肝腫瘍切除患者における手術創部位別の術後回復過程と患者QOLの相違 <原著論文>

本研究は,肝腫瘍に対する手術創部位によって患者の術後回復過程やQOLに,どのような相違が認められるかを明らかにすることを目的とした.対象は,肝腫瘍切除術を受けた患者17名で,手術創の違いにより開胸+開腹群,開腹群の二群に分けて検討を行った.データ収集の方法は,診療記録と「身体的内容」「心理的内容」「社会的内容」から構成された質問紙調査により行った.

その結果,歩行開始時期は開胸+開腹群が開腹群に比べ有意に遅延し,膀胱カテーテル抜去時期やPatient controlled epidural analgesia(PCEA)装着期間,術後～退院までの平均在院日数においても遅延する傾向がみられた.また,創部痛や食欲出現時期においても開胸+開腹群が開腹群に比べ有意に遅延し,術後の生活様式の変化の有無においても有意差を認めた.

従って,医療者は手術創部位によって患者の術後経過に違いが認められることを理解した上で適切なケアや指導を行っていくとともに,患者にとって手術を受けて良かったと思えるような支援を行っていく必要があることが示唆された.

The purpose of this study was to clarify the kind of divergence observed in terms of the preoperative recovery process and QOL of patients, depending on the location of the surgical wound for liver tumors. The subjects consisted of 17 patients that underwent resection for liver tumors, and an analysis was carried out by dividing them into two groups, the thoracotomy plus laparotomy group and the laparotomy group, based on the difference in their surgical wounds. Data were collected by browsing through the clinical records and by a questionnaire consisting of "physical content," "psychological content," and "social content."

As a result, the period of gait initiation was found to be significantly delayed for the thoracotomy plus laparotomy group compared to the laparotomy group, and a tendency to be delayed was also observed during urethral catheter suture removal, the period of equipping PCEA, and the average hospital days following surgery until discharge. Moreover, wound pain and the recovery of the patient's appetite were significantly delayed in the thoracotomy plus laparotomy group compared to the laparotomy group, and a significant difference was also observed in the presence of postoperative lifestyle change.

Therefore, it was suggested that it is necessary for medical staff to carry out appropriate care and guidance with the understanding that there are differences in a patient's postoperative recovery depending on the location of the surgical wound, and along with that, to provide sufficient support to enable the patients to have a positive approach to undergoing surgery.