口腔癌及癌前病變患者術後症狀困擾與照護需求之相關因素探討

背景: 口腔癌的治療以外科手術為主，放射治療及化學治療為輔，病患許多不適症狀不完全因為病變，而是導因於不同的醫療處置。因此希望藉此研究提供醫療團隊在制定口腔癌及癌前病變病患照護標準的參考。研究目的: 瞭解手術後急性期，不適症狀嚴重度及不同術式與醫護處置間相關係，病患對照護資訊及照護資訊提供方式的需求情形。研究方法: 透過｢口腔癌病患術後症狀困擾情形｣結構式問卷，於南部某醫學中心口腔顎面外科病房，進行口腔癌及癌前病變接受手術病患資料收集，自2004年3月15日至2005年1月31日共計收集口腔癌及癌前病變患者100位。結果: 口腔癌及癌前病變病患嚴重度平均值最高之前十項症狀為，排尿疼痛、失眠、臉部浮腫、喉嚨痛、喉嚨異物感、吞嚥液體困難、張口度小、口腔疼痛、痰多、容易嗆到咳嗽。手術時間、管路及補綴物留置，皆會影響病患的不適感受；診斷及病變期數會影響病患症狀嚴重度及照護需求；在症狀嚴重度上，口腔癌3-4期大於1-2期病患及癌前病變患者，而癌前病變中黏膜纖維化又高於其他癌前病變，且嚴重度和口腔癌病患無顯著差異。結論: 輔助治療、照顧者、過去病史等基本資料與各系統症狀間皆無顯著相關；行RND術式及手術傷口範圍愈大、手術時間愈長，在症狀上愈顯著不適，黏膜纖維化雖為癌前病變但在症狀嚴重度高。管路或補綴物留置、植皮傷口、抽痰、藥物試驗，對病患來說都是相當痛苦；生活限制對病患來說不適程度較能忍受。行頸部淋巴結廓清術(SND)術式、引流管留置及有接受抽痰的病患分別在照護需求顯著較高；年齡、教育程度等各基本資料，在照護需求上都沒有顯著的差異。在照護需求上病患需求最高的項目為:護理人員衛教、醫師解釋病情、飲食衛教或突發狀況處理、傷口照護及社會資源的資訊。在提供方式上最被接受的方式為:醫護人員口頭說明各項照護要點、24小時電話諮詢服務、與專科護理師討論照顧技巧和後續追蹤。

關鍵字

口腔癌；症狀困擾；照護需求

並列摘要

Background: The main treatment of oral cancer is surgeryand combine with radiotherapy and chemotherapy.Many uncomfortable symptom of patient don’t attribute to the disease completely, but result from different medical management.Therefore, the present study support medical team to set up reference of care of oral cancer patients. Purpose: To understand the relationship of acute stage, severity of uncomfortable symptom, and medical management after operation,the need of nursing information after operation and nursing information after operation. Methods: The design of questionnaire is structural and drafted as “disturbance of symptom after oral cancer patients receive operation” by identifying of documents. The data collection is performed to that patients receive tumor excision at Oral and Maxillofacial department of one medical center in south Taiwan. The present study collects 100 oral cancer and pre-cancerous patients since 2004/3/15 to 2005/1/31. Results: The ten symptoms of mean of severity are urodynia , insomnia , swelling of face ,sorethroat ,foreign body sensation of sorethroat, dysphagia,mouth opening limitation,pain of oral cavity,sputum, and cough. The factors that operative time, Foley tube, nasogastric tube, wound of skin graft and placement of fixation appliance all affect the feeling. Diagnosis and staging of disease are related to severity degree of patients’ symptoms and nursing need. On the severity of the symptom, the oral cancer patients of stage III & IV are greater than the patients of stage II & I and the pre-cancer patients, And in the pathological change before the cancer, probability of the oral submucous fibrosis is higher than the other pre-cancers pathologic change, There is not significant difference between the severity of OSF patient and oral cancer. Conclusion: There is no significant difference among adjuvant treatment, care giver, past history and systemic syndrome. Although the oral submucous fibrosis is a pathological change of pre-cancer lesion, it is high in the serious degree of symptom.It is painful for patients with placement of prosthesis and rout, wound of skin graft, sputum suction, and test of medication. Otherwise, patients can tolerate the discomfort resulted from limitation of common life. The patients with surgical method of SND, placement of drain tube and receiving sputum suction have more general need, method of care and rehabilitated need. There is no significant difference among pre-operative sanitary education, method of care and need of resource whether of age, education, belief, main care and habit to receive medical treatment. The main needs of patients in the nursing care are sanitary education by nurse, explain illness by doctor, education of diet or management of urgent condition, wound care and information of social resource. The most satisfying provided methods are doctor and nurse explain the key point of care, provide opportunity for patients or family to manipulation, service of telephone call of 24 hours, discuss with nurse specialist and continued follow up.