喉頭摘出術を受けた患者の退院後の生活における問題と対処

Difficulties and Solutions in Daily Life of Laryngectomy Patients after Discharge

要旨

　【目的】喉頭全摘術および下咽頭喉頭頸部食道切除術に共通する喉頭の摘出によって生じる形態・機能の変化から生活上の問題を導き出し，失声以外の生活上の問題を確定すること，それらの問題の術後経過年数による問題の程度，術後経過年数による変化および個別に工夫された対処法を明らかにする．

　【方法】喉頭摘出者の患者会に所属する喉頭摘出者1,602名に質問紙調査を実施した．799名から返送され（回収率49.9％），統計解析，内容分析を行った．

　【結果】生活上の問題は，第I因子［永久気管孔・呼吸］：②重いものが持てない，⑧入浴・シャワー時に気管孔に水が入りやすい，⑪気管孔から異物が入りやすい，⑫気道が乾燥しやすい，⑬気管孔から出血しやすい，⑭痰が頻繁に出やすい，⑮気管孔周囲の皮膚がただれやすい，第II因子［食事・排泄］：③排泄時にいきみにくい，④熱い食べ物をフーフーと息を吹いて冷ませない，⑤麺類や汁物をすすれない，⑥げっぷやおならが よく出る，⑦固形物が喉に詰まりやすい，⑩匂いが分かりにくい，第III因子［運動］：①全力で走ることが難しい，⑨水泳など運動に制限が生じる，の3因子15項目が確定された．③④⑤⑧⑭は，術後経過年数により問題の程度が減少した．失声・永久気管孔・痰・食事・便秘・生活全般に関わる対処法が示された．

　【考察】①⑨⑩は対処法が示されず，術後経過年数に関係なく問題が継続するため，指導方法の確立が必要である．

　[Objective] To identify difficulties other than aphonia faced by patients who have undergone laryngectomy as a surgical procedure commonly required in total laryngectomy and hypopharyngolaryngo-cervical esophagectomy, such difficulties were predicted based on morphological and functional changes related to the procedure. Furthermore, changes in the degrees of these difficulties with time after surgery and solutions in each case were examined.

　[Methods] A questionnaire survey was conducted, involving 1,602 laryngectomy patients, and responses were obtained from 799 (response rate: 49.9%). Statistical and content analyses were performed.

　[Results] The difficulties faced by these patients in daily life after discharge were explained by the following 3 factors and 15 subfactors: [Factor I: permanent tracheostomy and breathing]: 2) difficulty carrying heavy things, 8) frequent water in the tracheostomy when taking a bath or shower, 11) frequent foreign objects in the tracheostomy, 12) dry airways, 13) frequent bleeding from the tracheostomy, 14) frequent phlegm, and 15) skin erosion around the tracheostomy, [Factor II: meals and excretion]: 3) difficulty straining when excreting, 4) difficulty blowing on hot foods to cool them, 5) difficulty eating noodles and soups, 6) frequent belching and flatulence, 7) frequent choking on solid foods, and 10) hyposmia; and [Factor III: physical activities] 1) difficulty running with maximal effort and 9) limitations in physical activities, such as swimming. The degrees of difficulties represented by Subfactors 3)-5), 8), and 14) decreased with time after surgery. To resolve these difficulties, approaches to manage aphonia, the permanent tracheostomy, phlegm, meals, constipation, and overall daily life were suggested.

　[Discussion] The solutions to 1) 9) and 10) were not suggested. For a problem to continue irrespective of passed years after an operation, establishment of educational method is needed.