Successful Removal of an Endobronchial Hamartoma by Bronchoscopic Electrosurgical Snare Loop-A Case Report

支氣管內過誤瘤很少見，但若未及早診斷和適當處理，常常因引起支氣管阻塞而造成不可逆之肺傷害。一般是用外科手術治療，包括硬式支氣管鏡和外科肺切除術。我們在這兒報告一中風二十年長期臥牀患者，近五年出現反覆右下肺肺炎。支氣管鏡發現右下肺支氣管出口有一支氣管內腫瘤造成完全阻塞。由於做纖維式支氣管鏡電燒灼術過程中發現此腫瘤很結實，無法以電燒灼術移除，加上數年前牙齒嗆入病史，故高度懷疑為牙齒嗆入併慢性肉芽形成，在用電燒環套住做電燒過程中不預期地拔出了此腫瘤。拔出後發現支氣管粘膜有些微破損，但因患者右下肺早已慢性萎縮無通氣功能，故無氣胸或出血之併發症。拔出之腫瘤外觀像牙齒，但X光下卻不是牙齒而是呈現”popcorn”之鈣化，病理下發現此腫瘤其實是一支氣管內過誤瘤。近年來隨著纖維式支氣管鏡術的進步，例如雷射和電燒灼術，支氣管內過誤瘤之患者有了更多的機會先接受內科治療，以避免開刀和全身麻醉之風險。雖然電燒灼術是治療支氣管內過誤瘤之一種可行的方法，但仍然要選擇性地進行。

關鍵字

電燒環；支氣管內過誤瘤；纖維式支氣管鏡術

並列摘要

Endobronchial hamartomas (EH) are rare, but they often cause irreversible lung damage due to bronchial obstruction if not diagnosed early and treated properly. They are mainly treated with surgery; including rigid bronchoscopy and surgical lung resection. We report an EH that occurred in a long-term bed-ridden patient who had had a cerebral vascular accident 20 years before, and that presented with repetitive pulmonary infection of the right lower lobe during the past 5 years. Bronchoscopy revealed a right lower lobe endobronchial tumor with total occlusion. The tumor was firm and could not be eradicated by flexible fiberoptic bronchoscopic electrocautery. Since the patient had a history of tooth loss many years before, we highly suspected that the tumor was tooth impaction-related with chronic granulation formation. During fiberoptic bronchoscopic electrocautery, we unexpectedly ”extracted” the tumor with an electrosurgical snare loop. Bronchial mucosa defect was also noted but no complications (such as pneumothorax or massive bleeding) occurred because of the right lower lung chronic atelectasis. The tumor had a tooth-like appearance; however, it showed popcorn calcification on radiography. Pathology confirmed that it was an EH. With the recent developments in fiberoptic bronchoscopy, such as laser therapy and electrocautery, patients with EH have a greater possibility of successful medical treatment initially, thus avoiding the risk of surgery and general anesthesia. Although we suggest that fiberoptic bronchoscopic electrocautery is a feasible treatment for EH, it should be performed selectively.

並列關鍵字

electrosurgical snare loop ； endobronchial hamartoma ； fiberoptic bronchoscopy

國際替代計量

Successful Removal of an Endobronchial Hamartoma by Bronchoscopic Electrosurgical Snare Loop-A Case Report

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