范文一:左肾切除术
巴东县人民医院
手术记录单
姓 名 高艳兰 性别 女 年龄 14岁 科室 外3科 床号53床 住院号 88786 手术时间 2010-10-6
术前诊断 左肾挫伤(重度) 左肾动脉损伤性梗塞可能性大
术中诊断 左肾重度挫伤
左肾动脉损伤性梗塞并左肾急性缺血坏死 弥漫性腹膜炎 手术名称 左肾切除术 腹腔探查术
手术医师 王 奎 胡其准 助手医师 田从兵 唐波 麻醉方法 气管内 麻 醉 者 谭志翠
病人体位 右侧卧位 皮肤灭菌 PVP碘伏 切口位置和形式 左腰部斜切口 长度 15cm 使用特殊器材 ---------------
手术经过:
1、 麻醉达成后,病人取右侧卧位,常规消毒铺巾;
2、 依上述切口,切开皮肤及皮下组织,逐层切开肌层,显露并切开肾周筋膜,于肾周
脂肪囊内游离出肾脏及其肾盂输尿管;
3、 术中见左肾表面多处裂口,肾门处见一长约1.2cm裂口;左肾动脉内见一长约2cm
血凝块栓塞,左肾重度挫伤,呈急性缺血坏死状;
4、 充分显露肾蒂血管,将左肾动静脉用7号丝线双重结扎稳妥后切除肾脏,游离输尿
管及肾盂连接处,切断输尿管后双重结扎输尿管残端,残端消毒,取出肾脏,术野
充分止血;
5、 于左侧腹膜处切开腹膜探查腹腔:术中见腹腔内少量血性液体,实质性内脏及肠管
无挫伤及破裂出血,吸尽液体后未见明显出血灶,关闭腹膜;
6、 于肾床放置硅胶引流管,从侧腹壁腹膜外另戳一孔引出,点纱布器械无误,逐层关
闭切口;
7、 术中病人一般情况良好,麻醉效果好,术中出血约200ml,输血600ml,术后送病人
安返病房,切除物送病检。
术者(第一助手)签名
2010年10月6日
范文二: 肾切除术后护理注意什么
肾切除后对身体的损伤是很大的,要注意休息调养,术后为预防感染要做好护理,在护理肾切除术病人的时候一定要注意患者的排尿情况,时刻关注患者的体温变化,等到患者能进食的时候,要吃流食易消化的食物,具体肾切除术后要注意哪些?应该怎样护理呢?
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1.肾切除手术后患者在全身麻醉未清醒之前,应平卧并将头转向一侧,以防呕吐物误吸而窒息,一般需平卧2~3日,观察无并发症后才可下床活动。
2.肾切除术后不要随意揭开覆盖伤口的纱布,用手去触摸或用水去清洗伤口,以免伤口感染,如有感染迹象应及时治疗。
3.肾切除手术患者若有腹胀,可采用胃肠减压、肛管排气或在医生指导下服用中药。 精彩内容,尽在百度攻略:https://gl.baidu.com
4.肾切除术后3~5天内,患者常出现发热,体温可在38℃左右,可采取物理方法降温。
5. 手术后应随时注意排尿情况,如24小时内尿量不到500ml,需警惕脱水或肾功能衰竭。
6.肾切除术后切口疼痛常在24小时内达到高峰,约持续48~72小时可自行缓解,若手术后4~5天切口仍然疼痛且逐渐加重时,应及时告知医生。 精彩内容,尽在百度攻略:https://gl.baidu.com
7.术后根据临床情况和化验检查结果,对非蛋白氮增高、酸中毒、水和电解质紊乱等情况应及时采取治疗措施。
8.术后如进食量少,需由静脉补液。
9.如病情需要,肾切除术后应按肿瘤性质及时进行放射治疗或抗癌药物治疗。 精彩内容,尽在百度攻略:https://gl.baidu.com
肾切除术后饮食要注意,遵照医生的建议进行护理,不要让伤口感染,定期进行换药,术后几天感觉身体没有大碍的话可以下床适当活动,不要过于劳累,希望以上 肾切除术后护理注意什么?能帮到患者朋友。
范文三:我院首例后腹腔镜下左肾切除术患者围手术期护理
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我院首例后腹腔镜下左肾切除术患者围手术期护理 我院首例后腹腔镜下左肾切除术患者围手术期护理
【中图分类号】R699.2【文献标识码】A【文章编号】1672,
0256,02 3783(2012)05,
【摘要】目的 探讨后腹腔镜下肾切除术患者的围手术期护理。方法 2012年1月19日我科成功实施首例后腹腔镜下左肾切除术,护理组按照护理程序给予积极围手术期护理,密切观察病情,有效实施各项护理措施。结果 围手术期护理效果良好,患者顺利康复出院。
1、 术前护理
1.1、心理护理
1.1.1从患者进入病室起,责任护士主动介绍,消除患者的陌生感,详细介绍病区环境、制度、主管医生、护士及病区护士长、同病室的病友和作息时间。做好入院宣教,介绍疾病的相关知识,使其对自己所患疾病有一定认识和了解,保持良好的情绪来配合治疗,解除其思想顾虑,取得患者的信赖,从而建立良好的护患关系。
1.1.2经腹膜后腹腔镜下行肾切除手术是我院泌尿外科的一项微创新技术,病人对新技术新疗法缺乏可比性信息,病人对手术存在恐惧心理,害怕术中疼痛、生命有威胁及预后如何等。针对这些情况,我们耐心地疏导和解释,介绍腹腔镜的优点及本院开展情况,消除顾虑,使其能积极配合手术治疗。
1.2 术前准备
术前行三大常规检查,出凝血时间和凝血酶原测定,生化检查,内分泌实验 室检查;行B超及CT扫描,明确发病部位;术前一天备皮,术前12h禁食,4h禁饮;术前晚灌肠,以排空肠道的积便积气,术晨留置尿管,减少术中膀胱充盈而影响手术;术前30分钟常规使用抗菌药;备必要的急救药品、用物及抢救器材。
2、术后护理
2.1 常规护理
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2.1.1生命体征的观察:每2h测脉搏,呼吸,血压,血氧饱和度,如有异常报告医生及时处理。
2.1.2采取正确的卧位及活动:术后去枕平卧头偏向一侧,保持呼吸道通畅,全麻完全清醒后取平卧位,术后6h血压平稳后协助取半卧位;术后第一天协助床上活动四肢及翻身等,术后第3天,指导病员下床适量活动。
2.1.3 切口疼痛的护理:术后切口轻微疼痛,跟病员聊天,分散注意力。疼痛难忍时遵医嘱使用止痛药,并评价效果。
2.2高碳酸血症的观察:由于二氧化碳气腹后,对循环、呼吸系统有一定的影响,可出现一过性高二氧化碳血症,严重时可发生肺栓塞。术后给予低流量,间断性吸氧,以提高氧分压,促进二氧化碳排出。密切观察患者有无疲倦、烦躁、呼吸促等症状。避免持续高浓度吸氧,不利于二氧化碳排出。鼓励病人深呼吸,有效咳嗽,防止肺部感染的发生。
2.3 出血的观察:术中腹腔压力高可止血,放气后腹腔可继发性出血。术中损伤肾动脉鞘,肾上腺动脉的分支,血管微克夹松脱等均可发生出血,与开放手术相比,术后渗血相对多一些,因此术后严密观察生命体征变化,尤其是血压心率的变化,密切观察引流管引流液的颜色、性质及量,1,。保持引流管引流通畅,发生异常情况及时报告医生并采取相应的护理措施。
2.4 皮下气肿的观察:,由于手术中,需要二氧化碳建立人工气腹,若术中气腹压力过高,二氧化碳气体沿筋膜间隙上行弥散,引起皮下气肿,重者可达面颈部,可扪及捻发音,伴有咳嗽胸痛呼吸频率变化,2,,轻者可自行吸收,必要时通知医生采取相应措施。
2.5胃肠功能恢复的观察:术后由于麻醉肠道功能受抑制,肠腔内积气过多,手术操作刺激引起神经反射及二氧化碳潴留,术后第一天可在床上活动,促进肠蠕动,肠功能恢复即进流质饮食。
2.6、饮食护理:患者胃肠功能恢复后,指导病员进食流质饮食,避免进食甜食及豆制品等产气食品,无呕吐、腹胀等情况,逐步过渡到普通饮食。
2.7预防术后感染:留置尿管及血浆管引流期间,按无菌操作原
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由于病员全麻,应预防肺部感染,协助病人有效咳嗽咳痰,遵医嘱予雾化吸入,术后常规使用抗菌药。
2.8出院指导:病人出院后一周可进行日常轻工作及生活。如果出现伤口发红、疼痛等不适时应及时就诊。预防感冒,避免使用肾毒性药物。教会病员自行观察24小时尿量及颜色,定期门诊随访。
结论 通过护理过程,观察到后腹腔镜下肾切除术较开放式肾切除术优点多:患者痛苦小,术后主动活动能力强,并发症少,恢复快,伤口小。总结出术后良好精心的护理是手术成功的重要保障,术后护理及观察稍有疏忽都有可能导致严重的后果。虽然此手术的风险较大,但只要做好充分的术前准备、心理护理、术前指导及术后系统完整的护理观察与处理,能明显提高患者的安全性,且能促进患者康复,减少并发症的发生。系统完整的护理设计对患者的康复是极为重要的,外科手术固然重要,但好的护理也是必不可少的,它与手术的成功与否也是息息相关的,3,。因此,护理组要不断更新观念,提高护理水平,才能配合好新手术的开展。
参考文献
,1,周利琼,那彦群,郭应禄腔内泌尿外科新进展,J,北京大学学报(医学报) 2004.4.46(2):218—
,2,李瑜,张红,曲路,腹腔镜胆总管切开取石术内置引流术护理,J,护理学杂志
,3,张爱珍.临床营养学.北京:人民卫生出版社,2000:6-
作者单位:611400新津县人民医院
范文四:肾切除术后
肾切除术后
正常人体生理代谢功能只需要1个肾就足够了。肾脏有强大的代偿能力,去掉一个肾后,另一个肾脏会代偿性的功能强大。随着人的衰老,疾病,压力,饮食习惯等等问题的出现也许会出现高负荷,肾脏类的疾病问题慢慢显示出来。
1. 术后半年内主要以低盐饮食, 若无高血压, 水肿, 少尿等现象, 可适量增加食盐的量每日6_8克(饮料瓶盖的三分之二左右).
2. 蛋白质摄入量不宜过高, 以免增加肾的负担 ,最好清淡饮食, 禁忌油腻, 限制胆固醇高的食物如动物内脏、蛋黄、蟹黄、鱼籽、猪蹄、肉皮、鸡皮等的摄入。可间歇适当进食含钙丰富的食品如牛奶, 但补钙不可过量,否则会加重肾脏负担。提倡少量多餐,多吃绿叶蔬菜,多吃维生素高的新鲜水果和有利尿作用的食物, 如:冬瓜, 鲫鱼`````多饮水。
3. 保持大便通畅。注意排尿情况,观察尿液的颜色, 量, 性状。
6. 预防感染, 尽量不去公共场所, 防着凉, 注意卫生, 勤换衣裤
7. 注意不要过于劳累,注意休息,保持心情愉快,避免加重肾脏负担。如需使用药物,必须选择肾毒性低的药物。 一个肾只要你保持良好的生活习惯。良好的心情,必要的检查,是完全可以一直用下。 脾切除后, 机体免疫力一定会下降, 容易发生感染, 如呼吸道感染, 肠道感染等等, 所以脾切除后要注意加强防止感染, 包括保暖, 饮食卫生, 个人卫生, 戒烟酒,适当锻炼等。.
加强营养,调节身体是很有必要的。祝你健康!
范文五:肾切除术后
A bdominal I maging
aSpringer Science+BusinessMedia New York 2015
Abdom Imaging (2015)
DOI:10.1007/s00261-015-0410-3
Computed tomography after nephron-sparing surgery
Alessio Comai, 1M. Trenti, 2R. Mayr, 3A. Pycha, 2G. Bonatti, 1M. Lodde 2
12
Department of Radiology, Central Hospital of Bolzano, 5Lorenz-Bo hler Street, 39100Bolzano, Italy Department of Urology, Central Hospital of Bolzano, Bolzano, Italy 3
Department of Urology, St. Josef Hospital, University of Regensburg, Regensburg, Germany
Abstract
The increased use of abdominal cross-sectional imaging has contributed to a greater detection of incidental small renal masses. Treatment options for localized disease renal cell carcinoma include radical nephrectomy or partial nephrectomy (PN),the former being preferred for treatment of early-stage tumors. The most adopted technique for follow-up imaging is contrast-enhanced computed tomography (CT),whose ?ndingscan cause uncertainty and unnecessary repetition of examinations. Our purpose is to describe CT ?ndingsafter PN and to describe evolution in time of such images.
Key words:Computed tomography—Nephronsparing surgery—Renalcancer—Cancerimaging
Treatment options for localized disease renal cell carci-noma (RCC)include radical nephrectomy (RN)or partial nephrectomy (PN).Nephron-sparing surgery or partial nephrectomy is preferred in the treatment of early-stage disease especially for patients in whom preservation of renal function is a relevant clinical consideration [1].Other therapeutic options are laparoscopic or percutaneous tu-mor ablation and active surveillance. Despite high success rates, RCC has a recurrence rate of 7%for T1with most events occurring within the first 3years [2, 3].A rational surveillance policy is necessary for the detection of recur-rence. In addition, the side effects of intensive surveillance may be avoided in patients with a favorable prognosis, where for instance there is an increasing concern for ma-lignancies due to radiation exposure.
The most adopted technique for follow-up imaging is contrast-enhanced CT due to its high accuracy and wide availability. Other commonly used imaging techniques
are ultrasound and MRI. Ultrasound is a less-invasive and easily available modality but is limited by lower sensitivity, especially for the detection of small recurrent mass lesions. MRI has a similar diagnostic accuracy with respect to CT but is more expensive and less available. According to AUA guidelines, low-risk patients may undergo yearly to abdominal imaging (US,CT, or MRI) for 3years following a partial nephrectomy based on individual risk factors if the initial postoperative scan is negative. Sometimes follow-up imaging ?ndingsafter PN can be overestimated and lead to the repetition of CT examinations. In a recent study, for example, PN was established as a positive predictor variable for radiation exposure compared to RN [4].The objective of our paper is to improve the post-operative imaging knowledge of urologists and radiologists by introducing a series of CT scan findings after PN. We also aim to describe the evolution in time of findings and correlate them with RCC recurrence.
CT technique
Multidetector CT systems permit rapid scanning and thin collimation improving spatial and temporal resolu-tion. Bowel opaci?cationis not mandatory but can im-prove differentiation between lymph nodes and bowel loops. Kidney examinations are usually performed with a triple-phase technique:native or precontrast scans are followed by corticomedullary phase images, obtained 20–35s after administration of intravenous contrast material, which is useful not only for the demonstration of the vascular anatomy but also to detect early en-hancing tumors, as renal cell carcinoma. Moreover, this phase is particularly crucial to detect acute hemorrhagic complications after surgery. Then parenchymal or nephrographic phase follows 100–180s after IV contrast injection showing homogeneous enhancement of cortex and medulla and relative hypoattenuation of neoplastic lesions. If modi?cation,such as strictures, dilation
and
Correspondence to:Alessio Comai; email:alcomai@gmail.com
A. Comai et al.:Computed tomography after nephron-sparing surgery
Fig. 1. Parenchymal defects:partial peripheral round-shaped (A ) or triangular-shaped (B ) parenchymal defects compared with a small full thickness defect (C ). Solid enhancing tissue (asterisk ) fills the dorsal part of the surgical parenchymal defect:tumor recidive (D ).
leakage, are presumed, pyelogram or excretory phase images after 7–10min can be acquired showing opaci?-cation of collecting system in the suspect of modi?ca-tions, such as strictures, dilation and leakage. Alternatively, a preload of contrast material can be given to the patient to obtain opaci?cationof excretory system in combination with the parenchymal or nephrographic phase.
Thin-section scans allow high-resolution 3D multi-planar reconstructions (MPR)in coronal and sagittal planes at post-processing, which contribute to demon-strate the extent of lesions. Maximum intensity projec-tion (MIP)imaging is another processing tool, which
consists in the projection of highest-attenuation voxels into a 2D image and contributes to better represent cortical pro?lesand vessel integrity, particularly crucial in acute post-operative setting [5].These 3D post-pro-cessing instruments play a fundamental role in the eval-uation of postoperative kidney modifications.
Imaging features
Parenchymal defect
The most common cross-sectional imaging ?ndingis parenchymal defect (Fig.1A–D).It represents the op-erative site and is distinguished in partial
thickness
A. Comai et al.:Computed tomography after nephron-sparing surgery
Fig. 2. Granulation tissue:mild enhancing stripe of tissue (white arrow ) in perinephric fat with nodular aspects simulates persistent tumor at 6-months follow-up CT (A ). Subsequent CT after 12months shows regression and residual scar (B , white arrow ).
(Fig.1A, B) and full thickness defects (Fig.1C) de-pending if it extends or not from the cortical surface to the medulla. The former is frequently associated with enucleation of small tumors, the latter to more con-spicuous masses and heminephrectomy. Parenchymal defects tend to shrink over time because of scarring re-traction. The definition of a parenchymal defect is crucial for the evaluation of surgical margins and for the iden-tification of residual or recurrent cancer. Ill-defined margins and the presence of enhancing tissue into the surgical site are signs of tumor residual or recurrence (Fig.1D). Parenchymal defects usually contain fluid, fat tissue, or granulation tissue. Fluid collections will be discussed later in this manuscript. Autologous fat tissue can be used by the surgeon to fill the excision site and can be easily recognized based on its negative attenuation values (Fig.1A). Granulation tissue is formed by inter-mediate-attenuating tissue with mild delayed enhance-ment, which has been shown to decrease in size on sequential CT studies [6].Differential diagnosis with granulation tissue can be difficult and biopsy or follow-up is often recommended in order to differentiate be-tween these two entities (Fig.2A, B). Sometimes
parenchymal defects are closed with bolsters of bioab-sorbable agents which can induce foreign body reaction and form granulomas mimicking tumor residual [7].
Perinephric fat stranding
This radiologic sign is represented by linear dense images with a typically radial orientation localized in perinephric soft tissue (Fig.3). Stranding represents residual of post-surgical inflammatory modifications that evolve in fi-brosclerotic tissue and are usually more conspicuous and thick immediately after surgery. The renal fascia is often involved in the inflammatory process and appears thickened and retracted toward the surgical site (Fig.3A). This sign is very specific and can be encoun-tered in a variety of surgical and pathological conditions, as for example in case of pyelonephritis.
Membrane-like or circular strands can be also iden-ti?edat follow-up imaging, showing a concentric orien-tation with respect to kidney contour (Fig.4). They differ from radially oriented perinephric fat strands but are probably the result of the same inflammatory pro-cess. These structures can externally border the
surgical
A. Comai et al.:Computed tomography after nephron-sparing surgery
Fig. 3. Perinephric fat stranding:radially oriented linear images in perinephric fat tissue located at lower pole parenchymal defect (white arrows ). In Fig. 2A, renal fascia is involved and appears thickened and retracted (asterisk ).
site containing fluid-attenuating tissue or fat tissue and occasionally enhance after IV contrast injection, as they probably represent granulomatous reaction (Fig.4A). Alternatively, membrane-like images can be encountered in perinephritic fat, adjacent to the operation site and containing fat tissue. In this case, they represent small encapsulated foci of fat necrosis (Fig.4B).
High attenuation objects
High attenuation images on precontrast scans are fre-quently associated with surgical non-absorbable materi-als located around and inside the operative bed after surgery, such as polytetra?uoroethylenemesh (Gore-Tex ò, WL Gore and Associates, Flagstaff, AZ, USA). Gore-tex mesh appears as linear high attenuation image closing the operative bed while laying on adjacent renal contour (Fig.5A). Other hemostatic products are usually absorbed within 1–2weeks and therefore are no longer visible at the time of follow-up CT scans. Examples are TachoSil ò, an absorbable fibrin sealant patch, Glu-
bran ò, synthetic surgical glue, Tabotamp ò, an oxidized regenerated cellulose patch, and FloSeal ò, a thrombin-coated gelatin matrix. It must be noted that in early postoperative imaging hemostatic sponges may appear as rim-enhancing lesions that could be mistaken for abscess or tumor recurrence [7].Other high attenuation surgical materials, which are occasionally found in postoperative imaging, are vascular clips and embolization coils (Figs.2B, 5B). The latter are used to treat hemorrhagic complications which may occur after surgery or may be caused by tumor recurrence (Fig.6).
Fluid collections
Fluid collections are de?nedas well-de?nedabnormality that can be found inside or outside the surgical site. Their attenuation values can be different depending on the constitution (blood,lymph, serum, urine) as well as shape, location, and presence of gas bubbles (Fig.5A). Fluid collections can fill the parenchymal defect adopt-ing a round or triangular shape (Fig.7A).
Alternatively,
A. Comai et al.:Computed tomography after nephron-sparing surgery
Fig. 4. Membrane-like or circular strands:concentrically oriented linear image borders a fluid collection in the surgical site and shows mild enhancement (A ). An alternative mem-brane-like image extending in perinephritic fat near the sur-gical site and bordering fat tissue; contrast enhancement is not present (B
).
Fig. 5. High attenuation images on native scans:the linear hyperdense image along the external surface of kidney represents a PTFE mesh (A ). Strongly high attenuation globular image with peripheral artifacts refers to a metallic embolization coil (B ).
A. Comai et al.:Computed tomography after nephron-sparing surgery
Fig. 6. Gas-containig fluid collection in perinephric fat (as-terisk ); in the surgical site the slightly hyperattenuating cres-cent-shaped image represents fresh blood (A ). Arterial phase
scans demonstrate a pseudoaneurysm confirmed at angiog-raphy (B –D , white arrows ).
they can extend through the subcapsular virtual space, typically showing a crescent shape (Fig.7B), or in the perirenal/pararenalspaces (Fig.7C, D).
Fluid collections can represent hematomas, seromas, lymphoceles, or urinomas. They often are bordered from thin, occasionally enhancing walls and tend to remain stable or to resolve over time. If thick enhancing walls are present, a focal abscess must be excluded [8].More-over, intracapsular collections with enhancing wall must be distinguished from recurrent cystic renal malignancy [9].Figure 8represents a progressively resolving sub-capsular collection. Extracapsular collections are
less
A. Comai et al.:Computed tomography after nephron-sparing surgery
Fig. 7. Fluid collections:a typical subcapsular fluid collec-tion filling a triangular-shaped parenchymal defect (A ). A subtle subcapsular semilunar-shaped fluid collection extend-
ing beyond the operatory site (B ). An ovalar fluid collection in the medial pararenal space (asterisk ) showing contrast en-hancement in late excretory phase:urinoma (C , D ).
A. Comai et al.:Computed tomography after nephron-sparing surgery
Fig. 8. Partially resolving subcapsular fluid collection:4-, 11-, and 18-month CT scans showing a progressively reducing subcapsular fluid collection. In the latter control a cyst-like residual is present.
frequent and usually resolve nearly completely within 12months [10].Late excretory phase or a preload of contrast material is crucial to identify urinomas as con-trast accumulation outside the collecting system (Fig.7C, D).
Conclusion
Nephron-sparing surgery is widely adopted to treat lo-calized RCC. Knowledge of CT imaging ?ndingsafter nephron-sparing surgery is important for urologists and radiologists to understand their clinical signi?canceand to reduce the number of unnecessary surveillance ex-aminations.
Conflict of interest All the authors declare no conflict of interest.
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