照顧一位年輕乳癌病人行乳房切除併立即性重建手術全期之護理經驗

Caring for a Young Breast Cancer Patient With Mastectomy and Immediate Reconstructive Surgery

10.6880/TJON.201810/SP_18.06

鄭如婷(Ju-Ting Cheng)；方雅晶(Ya-Ching Fang)；陳怡秀(I-Hsiu Chen)

乳癌 ； 乳房重建 ； 手術全期 ； Breast cancer ； reconstruction ； perioperative

腫瘤護理雜誌

18卷增訂刊（2018 / 10 / 01）

65 - 79

繁體中文

本文是在探討一位37歲年輕女性乳癌病人，行右側乳房切除術並立即行自體游離式深下腹動脈穿通枝皮瓣之手術全期護理經驗。護理期間為2015年2月4日至2015年2月11日，筆者運用會談、觀察、身體評估及查閱病歷方式收集資料，以手術全期為基礎，評估個案生理、心理、社會、靈性及發展等整體層面之健康問題，確認個案的健康問題，包含手術前期焦慮、手術中期潛在危險性傷害、手術後期急性疼痛因對手術流程不甚了解、擔心重建是否成功，及癌細胞是否轉移，不停地重複詢問手術相關問題，而產生焦慮不安的情緒而哭泣，因筆者為開刀房護理師常面對接受手術的乳癌病人，深刻覺得病人心理支持大於生理需要，故引發筆者探討此個案之動機。在照護過程中運用開刀房團隊資源管理（Team Resource Management, TRM），維護病人安全及舒適使手術順利完成；手術後指導個案深呼吸技巧、協助正確臥位並適時給予正向回饋，運用音樂療法轉移注意力，使個案疼痛情形改善。有鑑於臨床接受乳房重建手術的病人有日漸增加之趨勢，為了讓此類病人有更優質的照護，故建議院方引進乳癌重建手術專用的舒適枕，可適合每個病人臥位，不會因為姿勢滑動位移，未來讓更多乳癌手術病人能受惠。

This paper's purpose is to share the nursing experience of a 37 y/o female breast cancer patient who underwent immediate deep inferior epigastric perforator flap reconstruction after a right breast mastectomy. Using peri-operative nursing care as base between February 4 to February 11, 2015, data was collected through interviews, observation, physical assessment and chart review to assess different aspects of health conditions. This was done to confirm the health issues of the patient, which include pre-operative anxiety, risk of operation related injury or mortality, and post-operative acute pain, concerns over the outcome of reconstruction, and possible metastasis. The constant doubt and questions related to surgery contribute to unstable mood, anxiety and crying. Author is an OR nurse in frequent contact with breast cancer patients and thus can feel deeply that the patients' psychological support is as important as the physiological needs. This is what motivated the author to investigate deeper the recovery path of this patient. In order to effectively perform the surgery, during the course of care, Team Resource Management (TRM)was used to maintain patient safety and comfort. TRM activities include post-surgery deep breathing technique, proper sleeping method, and musical therapy to reduce pain. It is recommended that hospitals use comfortable pillows specifically designed to stay in place for breast reconstruction patients regardless of the multiple sleeping positions.

1. 侯宜均, Y. J.,林月娥, Y. E.,高玉鳳, Y. F(2018)。提升腫瘤科病房護理人員執行自控式止痛裝置的完整性。瘤護理雜誌，18(1)，61-75。
   連結：
2. 顏沛滋, P. T.,劉景萍, C. P.,蘇籹銦, N. Y.(2016)。癌症病人治療旅程中的陪伴者~癌症資源中心服務。腫瘤護理雜誌，16(增訂刊)，21-30。
   連結：
3. Bellavance, E. C.,Kesmodel, S. B.(2016).Deci- sion-making in the surgical treatment of breast cancer: Factors influencing women s choices for mastectomy and breast conserving surgery.Frontiers in Oncology,6(74),1-7.
4. Kim, H. Y.,So, H. S.(2012).A structural model for psychosocial adjustment in patients with early breast cancer.Journal of Korean Acad- emy of Nursing,42(1),105-115.
5. Unukovych, D.,Wickman, M.,Sandelin, K.,Arver, B.,Johansson, H.,Brandberg, Y.(2016).Associations between reoperations and psycho- logical factors after contralateral risk-reduc- ing mastectomy: A two-year follow-up study.International Journal of Breast Cancer,1-7.
6. Wang, Y. H.,Cheng, M. H.,Kao, H. K.,Tsao, C. K.(2007).Using microvascular anastomotic cou- pler system for venous anastomosis of internal mammary vein in breast reconstruction.The Journal of Plastic Surgical Association,16(3),183-188.
7. 方前量, C. L.,許晉豪, C. H.,楊昕禕, H. Y.,林依伶, Y. L(2018)。DIEP皮瓣術後腹壁的修補不論是使用Mesh或是直接修補，可藉由Progressive Tension Sutures與CloseDrainage來避免Seroma的發生。臺灣整形外科醫學會雜誌，27(1)，1-11。
8. 伍雁鈴（校閱）, Y. L.(Ed.)(2015).手術室護理.台北市=Taipei City, Taiwan, ROC:華杏=Farseeing.
9. 林耀盛, Y. S.,胡至家, C. C.,張娟鳳, C. F.(2009)。鬱傾向和親密關係對乳癌術後婦女身體意象影響之相關探討。高雄行為科學學刊，1(1)，25-39。
10. 陳玉紛, Y. F.,張慕民, M. M.,潘雪幸, H. H.(2014)。接受抗癌治療之乳癌病人身體心像改變及其護理。腫瘤護理雜誌，14(1)，13-24。
11. 廖張京棣（校閱）, Z. J. Di.(Ed.)(2013).最新實用內外科護理學下冊.台北市=Taipei City, Taiwan, ROC:永大=Yeong-dah.
12. 衛生福利部(2018年6月15日).女性主要癌症死亡原因-與上年比較,取自https://www. mohw.gov.tw/cp-3795-41794-html

1. 黃聖淑,曾月英(2022)。一位乳癌婦女面臨再次乳房重建之護理經驗。領導護理，23(2)，74-91。