魚刺哽刺的診斷及處置

Diagnosis and Mangement of Fishbone Ingestion

魚刺哽刺是耳鼻喉科急診常見的問題，但過去相關的研究並不多，本研究的目的有二：調查魚刺哽刺的症狀及處置的情況，並比較有發現魚刺者與未發現魚刺者的症狀是否不同。本研究是以某醫院急診病患為樣本進行電話訪視的回溯性研究。研究樣本共291人，回覆率為71.1% ，共有207人進入分析。結果發現在六小時之內就醫者發現魚刺的比率較高（OR=2.52）；臨床症狀多在三日內緩解（87.92%），有發現魚刺者的症狀多在就醫拔除後立即緩解（76.17%）；臨床症狀用來判斷魚刺是否存在的敏感度不高；頸部X光檢查的使用率高（69.1%），但敏感度並不高（0.47）。本研究建議：就醫時間可以做為診斷魚刺是否存在的參考依據；檢查魚刺哽刺方式應以間接喉鏡為主，頸部X光攝影不宜作為常規檢查。

Fishbone ingestion is a common problem in emergency service but is seldom studied. In this study we examined the symptom and the management of fishbone ingestion and compared these between fishbone present group and fishbone absent group. The study was a hospital-based retrospective study on 207(71.1% 0f 291) subjects who visited the ER of NTUH with the chief complaint of fishbone ingestion. Questionnaire was conducted through telephone interview. We found that fishbone was more frequently present if the patient visited hospital within 6 hours after the injury (OR=2.52). The symptoms usually relieved within 3 days (87.92%) and relieved soon if the fishbone was removed (76.17%). No specific clinical symptom was associated with the diagnosis of the presence of fishbone. The utilization rate of neck X ray examination was high (69.1%) but the sensitivity was low (0.47). We conclude that the interval of visiting hospital could be applied to diagnose whether the fishbone was present and laryngoscopy rather than neck X ray should be extensively used to examine the patient.