低位直腸癌患者行肛門保留手術後，由於剩餘肛門管有限，常會影響排便控制，對社交生活造成衝擊，影響生活品質甚巨。排便功能復健過程複雜，目前尚無標準化的復健介入流程，若能瞭解患者復健之歷程將有助於建立介入流程，以維護及提昇病患的照護品質。故本研究目的即在探討低位直腸癌患者行肛門保留術後排便型態重建之歷程與經驗，並發展此類病患的排便型態重建的照護流程。
本研究運用個案研究法，以立意取樣，選取南部某醫學中心低位直腸癌行肛門保留手術並接受排便功能重建照護介入之個案。資料收集從97年11月至98年3月，藉由病歷、個案照護資料表、及一對一訪談等方式收集資料；並以內容分析法進行分析。共收集4位個案之資料，年齡介於63至73歲，3位男性1位女性。
研究結果顯示第一次造口手術後會出現不自主滲黏液、用力時滲黏液、急迫感、頻繁解黏液便、久站屁股酸、及肛門下墜感等困擾症狀。術後2-4週，同時衛教進行擴張肛門及骨盆底肌肉收縮運動(pelvic exercise, PE)， 1至4週後，前述困擾症狀逐漸獲得改善；7至21週後，肛門收縮力量由2分進步到3分。個案初期執行PE及墊腳尖運動時須注意用力錯誤的現象；同時需注意其依賴家屬協助擴肛運動之心理障礙。排便行為的調整方面，4位個案都能做到快速夾緊肛門5次，以減少排便頻率。飲食調整部分，進食量都掌控於8分飽，及禁吃粗纖維。藥物調整部分，個案皆會依排便情形自行調整藥物。由於感受到排便功能恢復的重要及復健介入措施之成效，持續追蹤至造口接回後半年，個案皆能持續執行衛教措施，且3位個案已無失禁情形。個案造口接回後感受由污穢黑白的人生轉變為潔淨彩色的人生。綜合4位個案之經驗，本研究設置衛教指引與照護措施流程，做為臨床照護之參考。

Resection due to a lower rectal cancer with anal sphincter-preserving operation may affect patients’ normal function of defecation and social interaction, seriously devastating the quality of life. The treatment and rehabilitation process is long and complex, and presently, there is no standard clinical guideline in the rehabilitation process. Thus, in order to design an effective protocol to facilitate patients’ defecation capacity, it is necessary to understand patients’ experience during this process. The purpose of this study was to explore the recovering experience of patients with low rectal cancer after their anal sphincter-saving operation and to develop an instructional protocol to guide health care professions in how to reconstruct patients’ defecation function.
Case study was applied and purposive sampling was used to recruit subjects who received anal sphincter-saving operation in a medical center located in Southern Taiwan. Data were collected from November, 2008 to March, 2009 through patient’s medical chart, health care documents, and face to face interview transcripts. Content analysis was used to analyze the data. Finally, four subjects (1 female) participated in this study (age ranged from 63 to 73).
Study results indicated that after the first ostomy operation, subjects suffered from incontinence of mucus, incontinence of mucus due to exertion of pressure, urgency and frequent mucus, bottom ache by prolong standing, and anal tenesmus. All these symptoms were alleviated after 1 to 4 weeks of anastomosis dilation and pelvic exercise (PE) training initiated 2 to 4 weeks after the ostomy operation. After 7-21 weeks PE training, anal muscle power improved from 2 to 3 points. When performing PE and tiptoe-standing exercise, subjects usually misused their muscle parts and need to be informed. Furthermore, subjects may need to adjust psychologically to their need of relying on a family member to assist them in the anastomosis dilation training. Through the defecation exercise, all subjects were able to perform rapid contraction of the anal sphincter 5 times in order to minimize the frequency of defecation. Additionally, all subjects were able to follow the diet control of consuming no more then 80% full per meal and prohibited from eating foods with crude fiber. Subjects might self-regulate their intake of anti-diarrheal medication and laxatives accordingly to their defecation problems. Due to the importance of incontinence and effectiveness of the rehabilitation interventions, all subjects reported that they have maintained PE, diet control, and prolong defecation exercise during the sixth month follow-up after their ostomy take-down operation. Furthermore, 3 of 4 subjects were free from incontinence. The subjects reported their lives from dirty to clean after take-down of colostomy. Based on the experience of four subjects, health care educational guidelines and procedures were suggested.

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