賀玉雙 李云紅

彩超引導(dǎo)下麥默通微創(chuàng)治療乳腺腫瘤的療效觀察與護(hù)理

賀玉雙 李云紅

目的 探討彩超引導(dǎo)下麥默通微創(chuàng)手術(shù)治療乳腺良性腫物的應(yīng)用及護(hù)理效果。方法 65例患者在彩超引導(dǎo)下,利用麥默通實(shí)施微創(chuàng)手術(shù)及活檢術(shù),根據(jù)護(hù)理干預(yù)措施不同將患者分為對(duì)照組(30例)和觀察組(35例)。對(duì)照組行常規(guī)護(hù)理。觀察組實(shí)施系統(tǒng)的護(hù)理干預(yù),觀察臨床療效。結(jié)果 對(duì)照組患者積極配合26例(86.7%),手術(shù)時(shí)間(36.3±7.1)min,術(shù)中出血量(8.0±0.9)ml,旋切次數(shù)(13.6±2.4)次,術(shù)后住院時(shí)間(5.2±2.4)d。觀察組患者積極配合34例(97.1%),手術(shù)時(shí)間(27.6±6.1)min,術(shù)中出血量(6.7±0.6)ml,旋切次數(shù)(10.2±1.0)次,術(shù)后住院時(shí)間(4.7±1.9)d。觀察患者積極配合例數(shù)多于對(duì)照組(P＜0.05)；觀察組手術(shù)時(shí)間、術(shù)中出血量、旋切次數(shù)及術(shù)后住院時(shí)間均優(yōu)于對(duì)照組(P＜0.05)。觀察組術(shù)后并發(fā)癥發(fā)生率(5.7%)明顯低于對(duì)照組(16.7%),差異具有統(tǒng)計(jì)學(xué)意義(P＜0.05)。結(jié)論 彩超引導(dǎo)下麥默通微創(chuàng)治療乳腺良性腫物,操作安全、簡便、創(chuàng)口小不留瘢痕,提高了患者生存質(zhì)量；充分的術(shù)前準(zhǔn)備與適當(dāng)?shù)男睦碜o(hù)理,增加了患者耐受手術(shù)的自信心,術(shù)中密切配合與術(shù)后的精心護(hù)理是確保手術(shù)順利進(jìn)行并盡快康復(fù)的關(guān)鍵,以其治療乳腺腫瘤值得運(yùn)用。

麥默通微創(chuàng)治療；乳腺腫瘤；彩超；護(hù)理

乳腺腫瘤是女性的常見病之一,早期乳腺腫瘤多為良性,其中以纖維腺瘤居多,約占良性腫瘤的75%［1］。手術(shù)治療是乳腺腫瘤的首選治療方案。隨著生活水平的提高,人們對(duì)審美要求越來越高,對(duì)生活的質(zhì)量也是精益求精,傳統(tǒng)乳腺手術(shù)不僅在乳房上留下明顯瘢痕,傷口愈合時(shí)間長,嚴(yán)重影響美觀,特別是對(duì)低齡、未婚未育的女性患者,在身心兩方面留下陰影與創(chuàng)傷［2-5］。近年來,隨著乳腺腫塊切除理念的不斷更新,乳腺診斷治療技術(shù)也走在了科技的前沿,麥默通微創(chuàng)旋切活組織檢查系統(tǒng)已被廣泛應(yīng)用于乳腺腫塊的活組織檢查及良性腫塊的切除術(shù)中［2］。麥默通乳腺微創(chuàng)旋切手術(shù)是在B型超聲引導(dǎo)下利用真空負(fù)壓吸引原理進(jìn)行乳腺組織微創(chuàng)旋切取樣,可對(duì)乳腺可疑病灶進(jìn)行重復(fù)切割,使一次穿刺能切取多個(gè)標(biāo)本和較小乳腺良性腫瘤的微創(chuàng)切除。雖然麥默通微創(chuàng)手術(shù)已日趨成熟,但手術(shù)并發(fā)癥仍時(shí)有發(fā)生［3］,有效的手術(shù)配合及護(hù)理方法可明顯減輕對(duì)患者造成的手術(shù)創(chuàng)傷,顯著縮短患者的治療時(shí)間,提高患者配合治療程度,減少術(shù)后并發(fā)癥的發(fā)生。本院在撫順市率先引進(jìn)麥默通乳房微創(chuàng)旋切系統(tǒng),并開展彩超引導(dǎo)下乳腺腫瘤微創(chuàng)旋切術(shù)。選取本科2016年1～12月診治的乳腺良性腫瘤患者65例,均行彩超引導(dǎo)下乳腺腫瘤微創(chuàng)旋切術(shù)治療,現(xiàn)將手術(shù)配合及護(hù)理報(bào)告如下。

1 資料與方法

1.1 一般資料 選取本科2016年1～12月收治行麥默通乳房微創(chuàng)手術(shù)的乳腺良性腫瘤患者65例,經(jīng)超聲診斷確診,完善其他檢查,無其他疾病及手術(shù)禁忌證。根據(jù)護(hù)理干預(yù)措施不同將患者分為對(duì)照組(30例)和觀察組(35例)。對(duì)照組患者年齡20～41歲,平均年齡(29.2±3.9)歲,腫瘤直徑0.9～3.2 cm,平均直徑(2.1±0.6)cm。觀察組患者年齡20～42歲,平均年齡(30.3±4.7)歲,腫瘤直徑0.8～3.3 cm,平均直徑(2.0±0.6)cm。兩組患者年齡、腫瘤大小等一般資料比較差異無統(tǒng)計(jì)學(xué)意義(P＞0.05),具有可比性。

1.2 方法 兩組乳腺良性腫瘤患者均在彩超引導(dǎo)下行麥默通微創(chuàng)旋切術(shù)治療［6-11］。對(duì)照組患者行常規(guī)護(hù)理。觀察組患者實(shí)施系統(tǒng)的護(hù)理干預(yù),其內(nèi)容包括：①術(shù)前護(hù)理。首先進(jìn)行完善的術(shù)前評(píng)估,包括患者患病的基本情況、生命體征、腫物位置大小、有無基礎(chǔ)疾病、心理狀態(tài)、對(duì)疾病的接受能力、文化程度等,然后根據(jù)評(píng)估情況進(jìn)行健康宣教,仔細(xì)向患者講解疾病相關(guān)知識(shí)、治療方式、手術(shù)注意事項(xiàng)、可能發(fā)生的并發(fā)癥及觀察方法,必要時(shí)讓同疾病患者現(xiàn)身示范,最大可能消除患者緊張、焦慮、恐懼等不良情緒,建立信心,使其坦然接受并主動(dòng)配合治療［12］。②手術(shù)配合。屏風(fēng)遮擋,幫助患者置平臥位,確定術(shù)側(cè),胸部墊一小枕,患側(cè)上肢舉過頭頂,盡量暴露術(shù)側(cè)乳房,實(shí)施常規(guī)消毒鋪巾,配合醫(yī)生實(shí)施局部麻醉。安慰患者,接通機(jī)器電源并檢查各個(gè)管路的連接緊密性,安裝旋轉(zhuǎn)刀,開機(jī)進(jìn)入工作界面,根據(jù)手術(shù)的操作進(jìn)程及時(shí)切換界面,及時(shí)傳遞各種操作設(shè)備,準(zhǔn)備生理鹽水進(jìn)行器械沖洗。術(shù)中密切觀察患者反應(yīng),術(shù)畢協(xié)助醫(yī)生包扎切口,局部按壓止血,棉墊加壓包扎［13］。③術(shù)后護(hù)理。監(jiān)測患者生命體征,及時(shí)詢問、觀察不良發(fā)應(yīng)并對(duì)癥處理。密切觀察術(shù)后切口有無出血、滲血、感染等情況,告知患者腹式呼吸方法及其必要性,指導(dǎo)患者進(jìn)食高蛋白、高維生素、高熱量、低脂飲食,指導(dǎo)適度的被動(dòng)和主動(dòng)活動(dòng)［14,15］。④術(shù)后隨訪。告知患者定期復(fù)診。

1.3 觀察指標(biāo) 觀察兩組患者的治療配合度(積極配合情況)；記錄手術(shù)時(shí)間、術(shù)中出血量、旋切次數(shù)、術(shù)后住院時(shí)間；比較兩組術(shù)后并發(fā)癥發(fā)生情況。

1.4 統(tǒng)計(jì)學(xué)方法 采用SPSS17.0統(tǒng)計(jì)學(xué)軟件對(duì)數(shù)據(jù)進(jìn)行統(tǒng)計(jì)分析。計(jì)量資料以均數(shù)± 標(biāo)準(zhǔn)差(±s)表示,采用t檢驗(yàn)；計(jì)數(shù)資料以率(%)表示,采用χ2檢驗(yàn)。P＜0.05表示差異具有統(tǒng)計(jì)學(xué)意義。

2 結(jié)果

2.1 兩組患者積極配合情況、手術(shù)時(shí)間、術(shù)中出血、旋切次數(shù)及住院時(shí)間比較 對(duì)照組患者積極配合26例 (86.7%),手術(shù)時(shí)間(36.3±7.1)min,術(shù)中出血量(8.0±0.9)ml,旋切次數(shù)(13.6±2.4)次,術(shù)后住院時(shí)間(5.2±2.4)d。觀察組患者積極配合34例(97.1%),手術(shù)時(shí)間(27.6±6.1)min,術(shù)中出血量(6.7±0.6)ml,旋切次數(shù)(10.2±1.0)次,術(shù)后住院時(shí)間(4.7±1.9)d。觀察患者積極配合例數(shù)多于對(duì)照組,差異具有統(tǒng)計(jì)學(xué)意義(P＜0.05)；觀察組手術(shù)時(shí)間、術(shù)中出血量、旋切次數(shù)及術(shù)后住院時(shí)間均優(yōu)于對(duì)照組,差異具有統(tǒng)計(jì)學(xué)意義(P＜0.05)。見表1。

表1 兩組患者積極配合、手術(shù)時(shí)間、術(shù)中出血、旋切次數(shù)及住院時(shí)間比較 ［n(%), ±s］

表1 兩組患者積極配合、手術(shù)時(shí)間、術(shù)中出血、旋切次數(shù)及住院時(shí)間比較 ［n(%), ±s］

注：與對(duì)照組比較,aP＜0.05

組別 例數(shù) 積極配合 手術(shù)時(shí)間(min) 術(shù)中出血量(ml) 旋切次數(shù)(次) 術(shù)后住院時(shí)間(d)觀察組 35 34(97.1)a 27.6±6.1a 6.7±0.6a 10.2±1.0a 4.7±1.9a對(duì)照組 30 26(86.7) 36.3±7.1 8.0±0.9 13.6±2.4 5.2±2.4 P＜0.05 ＜0.05 ＜0.05 ＜0.05 ＜0.05

2.2 兩組患者術(shù)后并發(fā)癥發(fā)生情況比較 對(duì)照組患者中出血2例,感染2例,腔內(nèi)出血1例,并發(fā)癥發(fā)生率16.7%,觀察組患者中出血1例,感染1例,腔內(nèi)出血0例,并發(fā)癥發(fā)生率5.7%。觀察組術(shù)后并發(fā)癥發(fā)生率明顯低于對(duì)照組,差異具有統(tǒng)計(jì)學(xué)意義(P＜0.05)。

3 討論

近年來,人們生活水平不斷提高,工作壓力也不斷增加,乳腺疾病患病率呈上升趨勢［4］。傳統(tǒng)治療以手術(shù)為主,術(shù)后易形成瘢痕,影響女性對(duì)美觀的要求。但隨著麥默通微創(chuàng)旋切技術(shù)的開展,實(shí)現(xiàn)了對(duì)乳腺疾病手術(shù)切除的微創(chuàng)化,并且對(duì)女性乳房外表影響甚微,創(chuàng)口小,利于愈合,術(shù)后瘢痕小,更易被接受,且手術(shù)過程操作簡單,兼具切除及活檢功能,安全有效,成功率高,已成為良性乳腺疾病治療的基本趨勢［16-20］。本科2016年1～12月開展彩超引導(dǎo)下麥默通微創(chuàng)旋切術(shù)治療乳腺良性腫瘤,深受患者歡迎。

面對(duì)這一全新的手術(shù)方式,護(hù)士的配合和護(hù)理至關(guān)重要。本科護(hù)士在配合和護(hù)理過程中熟練掌握乳腺麥默通微創(chuàng)手術(shù)的目的、適應(yīng)證、并發(fā)癥和操作要領(lǐng)；認(rèn)真做好術(shù)前、術(shù)中及術(shù)后護(hù)理；充分的術(shù)前準(zhǔn)備與適當(dāng)?shù)男睦碜o(hù)理,增加了患者耐受手術(shù)的自信心；超聲旋切術(shù)的安全性、有效性以及成功病例等,增強(qiáng)患者配合度；術(shù)中密切配合與術(shù)后的精心護(hù)理確保患者手術(shù)順利進(jìn)行并盡早康復(fù)。

綜上所述,超聲引導(dǎo)下麥默通微創(chuàng)治療乳腺良性腫物,配合規(guī)范有效的術(shù)前、術(shù)后護(hù)理對(duì)患者配合程度、傷口愈合、病情恢復(fù)都有相當(dāng)積極的意義,值得廣泛運(yùn)用。

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Observation of curative effect and nursing in color Doppler ultrasound-guided mammotome minimallyinvasive treatment for breast tumor

HE Yu-shuang,LI Yun-hong.Liaoning Fushun City Fourth Hospital,Fushun 113123,China

Objective To investigate application and nursing effect of color Doppler ultrasound-guided mammotome minimally invasive treatment for benign breast tumor.Methods A total of 65 patients receiving color Doppler ultrasound-guided mammotome minimally invasive treatment and biopsy were divided by different nursing intervention measures into control group (30 cases) and observation group (35 cases).The control group received conventional nursing,and the observation group received systematic nursing intervention.Their clinical effects were observed.Results The control group had 26 cases with active cooperation (86.7%),operation time as (36.3±7.1) min,intraoperative bleeding volume as (8.0±0.9) ml,rotary-cut time as (13.6±2.4) times,and postoperative hospital stay time as (5.2±2.4) d.The observation group had 34 cases with active cooperation (97.1%),operation time as (27.6±6.1) min,intraoperative bleeding volume as (6.7±0.6) ml,rotary-cut time as (10.2±1.0) times,and postoperative hospital stay time as (4.7±1.9) d.The observation group had more cases with active cooperation than the control group (P＜0.05).The observation group had all better operation time,intraoperative bleeding volume,rotary-cut time and postoperative hospital stay time than the control group (P＜0.05).The observation group had lower incidence of postoperative complications (5.7%) than the control group (16.7%),and their difference had statistical significance (P＜0.05).Conclusion Color Doppler ultrasound-guided mammotome minimally invasive treatment for benign breast tumor shows safe operation,convenience and small incision without scar,and it also enhances quality of life in patients.Fully preoperative preparation and appropriate psychological nursing can enhance self-confidence in operation tolerance.It is necessary for combination of closely intraoperative cooperation and detailed postoperative nursing to guarantee successful operation and quick rehabilitation.This method is worthy of application in treating breast tumor.

Mammotome minimally invasive treatment; Breast tumor; Color Doppler ultrasound; Nursing

10.14164/j.cnki.cn11-5581/r.2017.04.075

2017-01-13］

113123 遼寧省撫順市第四醫(yī)院