肝癌病患產生肺動脈腫瘤栓塞合併急性呼吸窘迫

前言：造成癌症病患急性呼吸衰竭的原因很多，肺動脈腫瘤栓塞是其中較為罕見原因之一。本研究主要目的乃探討肝癌病患合併嚴重肺動脈栓塞時常見的臨床表徵及診治模式。材料及方法：採回溯性研究方法，蒐集1994年1月1日至2003年12月31日北部某醫學中心之肝癌合併肺動脈栓塞之個案並分析所有病患於急診就診之資料，包括臨床特徵、症狀、診斷方法、治療及其預後。結果：於研究期間共收集有四位肝癌合併肺栓塞病患，診斷肺動脈腫瘤栓塞的方法包括電腦斷層血管攝影，核子醫學掃描，或心臟超音波等，四位病患的影像檢查均顯示有腫瘤侵犯下腔靜脈並合併有下腔靜脈栓塞或右心室栓塞。其中有兩位病患因為意識不清及呼吸衰竭被送至急診；另兩位病患則有呼吸困難及發紺而就診。4位病患均為B型肝炎帶原者、心電圖均有典型的右心室損傷、及低血氧。有2位病患接受heparin治療2天，但因有腸胃道出血而停藥，其中1位隨後有接受化學療法及放射線治療而存活7個月，其餘3位病患均於1個月內死亡。結論：肝癌病患發生呼吸困難或衰竭、休克、或意識不清時，除了常見的肝癌併發症外，急診醫師應將肺栓塞列入鑑別診斷，特別是當影像學檢查發現有肝腫瘤侵犯下腔靜脈或右心室時，以便早期治療。

關鍵字

肺動脈腫瘤栓塞；肝癌；下腔靜脈栓塞

並列摘要

Background: Acute respiratory distress in cancer patients was rare attributed to pulmonary tumor embolism. The purpose of this study was to investigate the clinical presentations and managements in hepatoma patients complicated with pulmonary embolism in the emergency department (ED). Materials and Methods: A retrospective chart review was conducted from Jan. 1, 1994 to Dec. 31, 2003 in a medical center in northern Taiwan. We collected and analyzed the clinical presentations, diagnostic modalities, treatment programs and prognosis in all hepatoma patients with pulmonary embolism in the ED. Results: During study period, a total of 4 patients were recruited. The diagnosis of pulmonary tumor embolism was based on image studies, including computed tomographic angiography, nuclear ventilation-perfusion scan, or echocardiography, that demonstrated tumor invasion into inferior vena cava (IVC) with thrombus formation in IVC or right ventricle (RV). Among whom 2 patients were in acute respiratory failure and comatose status, and the other 2 patients were in respiratory distress and cyanotic status on ED visits. All 4 patients were hepatitis B carrier and have electrocardiography of right ventricular strain and hypoxia. Two patients received low-molecular weight or unfractionated heparin therapy but quit 2 days later due to gastro-enterol bleeding. One patient received chemotherapy and radiotherapy and survive for 7 months. The other 3 patients were dead within 1 month. Conclusions: Hepatoma patients presenting with acute respiratory failure or distress, shock, or comatose status during ED visits, emergency physician should take the pulmonary embolism into consideration in addition to hepatoma related complications. An early diagnosis can be made, especially when image studies demonstrated hepatoma with IVC or RV invasion, to initiate therapeutic modalities.

並列關鍵字

pulmonary tumor embolism ； hepatoma ； inferior vena cava thrombosis

國際替代計量

肝癌病患產生肺動脈腫瘤栓塞合併急性呼吸窘迫

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