作者：廖淑芬，王萍，曾淑燕，龚凤球，史力方

单位：中山大学附属第一医院 手术麻醉中心，广东 广州 510000

Authors: Liao Shufen, Wang Ping, Zeng Shuyan, Gong Fengqiu, Shi Lifang

Unit: Surgical Anesthesia Center，the First Affiliated Hospital of Sun Yat -sen University， Guangzhou 510000，Guangdong，China

摘要：

目的 探讨巨大膈疝经胸、腹腔镜联合入路完成疝修补的护理配合与体会。方法 选取2021年8月29日中山大学附属第一医院收治的1例健身所致创伤性巨大膈疝患者,经胸腹腔镜手术联合治疗术前访视,依据多学科讨论意见准备患者体位、手术器械、物品,尤其关注补片类型、放置部位;术中巡回护士与器械护士各司其职,加快术间体位变换,保证手术流畅、安全完成。结果 患者依从性良好,手术配合顺利,患者术后恢复良好,膈疝修补确切,未出现并发症,手术效果满意。结论 巨大膈疝手术难度大,术中多需变换体位,手术护士应与术者充分沟通,全程参与患者的围手术期管理方可更好地完成术中配合,保证手术顺畅、安全完成。

关键词：胸腹腔镜联合手术；创伤性膈疝；体位变换；护理配合

Abstract：

Objective To explore the nursing cooperation and experience for the management of giant post -traumatic diaphragmatic hernia with thoracic and laparoscopic repair. Method Retrospectively analysed a patient with giant traumatic diaphragmatic hernia caused by exercise, who was admitted to the First Affiliated Hospital of Sun Yat -sen University on August 29, 2021 and treated with combined thoracoscopic and laparoscopic operation。 On the basis of multidisciplinary discussion opinions, surgical nurses should complete preoperative visit, prepare surgical positions, surgical instruments and common articles, with great attention to check the type and location of inserted mesh. During the operation, both rounding and instrumental nurses had their jobs well done, especially shifting the change of surgical positions, to promote the process of safe surgery. Result The patient's compliance was good, the operation was successfully performed, with hernia repair confirmed with hernia definitely repaired. The patient recovered well and satisfied great after surgery, with no complications developed. Conclusion The surgical repair of giant diaphragmatic hernia is challenging, which requires position shifts and high-level cooperation. Surgical nurses should fully communicate with surgeons, actively participate the whole process of perioperative management, and realize all fields of surgical cooperation to achieve a safe and fluent operation.

Key Words: Thoracic and laparoscopic surgery; Traumatic diaphragmatic hernia; Position shift; Nursing cooperation