吴丽珍　展 望　高 飞　陈运完　陈燕曼

[关键词]头皮;恶性肿瘤;带蒂皮瓣;缺损修复;护理配合

[中图分类号]R473.6    [文献标志码]B    [文章编号]1008-6455（2021）12-0163-03

Discussion on Nursing Cooperation in the Repairing Operation with Large Area Scalp Defection after Malignant Tumor

WU Li-zhen1，ZHAN Wang2，GAO Fei2，CHEN Yun-wan1，CHEN Yan-man1

[1.Operating Room;2.Department of Plastic and Aesthetic Surgery，Hainan Provincial People’s Hospital（Hainan Hospital Affiliated to Hainan Medical Colleage），Haikou 570311，Hainan，China]

Abstract： Objective  To explore the surgical nursing cooperation in the operation with large area scalp defection after malignant tumor excision. Methods  Summarizing the surgical nursing techniques of 12 cases of scalp malignant tumor excision in the author's hospital for the defect of the scalp while carrying out the repair of the lower oblique muscle with the skin flap. In order to ensure the success of surgical flaps， surgical nurses before surgery to strengthen the patient's education and psychological care， surgery to do a good job of hypothermia prevention and positional pressure sores care， strict implementation of tumor-free technology， after surgery strictly do a good job of shift， regular visits to patients. Results  The operation was completed successfully， the flap survived completely， and no nursing adverse events occurred. Conclusion  The key to the success of this kind operation is the perfect preoperative cooperation plan，close attention to the progress of the operation， strictly implement on the aseptic and the no-tumor technique.

Key words： scalp; malignant tumor; pedicle skin flap; defect repair; nursing cooperation

頭皮恶性肿瘤较常见的是基底细胞癌和鳞状细胞癌，手术切除是治疗首选方案[1]，由于此类肿瘤好发于成人，而成人头皮组织致密性大、松弛性较差，肿瘤较大者扩大切除后直接缝合的机率不大，常造成头皮缺损甚至颅骨外露的现象[2]。以往此类缺损的修复常采用轴型皮瓣转移的方法，但是此方法难以一期修复大面积头皮缺损，增加了临床工作难度。周梦娇[3]等研究指出，下斜方肌带蒂皮瓣较长、供给的组织量大、血供丰富，可以修复头颈侧颅底较大缺损。然而，正因为此处皮瓣血运丰富，而病变部位范围又较大，因此会加大手术难度，和手术时间。如果术中保温、体位摆置不当等均可造成术中压疮及低体温发生，因此，高质量护理配合也是提高手术成功的关键。现有12例在头皮恶性肿瘤术后大面积头皮缺损手术中采取严格的护理配合的案例均取得了良好效果。现报道如下。

1  资料和方法

1.1 一般资料：2018年9月-2020年2月在笔者医院应用下斜方肌肌皮瓣修复头皮恶性肿瘤术后大面头皮缺损手术共12例作为研究对象;女4例，男8例;年龄34～63岁，平均（45.7±4.12）岁;病变部位：额部2例，颞部6例，顶部4例;病灶侵犯颅骨5例，硬脑膜受损2例，病变合并慢性感染5例;肿瘤最大为13cm×15cm，病理结果回报均为头皮鳞状细胞癌，所有患者均自愿参与并签署知情同意书，本研究严格遵守赫尔辛基宣言。……