摘要
雙重主動脈弓為一罕見的先天性血管環異常，它會包夾氣管及食道，然後造成呼吸和吞嚥的困難，胸部X光攝影和心臟超音波常無法切確診斷此病，但隨著科技進步，此疾可由胸部電腦斷層，核磁共振或支氣管鏡診斷出來，手術治療的死亡率極低，為此症唯一的治療方式，我們報告一個男嬰，以餵食困難和呼吸衰竭為初期表現，插管治療無法改善高二氣化碳酸血症，胸部電腦斷層診斷出右側為主的雙重主動脈弓，因病況持續惡化，手術於隔天施行，術中將左側主動脈弓及開放性動脈導管截斷，並施行支氣管鏡，看到脈動的壓迫已解除，但氣管仍有狹窄及軟化，術後因持續的喘嗚，我們追蹤電腦斷層及支氣管鏡，發現下段氣管仍有局部狹窄及氣管軟化，於是，我們加強營養補給及肺部物理治療，他於術後十四天拔管，之後順利出院。結論：新生兒若有餵食困難及呼吸喘的表現，必須考慮血管環的可能性，可安排胸部電腦斷層及支氣管鏡，確定診斷後立即進行手術，術後，必須給予營養補給及肺部物理治療，以克服可能的先天性氣管軟化及狹窄，若有持續的症狀或無法脫離呼吸器，可追蹤胸部電腦斷層及支氣管鏡，嚴重的病人仍需接受氣管整形術。
並列摘要
Double aortic arch is a rare congenital vascular anomaly which encases trachea and esophagus and then causes respiratory and swallowing difficulties. Both chest radiography and echocardiography may not clearly identify the anomaly. However, with improving diagnostic modalities such computed tomography, magnetic resonance imaging or bronchoscopy, the disease can be diagnosed accurately. Surgical division is the only cure and carries very low mortality. Here we report a male newborn presented with poor feeding and respiratory failure. Intubation failed to correct hypoxemia and severe hypercapnea. Double aortic arch was found by chest CT and division of left arch and ligamentum arteriosus was performed. However, he still suffered from occasional wheezing that made weaning difficult. A follow-up CT and bronchoscopy revealed complete tracheal ring and tracheobronchomalacia. After nutritional support and intensive respiratory care, he was finally extubated 14 days after operation and discharged smoothly. In conclusion, in a newborn with poor feeding and tachypnea, airway stenosis caused by vascular ring should be considered. A chest CT and bronchoscopy are helpful to diagnosis. Surgery should not be delayed and postoperative care with maximal nutritional support and intensive respiratory care are addressed.
延伸閱讀
- Chen, F. L., Li, Y. C., Liu, P. Y., Weng, C. Y., Liao, C. P., & Liao, J. Y. (2003). 產前診斷胎兒雙主動脈弓血管環. 中山醫學雜誌, 14(1), 145-150. https://www.airitilibrary.com/Article/Detail?DocID=16803108-200301-14-1-145-150-a
- Liang, C. D., Su, W. J., & Chang, C. H. (1993). 新生兒大動脈轉位症大動脈轉換手術：一例報告. Acta Paediatrica Sinica, 34(2), 137-142. https://www.airitilibrary.com/Article/Detail?DocID=00016578-199304-34-2-137-142-a
- Chien, H. Y. C., & Sung, T. C. (1999). 新生兒昇主動脈之動脈瘤：一病例報告. Acta Paediatrica Sinica, 40(2), 121-123. https://doi.org/10.7097/APS.199904.0156
- 蔡永福、高信安、張北葉（1993）。新生兒支氣管胸膜瘻管：一病例報告。Acta Paediatrica Sinica，34(3)，223-227。https://www.airitilibrary.com/Article/Detail?DocID=00016578-199306-34-3-223-227-a
- 黃崇銘、陸振翮、孟春昌（1994）。魏火曜兒科研究基金會繼續教育病例简报－幼年性風濕性關節炎合併嚴重主動脈瓣逆流及輕微僧帽瓣逆流。Acta Paediatrica Sinica，35(s_1)，49-51。https://doi.org/10.7097/APS.199404.0049