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Objective To report the surgical nursing strategy of a patient undergoing resection of a rare giant neurofibroma.Methods Through the preoperative comprehensive assessment of patients,multidisciplinary joint consultation and proposed possible surgical risks and countermeasures,specialist to formulate surgical plans,surgical care and nursing key points,difficulties and countermeasures.Results The psychological nursing,detailed and perfect the preoperative preparation work,the personnel allocation was sufficient,the division of labor was clear,the disease changes were actively observed in the operation,the venous pathway was strictly managed,the accurate record,the risk that might occur in the active prevention operation and the treatment plan,the postoperative closely monitors the condition.Good observation and nursing in the operation area to prevent infection.Conclusions In view of difficult and complicated operation,through the comprehensive formulation of surgical nursing measures and strict execution in surgery,it is the guarantee for the smooth completion of the operation,the operation process is smooth,the successful implementation of tumor resection,the effect is satisfactory,the patient is returned to the ward,and there is no special discomfort.
RESUMO
PURPOSE: Neurofibromatosis(NF) is an autosomal- dominant systemic disease. Up to fifty percent of patients with NF are reported to have concomitant vascular abnormalities. In the resection of a larger NF, the risk of uncontrolled hemorrhage is much higher due to the difficulty of hemostasis of large vessels within the tumor. We ligated the base of the giant NF with a simple loop- shaped ligation before removal of the giant NF in both buttocks. And then we successfully reduced the amount of hemorrhage during the operation. METHODS: A 46-year-old female patient presented for giant masses of both gluteal area, which has been growing slowly for the last ten years. Each mass was about 30x20 cm in size. After designing the elliptical resection margin, we tightened the tumor base by using continuous loop- shaped suture ligation(weaving the thread up and down in a loop-shaped pattern, leaving a space of 2cm between each loop) with a straight needle and prolene 2-0. After skin incision, we proceeded the dissection toward the central and inferior side of the mass obliquely while we avoided breaking large vascular sinuses. We resected the tumor in a wedged-shape. Subcutaneous tissue was sutured layer by layer and skin was closed by vertical mattress and interrupted suture. The loop-shaped ligation of the base was removed and compressive dressing was done with gauzes and elastic bandages. RESULTS: Postoperative complications such as infection, hemorrhage, hematoma, and dehiscence did not occur. Perioperatively the patient was sufficiently transfused with five units of blood and two units of fresh frozen plasma. During the subsequent 1 year follow-up, the functional and cosmetic results were excellent. CONCLUSION: A continuous loop-shaped suture ligation procedure along the base of the giant NF effectively reduced the amount of hemorrhage during the operation, made dissection and ligation of vessels easily and quickly, and shorten the operating time and postoperative recovery time.