakage, which occurs due to incomplete closure of the common hepatic jejunal anastomosis. After operation, the patient should be closely observed for abdominal pain, abdominal distension, muscle tension, rebound pain, fever, etc. Observe the color, quantity and quality of the drainage at any time, and confirm whether there is bile leakage as soon as possible, so as to have a second operation as soon as possible.
3. Dietary guidance
Diet should be banned 2 ~ 3 days after operation, not only because intestinal peristalsis has not recovered, but also to reduce the stimulation of bile secretion and reduce the occurrence of bile leakage. After anal exhaust, children can eat liquid diet to avoid milk and sweets that are easy to cause intestinal inflation. They should eat a small number of meals at a time to avoid eating too much at a time, resulting in gastrointestinal discomfort and gradually transition to low-fat food. Most children have the habit of picky eating and partial eating. They should respect their taste as much as possible, so that they can resume their diet as soon as possible and strengthen postoperative nutrition.