照護先天性無子宮無陰道症候群女性行陰道成形術之護理經驗

Nursing Experience of a Woman with Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome undergoing vaginoplasty

本文描述一位23歲女性罹患先天性無子宮無陰道症候群，入院行腹腔鏡陰道成形手術之護理過程。個案年紀輕輕就必須面臨生殖系統手術，術後不但自我照護知識不足，更有低自尊的心理狀態。於2023年11月14日至2023年11月21日住院期間，運用Gordon十一項功能性健康型態評估，藉由觀察、傾聽、會談、身體評估方式收集個案之相關資料，確認個案有急性疼痛、情境性低自尊、特定知識缺失。藉由藥物、音樂、調整呼吸轉移注意力、熱敷、使用束腹帶緩解術後疼痛，運用治療性溝通與傾聽、寫日記促進個案正向思考、會診心理師諮商、鼓勵家屬給予心靈支持，重建個案之自我認同，以期與伴侶建立正常親密關係；對於人工陰道成形術後知識缺失，則是運用會陰部模型練習放置陰道擴張棒，進而可操作於自己的陰道內，出院返家輕鬆更換擴張棒。因婦科病房極少遇到此類個案，期望此篇經驗做為增進護理人員照護此類個案之參考。

This article describes the nursing experience of a 23-year-old female with Mayer-Rokitansky-Küster- Hauser (MRKH) syndrome who underwent a laparoscopic vaginoplasty, facing not only postoperative physical recovery but also significant situational low self-esteem and a knowledge deficit regarding specialized care. During her hospitalization from November 14 to November 21, 2023, data collected via Gordon's 11 functional health patterns—through direct observation, active listening, interviews, and physical assessments—identified three core health problems: acute pain, situational low self-esteem, and a specific knowledge deficit. Postoperative acute pain was successfully managed using a combination of pharmacological therapy and non-pharmacological interventions, including music therapy, deep breathing techniques, abdominal binders, and hot compresses. To address her low self-esteem and support identity reconstruction, the nursing team utilized therapeutic communication, reflective diary writing, psychological counseling, and strong family spiritual support, helping her build a positive selfconcept and prepare for normal future relationships with her partner. Furthermore, her post-vaginoplasty knowledge deficit was resolved through hands-on education using a perineal model, which allowed her to comfortably practice and master the insertion and maintenance of vaginal dilators independently prior to discharge. Given the rarity of MRKH syndrome cases in general gynecological wards, this shared nursing experience serves as a valuable clinical reference for medical staff optimizing multidisciplinary care and post-operative self-care guidance for similar patients.