罕見又致命的「主動脈-食道廔管」誤食魚刺後意想不到的隱形炸彈
2023-11-21 記者 蘇旋/報導
![](../../wp-content/uploads/2023/11/%e5%a5%87%e7%be%8e%e9%86%ab%e9%99%a2%e5%bf%83%e8%87%9f%e8%a1%80%e7%ae%a1%e5%a4%96%e7%a7%91%e4%b8%bb%e6%b2%bb%e9%86%ab%e5%b8%ab%e5%90%b3%e4%be%9d%e7%92%87%e8%a1%a8%e7%a4%ba%ef%bc%8c%e7%bd%95%e8%a6%8b%e5%8f%88%e8%87%b4%e5%91%bd%e7%9a%84%e3%80%8c%e4%b8%bb%e5%8b%95%e8%84%88%ef%bc%8d%e9%a3%9f%e9%81%93%e5%bb%94%e7%ae%a1%e3%80%8d%e8%aa%a4%e9%a3%9f%e9%ad%9a%e5%88%ba%e5%be%8c%e6%84%8f%e6%83%b3%e4%b8%8d%e5%88%b0%e7%9a%84%e9%9a%b1%e5%bd%a2%e7%82%b8%e5%bd%88%ef%bc%8c%e5%96%84%e7%94%a8%e4%b8%8d%e5%90%8c%e4%b8%bb%e5%8b%95%e8%84%88%e6%89%8b%e8%a1%93%e6%96%b9%e5%bc%8f%ef%bc%8c%e6%88%90%e5%8a%9f%e6%8c%bd%e6%95%91%e7%97%85%e4%ba%ba%e7%94%9f%e5%91%bd%ef%bc%81-1030x610.jpg)
奇美醫院心臟血管外科主治醫師吳依璇表示,罕見又致命的「主動脈-食道廔管」誤食魚刺後意想不到的隱形炸彈,善用不同主動脈手術方式,成功挽救病人生命!
主動脈-食道廔管是一種極為罕見但極具危險性的急症,被譽為誤食異物後死亡率最高的狀況之一。這種疾病往往在發生後迅速危及生命,因此必須在早期察覺並立即進行治療。根據國外醫學文獻的統計數據顯示,主動脈-食道廔管的致死率極高,即便經歷多次手術,僅有六成的病人能夠在治療後存活出院,四成的病人存活滿一年。奇美醫院特別提醒大眾,主動脈-食道廔管的致死風險極高,民眾在日常生活中切勿大意,一旦出現相關症狀應盡快就醫,以確保能夠在最短的時間內得到有效的治療。
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1.7公分魚刺竟造成腸胃道穿孔甚至主動脈-食道廔管而危及生命
一位72歲男士阿財(化名),去(111)年9月時因發燒、背痛、右上腹痛由救護車送至奇美醫療財團法人奇美醫院急診就醫。抵達急診室時,血壓只有81/65mmHg(正常值為120/80mmHg)、心跳每分鐘為95次(正常值約每分鐘60至100次)。急診醫師緊急影像學檢查發現,阿財疑似主動脈瘤破裂,立即通知心臟血管外科主治醫師吳依璇協助處置。
吳醫師診察發現阿財疑似有異物穿破食道並刺穿主動脈造成「主動脈-食道廔管」,立即請急診醫師置入鼻胃管並詢問病史,阿財告知一個多月前吃吳郭魚時有吞食到魚刺,因身體無礙並未就醫,由於鼻胃管洗胃為鮮紅血色,吳醫師研判主動脈-食道廔管併降主動脈感染性假性動脈瘤破裂造成腸胃道大量出血,緊急執行主動脈內覆膜支架置放手術,穩定生命徵象,後續會同胸腔外科進行主動脈切除置換術、食道切除清除感染源以及第三階段的食道重建手術,阿財已於日前康復出院。
奇美醫療財團法人奇美醫院心臟血管外科主治醫師吳依璇指出,食道就在主動脈的前方,食道的嚴重穿刺傷恐導致主動脈的高壓血液透過相連接之廔管(傷口)全往食道灌注,若未及時治療,恐造成大吐血、膿胸、敗血性休克等情。
吳依璇醫師說明,在過去的十多年間,拜新科技「主動脈內覆膜支架置放手術」之賜,越來越多主動脈破裂的病危病人得以迅速接受手術後挽回生命,再加上主動脈內覆膜支架置放手術傷口很小,以致傳統開胸或開腹進行主動脈手術已經較不成主流.但是像阿財的情況,就需要併用兩種手術方式,經過三階段手術才得以救命.在阻止主動脈大出血的情況下,阿財才能接受足夠的抗生素治療到血液培養陰性,並接受後續多次手術,最後得以存活。
根據目前文獻,對於主動脈-食道廔管的病人有三階段的處置方式。第一階段:「主動脈內覆膜支架置放手術」是穩定血液動力學的第一步,先讓病人撐過大出血休克;第二階段:接受「食道切除」及「胸主動脈切除」,清除感染源,並「以人工血管置換主動脈」;第三階段:「食道重建手術」,以胃部或大腸進行食道重建.中間還要輔助以抗生素的治療,以及後續復健的過程漫長且辛苦!
吳依璇醫師表示,主動脈-食道廔管,會造成主動脈破裂大出血,進而導致死亡!民眾如有誤食異物的情況,千萬不要嘗試大口吞飯、喝醋、以手指催吐或採用偏方,恐讓異物越卡越深,反而加重病情造成二次傷害。老話一句,預防勝於治療,進食的時候還是要多加小心!
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