腸胃道腐蝕性傷害－機轉及處置

The Mechanism and Treatment of Corrosive Injury in Gastrointestinal Tract

郭芝君(Chih-Chun Kuo) ； 許紘瑞(Hung-jui Hsu) ； 吳坤霖(Kun-Lin Wu) ； 蕭家仁(Chia-Jen Hsiao)

《內科學誌》 29卷1期 (2018/02) Pp. 15-27

https://doi.org/10.6314/JIMT.201802_29(1).03

摘要

腐蝕性傷害以強酸及強鹼最常見，不同物質的作用機轉不同，濃度、份量、型態及黏膜接觸時間不同，傷害的程度也不同。急性期的傷害包括呼吸道水腫及穿孔，慢性期有食道狹窄及腫瘤的風險。一般上消化道內視鏡被當作主要的診斷工具，近年來，電腦斷層及內視鏡超音波對於緊急手術評估的重要性也逐漸上升。但這些個案的疾病嚴重度及死亡率，即便在適當的治療後仍高，且長期的身體功能也較差。在預防狹窄上，以內科或內視鏡治療仍存在爭議，但使用食道支架置放具有明確預防狹窄的效果，而費用及需累積更多經驗是目前待改善的癥結。擴張是治療食道狹窄的第一選擇，但對長的、多處及彎曲的窄縮可能需要擴張探條進行多次擴張以提高成效。維持食道管腔的暢通或建立其它良好腸道營養管道以促進良好的營養狀態，是改善預後的重要關鍵。在各種重建手術中，利用大腸作食道重建可以達到較好的效果。急性傷害後，後續仍需要定期內視鏡追蹤以評估狹窄復發或惡性腫瘤的可能性。當然，降低腐蝕性傷害最好的方法就是透過教育及法令規範來避免發生。

關鍵字

腐蝕性攝入(Corrosive or caustic ingestion) ； 腐蝕性傷害(Corrosive or caustic injury) ； 腐蝕性狹窄(Corrosive stricture) ； 酸(Acids) ； 鹼(Alkalies) ； 內視鏡擴張術(Endoscopic dilatation)

並列摘要

For corrosive injuries of gastrointestinal tract, use of strong acid or alkaline is the leading cause. The injuries are not only of gastrointestinal tract but also of other systems with variant severity and medical cost. Severity of injury is variant according to different mechanism of substance, concentration, amount, physical form and duration of contact with the mucosa. Acute phase of corrosive injuries include swelling of respiratory tract and perforation; long term complications have the risk of esophageal stricture and cancer. Upper gastrointestinal endoscopy is considered the cornerstone for diagnosis. Recently, the importance of computed tomography and endoscopic ultrasound increased, especially for the detailed evaluation about emergent surgery. Stricture of esophagus or stomach is the major late complication. Dilatation is the first choice for esophageal stricture and bougies should be considered for long, multiple and tortuous narrowing. Keeping the lumen patent can improve the nutritional status and build the foundation for late reconstruction. Using colon for esophageal replacement offers advantageous efficacy. Further endoscopic screening for the risk of stricture/cancer of esophagus or stomach is recommended. Actually, the best way to reduce corrosive injury is to prevent it by education and law.