低位直腸癌行肛門括約肌保留手術病患之護理

Nursing Care for Lower Rectal Cancer Patients Undergoing Anal Sphincter-Saving Operation

低位直腸癌的切除術，以往以腹部會陰切除術，並置一永久性人工肛門為主。造口對於患者的生理、心理及社會等方面影響很大，近年因積極研發手術器械，並配合術前輔助性放射治療與化學治療，使手術得以保留肛門括約肌，且延長存活率及降低局部復發率，進而增進病患的生活品質。但低位直腸癌肛門括約肌保留手術後，患者會出現不同於一般直腸切除術後之問題，而國內外相關文獻缺乏，故本文將綜合國內外文獻及個人照護經驗，提供臨床護理這類病患之參考。

In the past, Abdominal Perineal Resection (APR) with a permanent end-sigmoid colostomy was the major operating procedure for lower rectal cancer. Colostomy seriously affects patients' physical and psychological functions. Recently, the development of surgical devices and pre-operation adjuvant treatment combined with chemoradiotherapy have made an anal sphincter-preserving (ASP) operation possible. With these new treatment procedures, both the survival and recurrence rates are improved, as is patients' quality of life. The complications associated with ASP, however, are different from those associated with APR. There is only limited discussion of these issues in the literature on the subject. This paper synthesizes the information in the literature with the authors' personal clinical experiences. We propose several nursing interventions that could be applied by clinical nurses to assist ASP patients in coping with post-operative complications.