腹腔镜下全腹膜外疝修补术护理.ppt

Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,Click to edit Master title style,腹腔镜下全腹膜外疝修补术护理,课堂目标,疝气定义，临床分型及临床表现,1,腹股沟结构及疝的解剖,2,传统疝修补术与腹腔镜术的区别,3,疝修补术围手术期护理（,重点,）,4,疝术后并发症护理,5,一、疝的定义和病因,定义,:,某一器官或组织从体腔的正常位置通过一个先天存在或后天形成的孔隙或缺损向外突出者统称疝。,病因,:,主要为腹壁薄弱及腹内压增加，包括先天及后天因素。,二、疝的分类,可复性、难复性、,嵌顿性,、绞窄性。,分类,膈疝,食道裂孔疝,腹外疝,腹内疝,临床上约,90,疝发生在腹部,疝门部位腹外疝：,腹股沟疝（,inguinal hernia,）、脐疝、白线疝、腹壁切口疝。,三、腹沟疝的临床表现,腹沟部出现肿物，在站立或腹部施压时明显。,检查可见肿物呈梨形，柔软，手触肿物有冲击感，可经手法复位。,Incarcerated indirect heria,时局部肿胀加重，不能回纳。,Strangulated indirect heria,出现血运障碍。,四、腹股沟区结构,Text,Text,Text,皮肤,浅筋膜,Comper(,浅层,Fat,）,Scarpa (,深层,Fiber,）,肌层,内界：腹直肌外缘,上界：髂前上棘至,腹直肌外缘,的水平线,下界：腹股沟韧带,Text,腹股沟区结构,腹外斜肌,腹股沟韧带,inguinallig.,腔隙韧带,(,陷窝韧带,),腹股沟管浅,(,皮下,),环,腹股沟区腹壁的层次,范围,五、疝的解剖,疝环、疝囊、疝内容物、疝外被盖,六、疝气围手术期护理,1,术前护理,2,术后护理及健康宣教,3,术后并发症观察及护理,1.,术前护理,术前常规准备,心理护理,术前健康宣教,2.,术后护理,一般护理，伤口、饮食、活动,严密观察生命体征变化,严密观察病情,加强术后健康宣教,3.,术后并发症观察及护理,阴囊水血肿,(scrotal hematoma),睾丸坏死（,testis necrosis),髂腹股沟神经痛,疝复发,皮下气肿,内脏损伤,七,.,疝气补片,八,.,腹腔镜疝修补术演示,思考题,简述腹腔镜疝修补术的优缺点？,疝的解剖及分型？,小结,美容效果好，没有大切口，只需在腹壁上戳三个,0.5,至,1.0,厘米的小孔,手术创伤小，术后疼痛轻，使用镇痛药物少,恢复快，术后两天即可出院,避免了缺血性睾丸炎的发生,尤其适用于双侧腹股沟疝，微创效果更加明显,复发率低于传统疝修补术,腹腔镜疝修补术与传统疝修补手术相比具有以下优点,参考文献,腹腔镜下疝修补术的现状与发展,THE STATUS AND DEVELOPMENT IN LAPAROSCOPIC HERNIORRHAPHY,中国医学工程,China Medical Engineering,丁雷,王存川,腹腔镜疝修补术与张力疝修补术创伤程度的对比研究,Comparative research of traumatic degree between laparoscopic repair of hernia and tension repair of hernia,中国内镜杂志,China Journal of Endoscopy,张健,王存川,王东亚,腹腔镜与开放式无张力疝修补术的疗效探讨,Evaluation of effects of laparoscopic hernia repair and open tension-free hernia repair,腹腔镜外科杂志,Journal of laparoscopic surgery,葛茂军,黄建平,朱庭芳,张海阳,钱建萍,葛利达,刘岗,孔宪诚,张浩,GE Mao-jun,HUANG Jian-ping,ZHU Ting-fang,传统腹股沟疝修补术、疝环充填式无张力疝修补术及腹腔镜疝修补术的临床比较,Comparison of conventional and mesh plug tension-free and laparoscopic inguinal herniorrhaphy,临床外科杂志,Journal of Clinical Surgery,朱健,顾钧,ZHU Jian,GU Jun,北京大学第三医院普通外科,-,章亿香,Thank You!,