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

肝切除术围手术期管理的变化和旨在提高生活质量的护理计划。

• 批准号: 09672389
• 负责人: AKASHI Keiko
• 金额: $ 1.41万
• 依托单位: Mie University
• 依托单位国家: 日本
• 项目类别: Grant-in-Aid for Scientific Research (C)
• 财政年份: 1997
• 资助国家: 日本
• 起止时间: 1997 至 1998
• 项目状态: 已结题
• 来源: https://kaken.nii.ac.jp/grant/KAKENHI-PROJECT-09672389/
• 关键词: hepatectomy; perioperative management; complication; thoracoabdominal approach; autologous transfusions; 開胸開膜アプローチ; 高ビリルビン血症

[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

[目的]为制定提高肝切除患者生活质量的护理计划，我们对10年前和近10年的肝切除患者进行了回顾性调查，从围手术期处理及相关因素的角度评价变化.[方法]对象：A组96例，前10年(1985~1988年)行肝切除96例，B组(近10年)109例(1995~1998年)。经皮肝穿胆管引流和自体胆汁摄取、术前经皮肝穿门静脉栓塞术、输血、术后开始口腔喂养和下地活动等。4)手术结果、住院死亡、术后并发症。[结果]1)有…。两组在患者背景或肝切除范围方面没有更多的差异。B组术前采用自体胆汁摄取和PTPE，采用胸腹入路、微波凝固、自体输血，缩短术后引流时间，提早开始进食和下地活动。2.)B组患者的住院死亡率和术后并发症均有所下降，但术前梗阻性黄疸患者的效果难以令人满意。结论]与10年前相比，近期肝切除患者的术后并发症和手术死亡已有减少的可能。导致这些变化的因素似乎是：(1)由于术前PTPE、胸腹入路、减少出血、自体输血而减少了手术侵袭性，以及(2)围手术期管理的进步和创新，包括最小限度地插入和早期拔除导管和引流管。然而，在与术前梗阻性黄疸相关的病例中，肝切除术的围手术期处理有时是有问题的，这将是未来的任务。较少

项目成果

明石恵子: "肝切除の周術期管理の変遷" 日本消化器外科学会雑誌. 31・6. 550 (1998)

Keiko Akashi：“肝脏切除术围手术期管理的变化”日本胃肠外科学会杂志 31, 6. 550 (1998)。

明石恵子: "消化器手術後のストレスに対する補中益気湯(TJ-41)の効果" PROGRESS IN MEDICINE. (印刷中). (1999)

Keiko Akashi：“Hochuekkito (TJ-41) 对胃肠道手术后压力的影响”医学进展（1999 年出版）。

Toshio IIDA: "Postural changes and ambulation" Gastroenterological Surgery. (in Japanese) 20 (4). 462-468 (1997)

Toshio IIDA：“姿势变化和行走”胃肠外科。

飯田俊雄: "体位変換と離床" 消化器外科. 20・4. 462-468 (1997)

饭田敏夫：“体位改变和下床”胃肠外科20・468（1997）。