照顧一位低位直腸癌行肛門保留手術病患之護理經驗

The Nursing of a Lower Rectal Cancer Patient after Sphincter-Preserving Surgery

保留肛門的低位直腸切除為近年直腸手術重大的突破。目前尚無相關文獻可協助臨床人員克服術後因排便功能異常所引發的一連串問題。本文敘述如何協助一位該項手術患者，克服手術後解便頻繁、滲便、肛門周圍皮膚破損疼痛不適與面對術後症狀的無助等問題。護理期間為96年1月18日至96年2月1日，運用會談、觀察、收集病史、評估個案，透過4篇行為過程紀錄的分析，發現個案主要護理問題有排便禁制功能異常、皮膚完整性受損、飲食調整不當、與無力感，藉由骨盆底肌肉運動的指導，並協助個案調整排便方式及調整飲食，使個案重新掌控排便狀況，找回預期中的生活品質。

The anal sphincter-preserving operation (ASP) has represented a significant improvement in surgical procedure for lower rectal cancer patients in recent years. Discussion has continued, however, on how to manage the reduced fecal function after such surgery. This case report describes how to help a patient with lower rectal cancer after ASP to overcome the problems due to changes in fecal function. Process recording was used to document the nursing process from Jan. 18 to Feb. 1, 2007. Data collected from interview, observation, and medical records, show that the p atient revealed four vital nursing problems: fecal function disorder, impaired skin integrity, inappropriate regulation of diet, and powerlessness. After practicing pelvic floor exercises, adjusting her fecal behavior and modifying her food intake, the patient regained control of her fecal function and improved her quality of life.