水腫變成「米其林手」 奈米超顯微手術助重拾鍋鏟
2021-11-28 11:37 記者許高祥/高雄報導
▲郭女士的右手(左)腫脹如米其林,在術後6個月消腫與正常手臂差不多(右)。(圖/高醫 提供)
一位70歲的家庭主婦郭女士,20年前罹患乳癌開完刀接受腋下淋巴結摘除後,右側手臂卻逐漸水腫,復健效果不佳,讓她的手臂腫脹疼痛宛如「米其林」,不敢出門也拿不起鍋鏟為家人煮飯,經人轉介至高醫整型外科張智豪醫師門診接受新世代奈米超顯微淋巴管靜脈吻合術。術後六個月後,手臂已消腫與正常手臂差不多,但活動度有限,醫師張智豪懷疑是脊椎壓迫的表現,積極幫郭女士執行核磁共振的影像學檢查,發現郭女士的頸椎呈現極度狹窄且壓迫到神經,於是轉診至林志隆副院長門診進行頸椎手術。目前郭女士恢復良好,手臂的淋巴水腫解決加上頸椎手術成功,郭女士終於可以再出門逛菜市場,拿起鍋鏟煮飯給最心愛的家人,共享天倫之樂。
另一位81歲的莊女士,23年前因左側乳癌後腋下淋巴結摘除加上放射治療引起左手臂末期淋巴水腫,反覆地蜂窩性組織炎讓她精神不濟、減少社交,後因鍾飲文院長的介紹,會診整型外科張智豪醫師,在奈米超顯微手術後的隔天,她的上臂立即消腫明顯,兩個月後已經消腫約30%,莊女士開始恢復外出運動的興趣與信心,並開始穿回體面漂亮的衣服。
高醫附設中和紀念醫院副院長林志隆表示,淋巴水腫是一種棘手病症,乳癌術後存活者每五個病患就一位有淋巴水腫的困擾,而且隨著年歲增長越發嚴重。院方在2018年特別推薦專精顯微手術的整形外科醫師張智豪赴日、美及韓三國進修;張醫師融合日本顯微技術及美國小鼠模型技術,研發出新一代的奈米超顯微淋巴管靜脈吻合手術,2年內已幫助110名淋巴水腫病友擺脫困擾,讓生活品質得到大幅改善。此新型手術可應用於乳癌、子宮頸癌及前列腺癌等癌症手術後的淋巴水腫治療,目前在臺灣能擁有可以將比頭髮細1/25的透明縫線縫在0.3mm的淋巴管上的奈米顯超顯微技術,可說鳳毛麟角,張智豪醫師的這項技術,可造福更多淋巴水腫的患者。
整型外科醫師張智豪表示,奈米超顯微淋巴管靜脈吻合術可應用於中重度之上肢淋巴水腫,是利用23高倍光學顯微鏡將小於0.5mm或更細的淋巴管及週邊靜脈找出,利用新的奈米橋接技術將淋巴管支架放置於淋巴管與靜脈的連接處執行嫁接,確保淋巴管與靜脈之間的暢通,達到100%引流淋巴液的效果,如果為末期之後的淋巴管因長期發炎會更小於0.5mm(日本淋巴水腫大師光嶋勳教授通稱小於0.3mm為奈米淋巴管),手術後可消腫至第二期甚至在外觀上可達與正常手臂差不多的手圍。目前張醫師橋接過最細的淋巴管為0.25mm,需在手臂上執行4~6個小於1.5公分的傷口,手術後不但立即消腫,而且傷口的疤痕淺而不明顯。
張智豪強調,新式的奈米顯微手術,刀口淺而小,恢復期快,手術後隔天即可感受消腫程度及手臂變軟,而且螢光染劑不具放射性,術後傷口照顧簡單,搭配術後專業復健療程,可以很快回到原本的生活,出院時持續彈繃加壓照護三個月後換穿壓力衣三個月後,即可擺脫淋巴水腫的困擾,這項技術對許多淋巴水腫的病友來說,是另一種新的選擇。
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