Changes in the perioperative management of hepatectomy and a nursing plan designed to improve the quality of life.

[目的]回顾性调查10年前及近期肝切除术患者的生活质量，从围手术期管理及相关因素的角度评价其变化，为制定提高肝切除术患者生活质量的护理计划提供依据。[方法]受试对象：A组为96例10年前肝切除患者B组为109例近期肝切除术患者（1995-1998）。参数：1）患者背景、基础疾病、术前情况等。2）手术因素;肝切除范围、术中出血量、是否引流等。3）围手术期处理;经皮肝穿刺胆道引流（PTBD）和自体胆汁摄入，术前经皮肝穿刺门静脉栓塞（PTPE），输血，术后开始经口进食及排便情况等。4）手术结果;住院死亡人数、术后并发症。（1）在 ...更多信息 在患者背景或肝切除程度方面，两组之间没有差异。B组术前行自体胆汁摄取和PTPE，并采用胸腹联合入路、微波凝固治疗、自体血回输，B组可缩短术后引流时间，并能较早开始经口进食和截肢。2.）的情况。B组住院死亡率和术后并发症减少，但对术前有梗阻性黄疸的患者效果不佳。造成这些变化的因素似乎是：（1）由于术前PTPE、胸腹联合入路、失血量减少、自体输血而降低了手术侵入性;（2）围手术期管理的进步和创新，包括导管和引流管的最小插入和早期拔出。然而，肝切除术的围手术期管理与术前梗阻性黄疸的情况下，有时是有问题的，这将是一个未来的任务。少

[Purpose] In order to draw up a nursing plan designed to improve the quality of life (QOL) of hepatectomy patients, we retrospectively investigated the hepatectomy patients 10 years ago and recently, and assessed changes from the standpoint of perioperative management and related factors.[ Methods] Subjects : Group A consisted of 96 hepatectomy patients operated on 10 years previously(1985-1988), and Group B consisted of 109 hepatectomy patients operated on recently (1995-1998).Parameters : 1) Patient background ; underlying disease, preoperative condition, etc. 2) Surgical factors ; extent of hepatectomy, blood loss, whether a drain was used, etc. 3) Perioperative management ; percutaneous transhepatic biliary drainage (PTBD) and autologous bile ingestion, preoperative percutaneoustranshepatic portal vein embolization (PTPE), blood transfusions, start of postoperative oral feeding andambulation, etc. 4) Surgical results ; hospital deaths, postoperative complications.[Results] 1) There … More were no differences between the two groups in patient background or extent of hepatectomy. In Group B, however, preoperative autologous bile ingestion and PTPE were performed, and the thoracoabdominal approach, microwave coagulation therapy, autologous transfusion were used, and in Group B it was possible to shorten postoperative drainage time, and start oral feeding and ambulation earlier. 2.) In Group B, hospital deaths and postoperative complications decreased, but the results in the patients with preoperative obstructive jaundice could hardly be described as satisfactory.Conclusion] It has been possible to reduce postoperative complications and operative deaths in recent hepatectomy patients, compared with 10 years previously. The factors responsible for these changes seem to have been : (1) reduced surgical invasiveness as a result of preoperative PTPE, the thoracoabdominal approach, reduced blood loss, autologous transfusions, and (2) the advances and innovations inperioperative management, including minimal insertion and early withdrawal of catheters and drains. However, perioperative management of hepatectomy in cases associated with preoperative obstructive jaundice has sometimes been problematic, and that will be a future task. Less