手術による人工肛門造設患者の主観的なQuality of Lifeの変化に関する縦断的研究

A Longitudinal Study of Changes in the Subjective Quality of Life of Patients After Surgical Construction of Colostomy

要旨

　人工肛門造設患者の生活の主観的評価に関連する認識の変化を予測し援助を行うために，人工肛門造設患者と直腸癌で手術を受け人工肛門を造設しなかった患者を比較し，縦断的変化を明らかにした．

　人工肛門造設患者に特徴的な認識の変化は，生活の主観的評価が退院前に低下し，退院後徐々に回復することであった．人工肛門造設患者の生活の主観的評価の低下をできるだけ少なくするためには，術後起こる認識の変化と対処について術前教育を行うことが必要であると考えられた．

　直腸癌で手術を受けた患者に共通する認識の変化は，積極的生活姿勢，健康的生活，排便の負担感，および食事の満足の変化であった．退院後積極的生活姿勢，および排便の負担感は増加し，健康的生活は退院前に低下し退院後も回復せず，食事の満足は人院中に低下し退院後に回復していた．直腸癌で手術を受けた患者は，術後積極的生活を心がけているが，健康的生活を感じられるようになるには，ある程度期間が必要であると考えられた．排便の負担感については，退院後も継続した援助が必要であると考える．また，食事に関しては，入院中食事の満足感が得られるよう改善していく必要があると考える．

Abstract

　With the aim of predicting changes in perception related to subjective attitude toward life after construction of colostomy and to assist patients after such operation, we compared patients who underwent artificia lconstruction of colostomy, and patients who were operated for rectal cancer but did not undergo construction of stoma. Thus, we identified longitudinal changes.

　One of the changes in the perception characteristic to patients after construction of colostomy was that subjective attitude toward life declined before discharge from the hospital, and then gradually improved after discharge. We believe it necessary to preoperatively educate the patients about predicted postoperative changes in perception, as well as countermeasures for coping with such changes, in order to minimize decline in the subjective attitude toward life after construction of colostomy.

　Changes in perception commonly observed among patients who underwent surgery for rectal cancer were those in positive attitude toward life, personal assessment of health, problem with evacuation, and satisfaction with diet. Positive attitude toward life and problem with evacuation increased after discharge from the hospital. Personal assessment of health declined before discharge, and did not improve after discharge from the hospital. Satisfaction with diet declined during hospitalization, and improved after discharge from the hospital. Patients who underwent surgery for rectal cancer were attempting to have positive attitude toward life ,but a certain period of time appeared to be necessary in order for them to feel that they were leading healthy life .With respect to problems with evacuation, continual assistance seemed nacessary even after discharge from the hospital. As to diet, improvement should be made so that patients would be able to have satisfaction with diet during hospitalization.