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

10.6386/CGN.202112_32(4).0010

蔡晴惠(Ching-Hui Tsai)；邱盈珍(Ying-Chen Chiu)；陳淑華(Shu-Hua Chen)

肝癌 ； 分階段肝切除術 ； 護理經驗 ； Hepatocellular carcinoma ； ALPPS ； Nursing experiences

長庚護理

32卷4期（2021 / 12 / 01）

107 - 117

繁體中文

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.

1. 徐薏姍, Y. S.,李淑真, S. C.,陳淑月, S. Y.(2015)。一位肝癌患著行肝切除術之護理經驗。弘光學報，76，1-13。
   連結：
2. 陳亞涵, Y. H.,蔡秀玉, H. Y,盧幸茹, H. J.(2018)。照顧一位年輕肝癌女性接受兩階段肝切除手術之照護經驗。腫瘤護理雜誌，18，41-52。
   連結：
3. 曾文亮, W. L.,曾夢如, W. L.,許翠華, T. H(2017)。一位肝癌病人接受肝葉切除術的手術全期護理經。新臺北護理期刊，19(1)，93-102。
   連結：
4. 劉佩君, P. J.,游馥蓮, F. L.(2017)。一位初次診斷急性骨髓性白血病病患之護理經驗。彰化護理，24(2)，73-83。
   連結：
5. Bertens, K. A.,Hawel, J.,Lung, K.,Buac, S.,Pineda-Solis, K.,Hernandez Alejandro, R(2015).ALPPS: Challeng ing the conceptof unresectabilitya systematic review.International Journal of Surgery,13,280-287.
6. Chan, A. C.,Poon, R. T.,Lo, C. M.(2015).Modified Anterior Approach for the ALPPS Procedure: How We Do It.World Journal of Surgery,39(11),2831-2835.
7. Hess, E. P.,Grudzen, C. R.,Thomson, R.,Raja, A. S.,Carpenter, C. R.(2015).Shared Decision making in the EmergencyDepartment: Respecting Patient Autonomy When Seconds Count.Academic Emergency Medicine,22,856-864.
8. Laurenzi, A.,Santoro, R.,Colasanti, M.,Lepiane, P.,Ettorre, G. M.(2014).The ALPPS procedure: a surgical option for hepatocellular carcinoma with major vascular invasion.World Journal of Surgery,38(6),1498-1503.
9. Low, J. K., & Sze, T. G. (2015). ALPPS–The New Frontier in Liver Surg-ery. https://www.ttsh.com.sg/ALPSS/
10. Salem, A. I.,Winslow, E. R.(2017).Current technical aspects of oncological hepatic surgery.Hepatobiliary & Pancreatic Diseases International,16(2),147-154.
11. 王強、馬寬生(2017)．ALPPS的發展衍變、問題爭議及未來展望．取自http://www.ifuun.com/a2017632679281/[Wang, Q., & Ma, K. S., (2017). The development of ALPPS, issues and future prospects. Retrieved from http://www.ifuun.com/a2017632679281/]
12. 王惠美, H. M.,趙慧玲, H. L.,黃薇瑄, W. H.,廖婉君, W. C.,胡曉珍, H. C.,陳德芳, D. F,于博芮, P. J.(2014)。一般外科病患術後傷口換藥疼痛改善專案。領導護理，15(3)，96-107。
13. 呂宜佩, Y. P.,陳筱玲, Y(2014)。應用紐曼模式於一位復發性肝癌病患接受再次手術治療之護理經驗。彰化護理，21(1)，50-59。
14. 陳盈蓉,Y. J.,陳雅玲, Y. L.,許莉宛, L. W.(2016)。一位初次診斷肝癌術後病人之照護經驗。高雄護理雜誌，33(2)，49-59。
15. 蔡佩真, P. Z.,陳淑芳, S. F.(2015)。照護一位乙狀結腸癌症併肝轉移病人接受肝腫瘤切除術後之護理經驗。馬偕護理雜誌，9(1)，66-75。
16. 衛生福利部(2018，6月15日)．106年國人死因統計結果．取自https://dep.mohw.gov.tw/DOS/cp-3960-41756-113.html [Health and Welfare Department. (2018, June). 106 years of national death statistics. Retrieved from https://dep.mohw.gov.tw/DOS/cp-3960-41756-113.html]