Department of Surgery, Institute of Clinical Sciences, Sahlgrenska University Hospital/Östra, Gothenburg, Sweden.
Department of Surgery, Angered Hospital, Gothenburg, Sweden.
J Clin Nurs. 2018 Feb;27(3-4):e623-e634. doi: 10.1111/jocn.14112. Epub 2017 Dec 7.
To illuminate what it means to live with a resected rectum due to rectal cancer, after reversal of a temporary loop ileostomy.
Today, treatment for rectal cancer is performed with increasing emphasis on sphincter-saving surgery, meaning that an anterior resection often includes construction of a temporary loop ileostomy that is later reversed. The majority of patients will subsequently have disordered bowel function, with symptoms ranging from urgency to faecal incontinence. The symptoms are thought to decrease over time, reaching a plateau 1 year after surgery. There is a lack of knowledge about patients' lived experience after 1 year.
An explorative qualitative study.
In-depth interviews were conducted with ten participants, 12-20 months after surgical closure of a temporary loop ileostomy following rectal cancer surgery. The transcribed interviews were analysed using a phenomenological hermeneutical method.
The thematic structural analysis resulted in three themes: living with uncertainty, struggling to live with altered bowel function and a preoccupation with bowel function. In the comprehensive understanding, a deeper overall understanding emerged, illuminating that the meaning of living with a resected rectum could be interpreted as being resilient.
The participants' lived experiences were understood as being resilient in that they struggled with the uncertainty and adversity of living with an unpredictable bowel, which was a constantly preoccupation and affected every aspect of life. The participants had not yet adapted to their situation but were struggling in solitude to get there, with little or no help from healthcare professionals.
The insight from this study highlights the importance of patients being systematically examined and followed up in regard to functional results and impact of symptoms on everyday life. Treatment, information, advice and counselling should be given to promote adaption to the new situation.
阐述因直肠癌而行临时回肠袢式造口术（loop ileostomy）反转后切除直肠对生活的影响。
目前，直肠癌的治疗越来越强调保留肛门括约肌，这意味着前切除术通常包括构建临时回肠袢式造口术，随后再进行反转。大多数患者随后会出现肠道功能紊乱，症状从急迫感到粪便失禁不等。这些症状被认为会随着时间的推移而减少，在手术后 1 年达到稳定状态。但人们对患者术后 1 年的生活体验知之甚少。
探索性定性研究。
对 10 名参与者进行深入访谈，这些参与者在直肠癌手术后的临时回肠袢式造口术关闭 12-20 个月后接受了采访。对转录的访谈采用现象学解释学方法进行分析。
主题结构分析得出了三个主题：生活在不确定性中、努力适应改变的肠道功能以及对肠道功能的关注。在全面理解中，出现了更深入的整体理解，阐明了切除直肠后的生活意义可以被解释为具有弹性。
参与者的生活体验被理解为具有弹性，因为他们在不确定和难以预测的肠道生活中挣扎，这是他们一直关注的问题，影响了生活的方方面面。参与者还没有适应他们的情况，而是在孤独中努力适应，几乎没有或根本没有得到医疗保健专业人员的帮助。
本研究的见解强调了系统检查和随访患者的功能结果以及症状对日常生活的影响的重要性。应该提供治疗、信息、建议和咨询，以促进适应新情况。
