The main symptoms of congenital choledochal cysts in children are abdominal pain, jaundice, abdominal masses, and some are occasionally discovered during physical examinations.
Preparation for preoperative care
1. Psychological aspects
Due to the fact that most of these patients are young children, those in this stage regard their mother and family members as everything to them. They crave safety and trust, worry about separation, and fear unfamiliar environments and people. When a nurse wearing work clothes approaches, she will be in a state of panic. This period is also a rapid stage of physical and cognitive development in a person's life, where they are filled with infinite curiosity and interest in their own body and external environment. In response to these characteristics, parents of children undergoing surgery should actively participate in the care of the child, in order to provide a therapeutic sensory activity environment for the child. Actively play with the child to increase their sense of safety and trust, and eliminate their fear and unfamiliarity. The parents' feelings before the operation were also contradictory, that is, they hoped to contact their children's pain as soon as possible, but also worried about the success or failure of the operation and whether the children's body could withstand the impact of the operation and its complications. Parents should carefully communicate with medical staff to have a detailed understanding of the surgical process, anesthesia methods, possible outcomes, risks of surgery, potential complications, and precautions for postoperative recovery, in order to eliminate their nervousness.
2. Preoperative anti infection and inhibition of pancreatic secretion
Patients with common bile duct cysts often have abnormalities at the confluence of the common bile duct and pancreatic duct, resulting in acute pancreatitis. Preoperative use of antibiotics, antibiotics, and other drugs not only alleviates the pain of the child, but also ensures the safety of the surgery.
3. Gastrointestinal preparation
Go on a low-fat diet or abstain from eating. On the day before surgery, abstain from consuming foods that produce gas, such as milk and legumes, to prevent intestinal bloating and affect the exposure of the surgical field and the recovery of postoperative gastrointestinal function. Indwelling a gastric tube before surgery can help avoid gastrointestinal bloating, hinder the exposure of the surgical field, and reduce the operating space of laparoscopic surgery. Additionally, due to the need for cholangiointestinal anastomosis, postoperative gastrointestinal decompression is also necessary; Indwelling a catheter also provides operating space for surgery; Clean the enema before surgery to prevent contamination of the anastomosis or overflow of feces into the abdominal cavity during the operation.
4. Preoperative skin care
The scope of skin preparation is the same as that of open surgery, with a focus on cleaning the umbilicus. Thoroughly clean the patient's umbilical area, as the first incision of the surgery is close to the umbilical edge, which can easily accumulate dirt. If not thoroughly cleaned, it can lead to infection of the incision.
Postoperative care
1. Vital sign monitoring
Due to the young age of the patient, after undergoing such a major surgery, they are generally weaker, so it is necessary to closely observe the postoperative vital signs of the patient. Respiratory rate and rhythm were monitored. Due to CO2 pneumoperitoneum used in laparoscopic surgery, CO2 diffused into the blood, making the child in a state similar to respiratory acidosis. Children need to expel residual CO2 through self-regulation functions such as deepening and accelerating breathing, so monitoring respiration is very important. Children should lie flat on pillows, with their heads tilted to one side, keep their respiratory tract unobstructed, and have a sputum aspirator by the bed. Low flow (2-3 L/min) and low concentration (PiO220% -25%) oxygen should be used to increase oxygen partial pressure (nasal catheters or mask style oxygen can be used). Monitor heart rate and blood pressure. Laparoscopic surgery, due to artificial pneumoperitoneum causing increased intra-abdominal pressure, can cause hemodynamic changes in the diaphragm, affecting the child's heart function. Therefore, monitoring blood pressure and heart rate after surgery is very important. The infusion speed should not be too fast, and attention should be paid to changes in urine volume to prevent heart failure. In laparoscopic surgery, due to the long surgical process and prolonged exposure of the patient's body, the CO2 used for pneumoperitoneum is frozen and liquefied before release, which can quickly cool the body and have a certain impact on the child. Therefore, special attention should be paid to keeping the child warm, and an electric blanket can be used if necessary.
2. Observation of postoperative complications
When the patient returns to the ward after surgery, the nurse should check for blood leakage at the Troca puncture site. After surgery, closely observe changes in blood pressure, pulse, and overall condition. If more than 50mL of bloody fluid is drained in a short period of time and hemoglobin drops rapidly, internal bleeding should be vigilant. After surgery, closely observe changes in vital and abdominal signs, and promptly detect and report to a physician. Pay attention to the occurrence of bile leakage, which may occur due to incomplete closure of the hepatic jejunal anastomosis. After surgery, the patient should be closely monitored for abdominal pain, bloating, muscle tension, rebound pain, fever, etc. Observe the color, quantity, and quality of the drainage material at any time to confirm whether there is bile leakage as soon as possible, in order to facilitate a second surgery as soon as possible.
3. Dietary guidance
Diet should be prohibited for 2-3 days after surgery, firstly because intestinal peristalsis has not recovered, and also to reduce stimulation of bile secretion and reduce the occurrence of bile leakage. After the patient's anus exhausts, they can eat a liquid diet and avoid consuming milk and sweets that can cause intestinal bloating. It is advisable to eat small amounts and multiple meals at once to avoid overeating, which can cause gastrointestinal discomfort and gradually transition to low-fat foods. Many children have picky and partial eating habits, and their taste should be respected as much as possible to enable them to recover their diet as soon as possible and strengthen postoperative nutrition.
