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男子被4厘米长鱼刺戳破食道 扎进心脏险丧命

2017-08-10 20:06:26   中国青年网

8 月 9 日深夜,来自上海的李大叔(化名)在东南大学附属中大医院经历了一场 4 个小时惊心动魄的手术,中大医院胸心外科、消化内科、手术麻醉科、重症医学科、医学影像科、输血科等多科联合,从李大叔的心脏中取出了一根两头无比尖锐长达 4 厘米的鱼刺,正是这个"不速之客"刺进心脏,差点要了李大叔的命。目前,该患者术后经重症医学科密切监护后,病情基本稳定,现已转入胸心外科普通病房,接受进一步观察治疗。

波折:因一根鱼刺两次转院

几天前,50 岁的李大叔突然发热,高烧 39 度不退,他急忙到当地医院就诊。经过一系列检查,一直不能确定病因。直到医生询问,李大叔才回想起五天前,跟家里人一起吃饭时吃了条鳊鱼,吃完后胸部有隐隐约约的刺痛感,但是疼痛感不很强烈,也就没有引起注意,仍跟往常般正常进食。

医生高度怀疑是鱼刺在体内引发感染而致使高烧,果然在 CT 检查中发现了鱼刺的踪影,只见鱼刺已刺穿食道。鉴于情况危急,建议李大叔到上海大医院接受治疗。转院后,医院考虑手术取出鱼刺风险大,建议采取保守治疗。然而李大叔高烧一直不退,一家人又陷入了迷茫。经人介绍,8 月 8 日晚上,李大叔连夜转入中大医院接受治疗。

漂流记:鱼刺刺破食管刺入心脏

李大叔这根鱼刺在他体内"周游"了大半圈,"从患者前后的三次 CT 检查发现,鱼刺一直在跑,被误食后最开始刺破食管,继而又刺破左心房,最后掉进了左心室。"接诊李大叔的胸心外科周建明主治医师介绍说。

随着鱼刺的"游走",李大叔的病情逐渐加重。如果鱼刺继续移位,可能会跑到血管里造成栓塞。若不慎再次移动,刺破大动脉,则面临大出血会有生命危险。而刺破心脏瓣膜,造成反流,则又会增加手术难度。

这鱼刺是取还是不取呢?若通过手术取出鱼刺,而目前李大叔有严重感染,手术面临巨大风险。可不取出鱼刺,感染会越来越严重。医生和家属都陷入了两难的抉择中 ……

手术:冲破重重风险 勇取 4 厘米鱼刺

"其实在感染状态下手术有很大的风险,但是,我们别无选择,病人不能再等下去了。"中大医院胸心外科主任薛涛说道。经过缜密检查,多学科会诊讨论反复评估感染情况,及与患者家属充分沟通后,薛涛主任带领手术团队王玉华副主任医师、周建明主治医师、陆启同主治医师、靖胜杰住院医师等决定冲破风险为患者实施手术。

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