原位新膀胱术后尿失禁患者自我管理体验及需求的纵向质性研究

doi:10.3761/j.issn.0254-1769.2026.02.008

中华护理杂志 ›› 2026, Vol. 61 ›› Issue (2): 205-212.DOI: 10.3761/j.issn.0254-1769.2026.02.008

原位新膀胱术后尿失禁患者自我管理体验及需求的纵向质性研究

丁佳蓉¹(), 陈慧¹, 王雪瑞², 孙小玲³^,^*(), 张银¹

1.南京大学医学院附属鼓楼医院泌尿外科南京市 210008
2.南京大学医学院附属鼓楼医院肝胆与肝移植外科南京市 210008
3.南京大学医学院附属鼓楼医院江北院区门诊部南京市 210031

收稿日期:2025-05-07 出版日期:2026-01-20 发布日期:2026-01-14
*通讯作者: 孙小玲，E-mail：sunxiaoling@nju.edu.cn
作者简介:丁佳蓉：女，硕士，主管护师，E-mail：gydjiarong@126.com
基金资助:
江苏省宁爱医学发展医疗救助基金会资助项目(NDYGN2024020)

A longitudinal qualitative study on self-management experiences and needs of patients with urinary incontinence after orthotopic neobladder surgery

DING Jiarong¹(), CHEN Hui¹, WANG Xuerui², SUN Xiaoling³^,^*(), ZHANG Yin¹

1. Department of Urology， Nanjing Drum Tower Hospital，the Affiliated Hospital of Nanjing University Medical School， Nanjing 210008， China
2. Division of Hepatobiliary and Transplantation Surgery， Nanjing Drum Tower Hospital，the Affiliated Hospital of Nanjing University Medical School， Nanjing 210008， China
3. Department of Outpatient， Jiangbei Branch of Nanjing Drum Tower Hospital，the Affiliated Hospital of Nanjing University Medical School， Nanjing 210031， China

Received:2025-05-07 Online:2026-01-20 Published:2026-01-14
* Corresponding author: SUN Xiaoling，E-mail：sunxiaoling@nju.edu.cn
Funding program:
China Hospital Reform and Development Research Institute of Nanjing University，Nanjing Drum Tower Hospital，Aid Project of Jiangsu Ningai Medical Development & Medical Aid Foundation(NDYGN2024020)

摘要/Abstract

摘要：

目的基于患者旅程地图，纵向追踪原位新膀胱术后尿失禁患者自我管理的阶段性体验及需求，为制订分阶段的护理干预方案提供依据。方法采用纵向质性研究方法，通过目的抽样选取2024年4—6月在南京市某三级甲等医院泌尿外科行原位新膀胱术的16例膀胱癌患者作为研究对象。于术后1、3、6个月对其进行半结构化访谈。采用内容分析法进行资料分析并绘制患者旅程地图。结果以术后恢复期（1~3个月）、适应期（4~6个月）和稳定期（>6个月） 3个康复阶段为时间轴，从任务、情绪和痛点3个维度归纳、提炼出患者的自我管理体验及需求，形成包括新膀胱适应性自主训练、自护技能系统性学习、排尿失控触发焦虑与信心危机、症状反复激发手术决策后悔与效果质疑、身心适应负荷失调、生活方式多维受限、信息过载与实操脱节等20个主题，并形成旅程地图。结论原位新膀胱术后尿失禁患者的自我管理具有阶段性和长期性，医护人员应依据患者不同阶段的动态体验与核心需求，提供即时、适配的分阶段综合护理干预，以优化患者的康复结局。

关键词: 原位新膀胱术, 尿失禁, 自我管理, 患者旅程地图, 纵向质性研究, 护理

Abstract:

Objective Based on the patient journey map，this study longitudinally tracks the staged self-management and needs of patients with urinary incontinence following orthotopic neobladder surgery to provide a foundation for developing phased and individualized nursing intervention programs. Methods A longitudinal qualitative research approach was adopted. A total of 16 bladder cancer patients who underwent orthotopic neobladder（ONB） surgery in the Department of Urology at a tertiary hospital in Nanjing between April and June 2024 were recruited by purposive sampling. Semi-structured interviews were conducted with the patients at 1 month （T1），3 months（T2），and 6 months（T3） postoperatively. Data were analyzed by content analysis，and patient journey maps were constructed. Results Using the 3 postoperative rehabilitation phases-recovery（1-3 months），adaptation（4-6 months），and stabilization（>6 months） as the timeline，patients’ self-management experiences and needs were systematically summarized in terms of tasks，emotions，and pain points. A total of 20 themes were identified，including adaptive self-training for the neobladder，systematic learning of self-care skills，anxiety and confidence crises triggered by urinary incontinence，regret over surgical decisions and doubts about outcomes due to symptom recurrence，imbalance in physical and psychological adaptation，multidimensional lifestyle restrictions，and information overload with a disconnect between knowledge and practice. Patient journey maps were constructed accordingly. Conclusion Self-management of urinary incontinence following ONB surgery is both phased and long-term in nature. Healthcare professionals should provide timely and appropriate phased comprehensive nursing interventions based on patients’ dynamic experiences and core needs at different stages to optimize rehabilitation outcomes.

Key words: Orthotopic Neobladder Surgery, Urinary Incontinence, Self-Management, Patient Journey Mapping, Longitudinal Qualitative Study, Nursing Care

丁佳蓉, 陈慧, 王雪瑞, 孙小玲, 张银. 原位新膀胱术后尿失禁患者自我管理体验及需求的纵向质性研究[J]. 中华护理杂志, 2026, 61(2): 205-212.

DING Jiarong, CHEN Hui, WANG Xuerui, SUN Xiaoling, ZHANG Yin. A longitudinal qualitative study on self-management experiences and needs of patients with urinary incontinence after orthotopic neobladder surgery[J]. Chinese Journal of Nursing, 2026, 61(2): 205-212.

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参考文献 24

[1]	Bray F, Laversanne M, Sung H, et al. Global cancer statistics 2022:GLOBOCAN estimates of incidence and mortality world-wide for 36 cancers in 185 countries[J]. CA Cancer J Clin, 2024, 74(3):229-263.
[2]	Tappero S, Dell’Oglio P, Cerruto MA, et al. Ileal conduit versus orthotopic neobladder urinary diversion in robot-assisted radi-cal cystectomy:results from a multi-institutional series[J]. Eur Urol Open Sci, 2023, 50:47-56.
[3]	Erdogan B, Berg S, Noldus J, et al. Early continence after ileal neobladder:objective data from inpatient rehabilitation[J]. World J Urol, 2021, 39(7):2531-2536. DOI PMID
[4]	Asimakopoulos AD, Finazzi Agrò E, Piechaud T, et al. Urody-namic parameters and continence outcomes in asymptomatic patients with ileal orthotopic neobladder:a systematic review and metanalysis[J]. Cancers, 2024, 16(7):1253. DOI URL
[5]	Grimm T, Grimm J, Buchner A, et al. Health-related quality of life after radical cystectomy and ileal orthotopic neobladder:effect of detailed continence outcomes[J]. World J Urol, 2019, 37(11):2385-2392. DOI
[6]	杨成才. 原位新膀胱术后患者尿失禁危险因素研究及预测模型的建立与验证[D]. 昆明: 昆明医科大学, 2022.
	Yang CC. Study on risk factors of urinary incontinence in patients after orthotopic neobladder surgery and establishment and verification of prediction model[D]. Kunming: Kunming Me-dical University, 2022.
[7]	沈玲玲, 谢有琼, 彭丽仁. 针灸联合电刺激生物反馈治疗原位新膀胱术后尿失禁的临床研究[J]. 时珍国医国药, 2024, 35(15):3417-3420.
	Shen LL, Xie YQ, Peng LR. Clinical study on acupuncture combined with electrical stimulation biofeedback in the treat-ment of urinary incontinence after orthotopic neobladder surgery[J]. Lishizhen Med Mater Med Res, 2024, 35(15):3417-3420.
[8]	范雨晴, 席祖洋, 魏永婷, 等. 胃癌术后患者居家营养管理旅程地图研究及护理对策[J]. 中华护理杂志, 2025, 60(17):2124-2130. DOI
	Fan YQ, Xi ZY, Wei YT, et al. Mapping the nutritional mana-gement journey of homebound patients after gastric cancer surgery and nursing countermeasures[J]. Chin J Nurs, 2025, 60(17):2124-2130.
[9]	乔悦, 刘庆伟, 林辉, 等. 中青年肝移植患者疾病管理的旅程地图研究[J]. 中华护理杂志, 2025, 60(15):1850-1857. DOI
	Qiao Y, Liu QW, Lin H, et al. A journey map study of disease management in young and middle-aged liver transplant reci-pients[J]. Chin J Nurs, 2025, 60(15):1850-1857.
[10]	Haylen BT, de Ridder D, Freeman RM, et al. An International Urogynecological Association(IUGA)/International Continence Society(ICS) joint report on the terminology for female pelvic floor dysfunction[J]. Int Urogynecology J, 2010, 21(1):5-26. DOI URL
[11]	周云仙. 护理质性研究:理论与案例[M]. 杭州: 浙江大学出版社, 2017.
	Zhou YX. Qualitative research in nursing:theory and cases[M]. Hangzhou: Zhejiang University Press, 2017.
[12]	Fu Y, Jackson C, Nelson A, et al. Exploring support, experien-ces and needs of older women and health professionals to inform a self-management package for urinary incontinence:a qualitative study[J]. BMJ Open, 2023, 13(7):e071831. DOI URL
[13]	Kim SH, Ryu E, Kim EJ. A narrative inquiry into the adjust-ment experiences of male bladder cancer survivors with a neobladder[J]. Int J Environ Res Public Health, 2020, 17(21):8260. DOI URL
[14]	Hsieh HF, Shannon SE. Three approaches to qualitative content analysis[J]. Qual Health Res, 2005, 15(9):1277-1288. DOI URL
[15]	Bennett D, Kajamaa A, Johnston J. How to do longitudinal quali-tative research[J]. Clin Teach, 2020, 17(5):489-492. DOI URL
[16]	王喜益. 慢性病适应中域理论的构建及验证[D]. 杭州: 浙江大学, 2020.
	Wang XY. Construction and verification of median theory of chronic disease adaptation[D]. Hangzhou: Zhejiang University, 2020.
[17]	Liu XF, Zeng JJ, Li LX, et al. The influence of doctor-patient communication on patients’ trust:the role of patient-physician consistency and perceived threat of disease[J]. Psychol Res Behav Manag, 2024, 17:2727-2737. DOI URL
[18]	Chang YL, Tsai YF, Hsu CL, et al. The effectiveness of a nurse-led exercise and health education informatics program on exer-cise capacity and quality of life among cancer survivors after esophagectomy:a randomized controlled trial[J]. Int J Nurs Stud, 2020, 101:103418.
[19]	O’Toole K, Chamberlain D, Giles T. Exploration of a nurse practitioner-led phase two cardiac rehabilitation programme on attendance and compliance[J]. J Clin Nurs, 2020, 29(5/6):785-793. DOI URL
[20]	高成菲, 顾婕, 马倩云, 等. 盆底肌训练联合肌电生物反馈在前列腺癌根治术后尿失禁患者中的应用研究[J]. 中华护理杂志, 2025, 60(4):418-424. DOI
	Gao CF, Gu J, Ma QY, et al. Application study of pelvic floor muscle training combined with electromyographic biofeedback in urinary incontinence patients after radical prostatectomy[J]. Chin J Nurs, 2025, 60(4):418-424. DOI
[21]	Hagger MS, Wood C, Stiff C, et al. Ego depletion and the strength model of self-control:a meta-analysis[J]. Psychol Bull, 2010, 136(4):495-525. DOI URL
[22]	Muraven M, Baumeister RF. Self-regulation and depletion of limited resources:does self-control resemble a muscle?[J]. Psy-chol Bull, 2000, 126(2):247-259.
[23]	Fang X, Ren K, Li Y, et al. Prevalence and influencing factors of social alienation among elderly patients undergoing radical prostatectomy for prostate cancer[J]. Curr Urol, 2024, 18(2):98-103.
[24]	刘文慧, 陈俊杰, 马春花. 多重慢性病患者自我管理的挑战与展望[J]. 现代预防医学, 2024, 51(6):1032-1035,1056.
	Liu WH, Chen JJ, Ma CH. Challenges and prospects of self-management in patients with multiple chronic conditions[J]. Mod Prev Med, 2024, 51(6):1032-1035,1056.

原位新膀胱术后尿失禁患者自我管理体验及需求的纵向质性研究

A longitudinal qualitative study on self-management experiences and needs of patients with urinary incontinence after orthotopic neobladder surgery

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