照顧一位年輕肝癌女性接受兩階段肝切除手術之護理經驗

The Nursing Experience of An Young Women Undergone Two Stage Operation for Liver Cancer

10.6880/TJON.201810/SP_18.04

陳亞涵(Ya-Han Chen)；蔡秀玉(Hsiu-Yu Tsai)；盧幸茹(Hsing-Ju Lu)

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

腫瘤護理雜誌

18卷增訂刊（2018 / 10 / 01）

41 - 52

繁體中文

本文描述一位肝癌年輕女性，因肝腫瘤位置鄰近肝臟血管，需接受兩階段手術。個案需面臨腹部大型手術及對癌症進展之未知性，產生極大的焦慮與不確定性，引發筆者選擇此個案分享照護經驗之動機。照護期間為2015年10月1日至2015年10月8日，運用Gordon十一項功能性健康型態進行評估與分析，透過實際護理、觀察、會談及身體評估等技巧收集資料，確立個案主要健康問題有：「急性疼痛」、「身體心像改變」、「焦慮」。護理過程中，筆者扮演支持、引導照護及指導者的角色，與個案建立良好的護病關係，並透過獨特性護理措施緩解個案生理不適及調適身心之問題。藉由主動說明肝腫瘤門脈靜脈結紮兩階段手術（Associating Liver Partition and Portal Vein Ligation for Staged Hepatectomy, ALPPS）過程及不了解之問題，協助解決新型手術技術相關認知及預後不確定感，提供相關資訊及適時給予正向鼓勵，使其能安心進而改善身心不適及促使生理功能逐漸恢復，以利順利出院療養。筆者希望藉此新型手術個案之護理經驗，提供臨床護理人員做為將來照護個案之參考。

We report the nursing experience of a young women undergoing a two-stage operation for liver cancer. The tumor was too close to the major vessels, to where a new surgical approach named Associating Liver Partition and Portal Vein Ligation for staged hepatectomy (ALPPS) was indicated. ALPPS involves a first stage in-situ liver partitioning and portal vein ligation, followed by a second stage liver resection after an interval of liver regeneration. Patient would suffer from anxiety, physical and mental stress of sequential operations. In the nursing care period between October 1st and 8th 2015, relevant data was collected from direct care, observation, interviews, and physical examination of the patient. The authors evaluated the patient using Gordon 11-item functional health patterns and confirmed that the patient had several health issues including acute pain, body image disturbance, and anxiety. During the nursing care, we used professional knowledge, skills, active care, and proper nursing activity to alleviate the physical discomfort; we also conveyed sympathy and empathy. Our care achieved the goals of self-care ability and confidence of recovery before discharge. The nursing experience of caring for this ALPPS patient will hopefully provide a useful reference for clinical nursing personnel in their future care activities of similar events.

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