What are the precautions after laparoscopic hysterectomy

Women with severe uterine diseases need to have their uterus removed in time to avoid complications. The most common surgical method is laparoscopic hysterectomy. After the operation, you must take good care of yourself, stay in bed, eat well, and also pay attention to preventing complications.

1. Routine postoperative care

1. Lying position and diet

Patients who have not fully awakened after general anesthesia should lie flat without a pillow, with their head tilted to one side, and are not allowed to eat or drink. Patients were placed in a semi-recumbent position 6 hours after surgery. Those without nausea, vomiting or intestinal injury were given normal food in small and frequent meals.

2. After the operation, the patient returns to the ward and is monitored for 3 hours. Measure blood pressure, pulse, and respiration once every hour within 6 hours after surgery until the patient's condition stabilizes, in order to detect internal bleeding or shock early. Measure body temperature once every 6 hours to monitor for upper respiratory tract infection and postoperative wound infection.

3. Ensure the smooth flow of various pipelines

For those with abdominal drainage tubes, pay attention to the amount and properties of the drainage fluid; when drainage is not smooth, carefully check whether the drainage tube is twisted or blocked; the drainage tube should be properly fixed to the bedside and a certain length should be left to prevent traction and displacement during turning over or moving. In this group of cases, one patient underwent laparoscopy and had an abdominal drainage tube placed afterwards. However, due to blood clot obstruction, drainage was poor and the problem was not discovered and treated in time. Blood accumulated in the pelvis and the patient had repeated high fever. Multiple antibiotics were ineffective. The patient recovered after laparotomy to remove the hematoma, which added to his pain. We should learn from this lesson. The catheter is removed promptly 24 hours after surgery to reduce the incidence of urinary retention.

2. Observation and care of postoperative complications

1. Bleeding from the puncture hole

Bleeding from the puncture hole is mostly caused by the disappearance of the compression effect after the puncture sheath is pulled out and the lack of firm pull of the Band-Aid, which leads to bleeding from the puncture hole. If blood extravasates and soaks the dressing, gauze should be used to compress and stop the bleeding in time, and the dressing should be replaced and pressure bandaged. If the effect is not good, one stitch can be sutured at the puncture hole to stop the bleeding. Therefore, when patients who have undergone laparoscopic surgery return to the ward, nurses need to check the umbilicus and the three points above the pubic area to observe whether there is any bleeding. The observation of the abdominal wound should not be ignored just because there is no large incision in the abdominal wall.

2. Bleeding from the cervical stump

This is a common complication of laparoscopic cish. There is a little vaginal bleeding in the first 2 days after surgery, which is light red in color. It is the residue discharged after electrocoagulation of the residual cavity of the cervix. No treatment is required. Closely observe the amount and color of bleeding. If vaginal bleeding turns bright red and is accompanied by blood clots, the cervix should be checked in time to find out the cause of bleeding and treat it symptomatically. Iodoform gauze can be stuffed into the vagina to compress and stop bleeding, and the cervix can be sutured if necessary. When nurses receive postoperative patients, they should ask the surgeon about the intraoperative situation, check the laparoscopic surgery records and postoperative medical records, and promptly estimate possible cervical bleeding so that observation and treatment are based on evidence and purpose.

3. Abdominal distension and soreness in shoulders and back

In pneumatic laparoscopic hysterectomy, due to the gas used, surgical position, and operation time, patients may experience varying degrees of abdominal distension and shoulder and back soreness. The nurse explained the reasons to the patient and encouraged him to do laparoscopic surgical gymnastics in bed, turn over more often, take a comfortable lying position, and get out of bed and move around as soon as possible. For patients with obvious abdominal distension or who have not passed gas 48 hours after surgery, 0.5 mg of neostigmine can be injected intramuscularly as prescribed by the doctor. Pay attention to whether there is abdominal pain, hyperactive bowel sounds, etc. when the abdomen is bloated.