一位接受聯合肝臟分割和門靜脈結紮的分階段肝切除術病人之加護經驗

Experience of Intensive Care in a Patient Receiving Associating Liver Partition and Portal Vein Ligation for Staged Hepatectomy

"聯合肝臟分割和門靜脈結紮的分階段肝切除術(Associating Liver Portition and Portal Vein Ligation for Staged Hepatectomy, ALPPS)是一種用於切除肝臟惡性腫瘤的新型手術技術，此技術為肝臟殘餘不足及被其他方法認為無法切除的患者，提供了另一種治癒的選擇與機會。本文描述照顧一位肝癌接受ALPPS病人之加護經驗，護理期間為2018年6月7日至6月13日，運用Gorden十一項健康功能型態評估，進行個案整體性健康資料的收集，透過傾聽、訪談、觀察的方式，確立護理健康問題為焦慮、疼痛及現存危險性感染。護理過程中，提供完整且個別性的照護措施，評估個案生理與情緒需求，運用數字量表評估焦慮及疼痛指數，引導個案說出內心感受，提供合宜的減輕疼痛方法，並嚴守無菌觀念的落實，避免傷口感染。期盼藉由此次護理經驗的分享，讓爾後照護此類個案之護理人員有所依循，以提升臨床照護品質。"

"Associating Liver Portition and Portal Vein Ligation for Staged Hepatectomy (ALPPS) is a new surgical technique for removal of hepatic malignancies. This technique provides a viable option for patients with insufficient residual liver or patients who are considered unresectable by other methods. This article described the experience of caring a patient with liver cancer receiving ALPPS. During the nursing period, from June 7 to 13 13, 2018, Gorden's eleven health function assessment tool was used to evaluate the patient and collect overall health data through listening, interviewing, and observing. The health problems identified included anxiety, pain, and existing dangerous infections. The following measures were provided during the care process, including providing complete and individualized care plan, assessing the patient’s physical and emotional needs, using a digital scale to assess anxiety and pain index, guiding the patient to express inner feelings, and providing appropriate pain relief methods. The process strictly adhered to the concept of sterility and avoided wound infection. It is hoped that through the sharing of nursing experience, nursing staffs who take care of such patients in the future will have principles to follow to improve the quality of clinical care."