1例肝癌合并肠癌术后小肠脱出患者的护理

Nursing Care of a Patient with Small Bowel Prolapse after Resection of Hepatocellular Carcinoma and Colorectal Adenoma

摘要: 总结1例肝细胞癌合并乙状结肠腺瘤术后发生小肠脱出患者的护理经验。患者因“肝占位”入院，先后行肝穿刺活检、腹腔镜下肝部分切除 + 乙状结肠部分切除 + 胆囊切除术，术后拔除盆腔引流管后突发小肠脱出(约15 cm)，行急诊小肠部分切除 + 肠吻合术。护理要点包括：急性期小肠脱出的紧急处理与病情监测、切口与脱出组织护理、疼痛护理、肠功能恢复护理、并发症预防(疝复发、感染、深静脉血栓等)、心理护理及营养支持。同时给予系统的出院指导。经过精心护理，疼痛评分、营养指标及焦虑评分均明显改善，未发生严重并发症。本案例为腹部术后疝形成及小肠脱出的护理提供了参考。

Abstract: To summarize the nursing experience of a patient who developed small bowel prolapse after surgery for hepatocellular carcinoma combined with sigmoid colon adenoma. The patient was admitted for a “liver space-occupying lesion” and subsequently underwent liver biopsy, laparoscopic partial hepatectomy, partial sigmoid colectomy, and cholecystectomy. After removal of the pelvic drainage tubes, sudden small bowel prolapse (approximately 15 cm) occurred, and emergency partial enterectomy with intestinal anastomosis was performed. Key nursing interventions included emergency management and condition monitoring during the acute phase, care of the incision and prolapsed bowel, pain management, promotion of bowel function recovery, prevention of complications (such as hernia recurrence, infection, and deep vein thrombosis), psychological care, and nutritional support. Systematic discharge guidance was also provided. Following comprehensive nursing care, pain scores, nutritional indicators, and anxiety scores improved significantly, and no serious complications occurred. This case provides a reference for the nursing management of postoperative hernia formation and small bowel prolapse after abdominal surgery.