3領域リンパ節郭清を伴う食道切除再建術を受けた食道がん患者の食の再獲得の困難と看護支援の検討

Difficulties Experienced by Patients in Resuming Meals after Esophagectomy and Reconstruction with 3-Field Lymph Node Dissection and Assessment of Their Nursing Care

要旨

　本研究の目的は，食道がんに罹患し3領域リンパ節郭清を伴う食道切除再建術を受けた患者が，手術後の経口摂取開始時から退院後早期までの時期に直面する食の再獲得の困難を明らかにし，その過程を支えるために必要な看護支援について検討することである．胸部食道がんにより右開胸開腹胸部食道切除胸壁前胃管再建術を受け，経口摂取が開始された患者9名を対象とした．面接と参加観察によりデータを収集し，得られたデータを質的帰納的に分析した．

　分析の結果，食道がん術後患者の食の再獲得の困難を表すカテゴリーとして，【食べるまでに非常な労力を要する】【嚥下･消化･吸収のすべてに苦労する】【不快な症状の予測･対策･対応ができない】【不快な症状により生活に影響が生じる】【食べたいのに食べられない】など，9つが導き出された．そして，食の再獲得の困難の構造は，〔食の構え〕〔不快な症状の出現と予測の困難さ〕〔食がもたらす生活基盤の混乱〕〔食の喜びの喪失〕の4つの部分から構成された．これらのことから，食の再獲得を促すための看護支援として，症状アセスメントに基づいた看護ケア，自分らしい食の構築，新たな楽しみの獲得と人生の創造に向けたかかわりが重要であることが示唆された．

Abstract

　We wanted to identify the particular difficulties in resuming meals experienced by patients who had undergone esophagectomy and reconstruction with 3-field lymph node dissection for esophageal cancer, from the early postoperative period, until shortly after discharge from hospital, and to examine the nursing care required to support the process. The subjects were 9 patients who had undergone right-thoracotomy thoraco-abdominal esophagectomy and thoracic wall anterior gastric reconstruction for cancer of the thoracic esophagus, and in whom oral feeding had been started. Data were collected by interview and observations, and were evaluated by qualitative induction analysis. We identified 9 categories of difficulty, including "It takes a great effort just to get ready to eat", "Swallowing, digestion, and absorption are all hard", "It is impossible to predict, prevent, or cope with unpleasant symptoms", "Unpleasant symptoms affect activities of daily living", and "Unable to eat even though wanting to". The 4 components of difficulty in resuming meals were :(1)attitude towards meals,(2)development of unpleasant symptoms and difficulty predicting them,(3)interference with quality of life, and(4)loss of the pleasure associated with meals. These findings suggested that nursing care to encourage resumption of meals needs to be based on symptom assessments, individual meal design, and helping patients find new pleasures and a creative life.