- 期刊
腺樣體切除及鼻後填塞術後併發急性肺水腫
Posterior Nasal Packing after Adenoidectomy Complicated with Acute Pulmonary Edema
摘要
腺樣體肥大造成耳咽管阻塞而產生持續性中耳積液，常見於小孩及青少年，為了減少中耳積液發生機率，腺樣體切除是常實施的手術。此手術的早期併發症常見的有術後出血、喉嚨疼痛、嘔吐、術中止血棉留置等，而急性肺水腫並不常見。本院於2002年5月經歷1名20歲男性，主訴耳朵悶漲感約2個月之久，理學檢查發現中耳積液，鼻咽鏡顯示突出肥大腫塊，疑似鼻咽癌，在門診接受3次鼻咽切片，皆為良性，因內科藥物對中耳積液治療無效，且鼻咽腫塊未排除為惡性之可能，於是建議患者入院接受鼻咽腫塊刮除手術及中耳通氣管置放術。術中因鼻咽部滲血而採取鼻後填塞，術後病人發生急性肺水腫，經氧氣及利尿劑治療，病人肺水腫現象立即改善，並於1週後出院，鼻咽腫塊病理報告為良性淋巴組織增生，門診追蹤病患情況良好。在此提出腺樣體切除術後合併鼻後填塞有導致急性肺水腫的可能。
並列摘要
Persistent otitis media with adenoid hypertrophy is a common disease among children and adolescents which can be treated with adenoidectomy. Early postoperative complications may include bleeding, sore throat, emesis, and airway blockage, but acute pulmonary edema is rarely encountered. We reported a case of this complication in a 20-year-old male who visited our hospital in May 2002 after suffering from ”ear fullness” for a two-month period. Otologic examination showed air-fluid level with bubbles in the left middle ear. Nasopharyngoscopy revealed a bizarre and protruding mass occupying the nasopharynx. These findings led to suspicion of nasopharyngeal carcinoma. Nasopharyngeal biopsy, performed three separate times, all suggested a benign pathology. Since the middle ear effusion did not respond to medical treatment, adenoidectomy accompanied by insertion of a pressure equalization tube was performed. Posterior nasal packing was employed after the operation to control persistent oozing from the nasopharynx. Following the operation, acute pulmonary edema developed and oxygen and diuretics were administered. Comparison of chest X-rays before and after treatment showed clinical improvement. He recovered completely from the pulmonary edema and was discharged one week later. The final pathology report indicated benign lymphoid hyperplasia. He was well during how many months or years follow-up.