口腔癌術後併發肺栓塞－病例報告

Pulmonary Embolism after Oral Cancer Surgery-A Case Report

劉恩碩(En-Shuo Liu) ； 王峙仁(Chih-Jen Wang) ； 林哲毅(Che-Yi Lin)

《臺灣口腔顎面外科學會雜誌》 30卷1期 (2019/03) Pp. 7-15

摘要

肺栓塞是一個難診斷且處理之疾病併有高死亡率。癌症外科手術中之併發症發生率並不高。本案例爲一口腔癌病患接受廣泛性切除、雙側頸部淋巴廓清術及游離皮瓣修補手術，術後九天發現呼吸淺快，血氧飽和度下降，動脈血液氣體分析呈現低氧血、血液檢查D-dimer偏高，心臟超音波發現左心室功能正常、右心室擴張、肺動脈高壓及三尖瓣嚴重回流，胸部電腦斷層攝影檢查顯示雙側肺動脈栓塞。後續利用體外循環系統，手術取出肺動脈血栓。本文藉由一個口腔癌術後發生肺栓塞的罕見案例，討論其診斷，治療及預防。

關鍵字

肺栓塞 ； 口腔癌

並列摘要

Pulmonary embolism is a disease difficult to diagnosis and management with high mortality. Incidence rate was low in complications of cancer surgery. We reported a patient with oral cancer who underwent wide excision, bilateral selective neck dissection and free flap reconstruction. Nine days after surgery, we found rapid shallow breathing, low SpO_2 of the patient. Arterial blood gas analysis showed hypoxemia. Blood tests showed a D-dimer level higher than normal. Echocardiography revealed normal left ventricular function, right ventricular dilatation, pulmonary hypertension and severe tricuspid reflux. Chest computed tomography showed bilateral pulmonary embolisms. The bilateral pulmonary emboli were surgically removed under the use of cardiopulmonary bypass. The aim of this article was by this case we can know the diagnosis, treatment and prevention of pulmonary embolism after head and neck surgery.

並列關鍵字

Pulmonary embolism ； Oral cancer