- 期刊
Spontaneous Closure of Tracheal Fistula caused by Descending Necrotizing Mediastinitis in a Diabetic Patient-A Case Report and Review of the Literature
下行性壞死縱膈腔炎引發氣管瘻管之自發性癒合
摘要
氣管瘻管是下行性壞死縱膈腔炎的一個少見且嚴重的併發症，外科修補是氣管癢管的主要處理方式。我們報告的病例是一個68歲女性因慢性氣喘及反覆呼吸衰竭而接受氣管內插管和呼吸器支持後出現深部頸部感染及下行性壞死縱膈腔炎，在抗生素及外科清瘡治療深部頸部感染及縱膈腔炎療程中，大量濃液出現在氣管插管，緊急軟式支氣管鏡檢查發現在氣管中段後方一個氣管瘻管，由於高度手術風險及家屬不同意手術，因此嘗試保守治療，在29天後，氣管鏡追蹤發現氣管癢管已自然癒合。病人因慢性氣喘、心臟衰竭及肌肉無力。因深部頸部感染併發縱膈腔炎而出現氣管瘻管自然癒合在文獻回顧上是罕見的。我們報告這個治療成功的案例，並且回顧的相關文獻。
並列摘要
We report our experience of the treatment of a 68-year-old female with a tracheal fistula which was associated with deep neck infection and descending necrotizing mediastintis. She received long-term care with endotracheal intubation and mechanical ventilator support after cervicomyotomy and transcervical mediastinal drainage. The fistula was healed. Thus, long- term controlled ventilation and mediastinal drainage were beneficial for the treatment of central airway injury.
延伸閱讀
- Chang, B. S., & Chen, C. L. (1994). 下行壞死性縱膈腔炎－病例報告. Journal of Medical Sciences, 14(5), 353-356. https://www.airitilibrary.com/Article/Detail?DocID=10114564-199404-201307010007-201307010007-353-356
- Wong, H. Y., Chen, C. H., Liu, Y. H., Hsia, T. C., Shih, C. M., Hsu, W. H., & Tu, C. Y. (2009). 使用呼吸器的食道癌病人接受食道切除所發生氣管撕裂後短期運用金屬支架使撕裂處成功癒合. 胸腔醫學, 24(4), 218-222. https://doi.org/10.29806/TM.200908.0006
- Huang, C. Y., Tsai, K. C., & Chen, H. W. (2017). 採取非手術方式成功治療食道破裂及縱膈腔發炎－病例報告. 北市醫學雜誌, 14(1), 85-90. https://doi.org/10.6200/TCMJ.2017.14.1.08
- Kao, M. C., Yu, Y. S., Liu, H. T., Tsai, S. K., Lin, S. M., & Huang, Y. C. (2005). 氣管內管袖口疝氣之形成導致氣管造口手術時發生氣道阻塞的意外. Acta Anaesthesiologica Taiwanica, 43(1), 59-62. https://www.airitilibrary.com/Article/Detail?DocID=02541319-200503-43-1-59-62-a
- Chao, B. L., Cheng, L. C., Tung, J. C., Huang, P. T., & Kuo, C. L. (1988). 經內視鏡注射硬化劑治療後幷發延遲性食道穿孔及椎骨旁膿瘍. 中華民國消化系醫學會雜誌, 5(3), 170-174. https://doi.org/10.6557/GJTa.198809_5(3).0007