「重展笑顏」──初次罹患口腔癌經皮瓣重建術後照護經驗

“Rebuilding a Smile”: A Nursing care Experience for a Primary oral Cancer Patient After flap Reconstruction Surgery

本文描述一位經營冬瓜茶飲事業，須經常展露微笑面對客人，因初次罹患口腔癌經皮瓣重建術後，對顏面外觀改變與多重陌生管路留置，擔憂無法回歸熱愛工作崗位之個案照護經驗。護理期間為2023年4月26日至5月8日，藉觀察、傾聽、筆談、直接照護、身體評估及查閱病歷方式收集資料，運用Gordon十一項功能性健康型態模式進行整體性評估，確立個案有呼吸道清除功能失效、急性疼痛與身體心像紊亂之健康問題。期間藉由護理獨特性與跨領域團隊協助，以定時監測疼痛情形，給予常規止痛用藥外，轉移疼痛注意力，能有效的緩解疼痛不適，且透過橫膈呼吸練習與胸腔物理治療，減少抽痰頻率，解決痰液蓄積問題，並引導說出對於術後顏面外觀改變與多重管路留置的感受與期待，一起擬定個別性之管路移除與口腔癌復健計畫，讓其順利移除所有術中留置管路，接受術後顏面改變的自己，重展笑顏，返回職場。此次照護經驗中，深感身體心像改變，對於口腔癌術後病人的衝擊，且在短期內須接受大量的護理指導，更甚不易，故建議臨床人員可藉由跨領域團隊共同建立口腔癌術後管路移除流程與復建計畫，減少對於術後治療的不安，更勇於面對病情治療。期許此護理經驗能提供日後口腔癌術後個案照護之參考。

This case study describes the nursing care of a patient who underwent flap reconstruction for primary oral cancer. The patient, who operated a winter melon tea business, frequently smiled when facing customers. He was concerned about returning to his beloved business because of the changes in his facial appearance and the presence of unfamiliar tubes following treatment. The nursing care period lasted from April 26, 2023, to May 8, 2023. Data were collected through observation, oral interviews, written communication, direct care, physical examination, and review of medical records. A holistic assessment based on Gordon's Eleven Functional Health Patterns identified three major health problems including impaired airway clearance, acute pain, and body image disturbance. Through interdisciplinary collaboration and specialized nursing care, the patient’s pain was effectively managed through regular monitoring, routine analgesia administration, and distraction techniques, which alleviated discomfort. Additionally, diaphragmatic breathing exercises and chest physiotherapy were successfully used to reduce the frequency of sputum extraction and relieve sputum accumulation. The nursing team encouraged the patient to express feelings and expectations regarding postoperative facial changes and multiple tube placements. Working collaboratively with the patient, an individualized plan for extubation and oral rehabilitation was developed. This approach allowed for uneventful extubation and supported the patient's acceptance of postoperative changes in his appearance, allowing him to return to his business with a smile. This nursing experience highlighted the profound physical and mental impacts on postoperative oral cancer patients, for whom nursing guidance is challenging due to the short time periods involved. Thus, we suggest that clinicians implement multidisciplinary postoperative extubation processes and rehabilitation protocols to minimize patient anxiety regarding postoperative treatment and encourage patients to face their condition and treatment with greater confidence. We hope that this nursing experience can serve as a reference for the future postoperative care of patients with oral cancer.