回歸正常重建尊嚴——肛門保留術後排便型態重建之經驗與歷程

Regaining Dignity: The Experience and Process of Reconstructing Normal Defecation Functions Through an Anal Sphincter-Saving Operation

背景：低位直腸癌切除肛門保留術後，常影響排便控制，因排便功能重建過程漫長且複雜，若能了解病患重建之經驗，方能建立符合病患需求且有效的衛教指導措施。
目的：探討低位直腸切除肛門保留術後，排便功能重建之歷程與經驗。方法：採用個案研究法，以立意取樣，針對四位低位直腸癌行肛門保留手術，並接受排便功能重建照護之個案，進行平均長達6－8個月的持續觀察與訪談追蹤，每位個案平均訪談5－7次。結果：結果共歸納出11個復健經驗主題。造口接回前：肛門滲液與不適感受、尊嚴受損、摸索施力點、恢復肛門緊閉功能。造口接回後：排便再度失控及肛門皮膚破損、體驗成效堅固訓練意志、相信成效盡力執行、盡力遵從、盡力減少用藥、清潔且尊嚴的自我形象及生活品質提升、恢復正常的契機。結論：實務應用 四位個案一致認為復健運動對控制排便有幫助，且都表示會持續復健活動。個案所提供復健活動的感受，可協助造口護士對病人提供身心方面更完整之支持。

Background: Resection through an anal sphincter-saving (ASS) operation may affect a low rectal cancer patient’s normal defecation function. The long and complex reconstruction process following such a procedure makes understanding the patient rehabilitation experience necessary in order to develop an effective educational strategy that addresses patient needs.
Purpose: This study investigated the defecation reconstruction experience of low rectal cancer patients after ASS. Methods: Researchers used a case study method and purposive sampling. Participants were followed for a period of 6 to 8 months and interviewed between 5 and 7 times.
Results: Eleven themes emerged from content analysis. Before temporary colostomy take-down: anal leakage and discomfort, dignity impairment, struggling to locate the contracting muscle, restoring anal strength. After colostomy take-down: loss of defecating control again and damage to peri-anal skin , perceived effects and insistence on persisting with training, faith in effectiveness, trying to comply, trying to restrict medication use, maintaining a hygienic self-image and dignity, promoting quality of life, and a chance to regain a normal life.
Conclusions / Implications: Participants described the rehabilitation exercise as beneficial to controlling the defecation and expressed their intent to continue such. Participant experiences can assist stoma nurses to provide better physical and psychological care to ASS patients.