口腔癌術後併發自由皮瓣靜脈血栓與肺水腫－病例報告

自由皮瓣移植在頭頸部癌症重建已是一個使用多年且可靠的手術方式，成功率可高達九成以上。這樣高的成功率可歸功於顯微鏡放大技術、縫合材料、手術器械的進步與越來越多顯微手術的經驗。但是，儘管由最有經驗的顯微手術醫師執行，仍有少部份皮瓣會發生血供障礙而需緊急手術搶救，畢竟技術並不是防止血供障礙唯一的因素。因此爲減少不期望的事件發生，顯微手術醫師應熟悉如何搶救發生血供障礙的皮瓣。內頸靜脈作爲一個自由皮瓣的受區靜脈有許多的好處，以他作爲接合靜脈有很高的成功率。然而，仍有很少的案例因爲內頸靜脈栓塞造成皮瓣血供障礙。儘管它發生機率很低，處理原則與其他靜脈栓塞一樣－嚴密的監測皮瓣活性與即時的搶救手術。肺水腫是一個可能的術後併發症，當術後發生時，最可能原因就是體液負荷過大。在術中或術後有許多原因需要灌入大量體液：如外傷手術與長時間的手術麻醉，爲維持病人血液動力；水分堆積於第三空間；大量水分流失；或術後發燒而增加無感流失等。其他會發展成術後肺水腫的病人爲非心因性肺水腫，原因可能爲低血納腦病變、頭部外傷、嗜鉻性細胞爲等。另外成人呼吸窘迫症爲另一考慮因素。本文籍由一個術後發生自由皮瓣血供障礙與併發肺水腫的案例，討論皮瓣搶救技術與發生肺水腫的原因。

關鍵字

自由皮瓣；內頸靜脈栓塞；肺水腫

並列摘要

Microvascular free-flap transfer is a dependable surgical choice for head and neck reconstructions. The success rate of free-flap transfers has reached more than 90%, which can be attributed to the advancements of microscopic magnification, suture materials, surgical instruments, and also more experience in microvascular surgery. However, even to the most experienced surgeons, sometimes there is a minority of compromised free flaps in need of emergent salvage surgery. In order to reduce any kind of undesired events, close monitoring and prompt salvage treatment of all free flaps are crucial. Moreover, every microvascular surgeon should be well trained in performing the salvage techniques. Acute respiratory failure is a possible postoperative complication of a major surgery Postoperative pulmonary edema is a common reason, especially with administration of a large amount of intravenous fluid. There are many reasons for the intake of a large amounts of fluid which include: maintaining a patient's hemodynamics during major surgery, and compensating third space loss, insensible loss, and blood loss. Other differential considerations for acute respiratory failure are pneumonia, pulmonary embolism, renal or heart failure, and even adult respiratory distress syndrome. In order to introduce several salvage techniques and differential diagnoses of pulmonary edema, we present a case of postoperative compromised free flap with pulmonary edema complications.

並列關鍵字

free flap transfer ； internal jugular vein thrombosis ； pulmonary edema

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口腔癌術後併發自由皮瓣靜脈血栓與肺水腫－病例報告

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