幽門側胃切除術後患者の術後症状が安定期の心理社会的側面に及ぼす影響

The Impact of Postoperative Symptoms on Psychosocial Aspects in the Stable Recovery Phase of Patients After Distal Gastrectomy

要　旨

　目的：幽門側胃切除術後患者の術後症状が安定期の心理社会的側面に及ぼす影響を明らかにする．

　方法：術後安定期の胃がん患者27名を対象とし，半構成的面接を行い，質的記述的分析を行った．

　結果：幽門側胃切除術後には，【食の変化】【食の変化に伴う症状】といった具体的な食の変化があった．これらによって，【食べることへの患難】や【身体の変化に伴う患難】を感じ，社会生活のなかで【自己開示に対するためらい】や【周囲に理解してもらえないことに対するいらだちと諦め】といった苦悩をして，【社会生活の縮小化】が生じていた．しかし，【症状出現予防や出現時の工夫】【食行動に対する自己開示】や【手術したことに対する周囲の理解を得る】ことができていた対象者もいた．また，【食べることに対する執念】をもって“食べること”で生きている実感を得ようとする対象者の姿があった一方で，【食べることで感じた満足感】や【回復することで得られた満足感】で表されるように，食事摂取量が減少しても社会生活を送れている実感があったことは満足感につながっていた．そして，【がんの手術をしたことに対する受け止めと希望】をもちながら，根底に【手術したことへの葛藤】【がんである自分の，未来に対する危機感】をかかえていた．

　考察：安定期にある幽門側胃切除術後患者の心理社会的影響を理解し，食行動に対する自己開示などのセルフケアを身につけられるような支援を安定期に入っても継続することで術後患者の生活の再構築につながると考えられる

　Objectives: To clarify the impact of postoperative symptoms on patients’ psychosocial state in the stable recovery phase after distal gastrectomy.

　Methods: Semi-structured interviews were conducted with 27 gastric cancer patients in the stable postoperative stage, and a qualitative descriptive analysis was performed.

　Results: After distal gastrectomy, specific dietary changes such as changes in eating behavior and symptoms associated with dietary changes were observed. These changes caused difficulty in eating and difficulties associated with physical changes, and socially, the downsizing of social life due to a hesitancy to self-disclose and frustration and resignation at not being understood by others. However, some subjects were able to prevent the appearance of symptoms or handle them when they appeared, or they disclosed their eating behavior and gained understanding from others about their surgery. It was observed that some individuals demonstrated an obsession with eating and sought to gain a sense of being alive through their eating. On the other hand, as reflected in the satisfaction with eating and satisfaction with recovery results, even when food intake had decreased, the experience of being able to continue social life contributed to their sense of satisfaction. In addition, while acceptance and hope for having undergone cancer surgery was at the root of their feelings, they also had conflicts about having undergone surgery and a sense of crisis about their future after having cancer.

　Discussion: It is believed that patients’ lives after surgery will be revived by understanding the psychosocial impacts on patients who are in the stable postoperative phase after distal gastrectomy, and by continuing to provide support to help them achieve self-care, such as self-disclosure about their eating behavior, even after they have entered the stable postoperative phase.