重點式超音波導引針刺抽氣術用於氣腹之輔助治療

Point-of-Ultrasound-Guided Needle Aspiration as an Adjunctive Therapy for Pneumoperitoneum

末期癌症病人常面臨多重併發症，其中，胃腸道穿孔導致的氣腹（pneumoperitoneum），可能引起顯著腹脹與呼吸困難，進一步影響生活品質。對於選擇保守治療與安寧緩和醫療的病人，如何有效且低侵入性地緩解症狀，是一項臨床挑戰。針刺抽氣術（needle aspiration）可作為氣腹導致呼吸困難的輔助治療手段，而重點式超音波（Point-of-Care Ultrasound, POCUS），則能提供即時影像引導，提高操作的準確性與安全性。一位84歲末期肺癌併腦轉移個案，因腹痛3天至急診就醫，電腦斷層顯示廣泛性氣腹（extensive pneumoperitoneum）與腸道擴張（diffuse ileus），診斷為胃腸道穿孔。病人及家屬選擇安寧緩和醫療，惟病人因腹脹導致嚴重呼吸困難，經重點式超音波確認腹腔內大量氣體後，進行針刺抽氣術。操作時使用超音波引導定位，於腹腔內抽取約2000cc氣體，並記錄術後症狀變化。術後病人呼吸困難顯著改善，主觀感受舒適度提高，無立即性併發症發生。重點式超音波成功輔助針刺抽氣術的進行，提高了操作的安全性與準確性，減少不必要的侵入性處置。針刺抽氣術可作為末期癌症病人合併氣腹導致呼吸困難的緩解手段，並能在安寧緩和醫療中發揮重要作用。重點式超音波提供即時影像引導，能提升操作的精準度與安全性，減少不必要的侵襲性治療。

Patients with terminal cancer often experience multiple complications, among which pneumoperitoneum resulting from gastrointestinal perforation can lead to significant abdominal distension and dyspnea, further impairing quality of life. In patients opting for conservative and palliative care, effectively and minimally invasively relieving symptoms remains a clinical challenge. Needle aspiration may serve as an adjunctive treatment for dyspnea caused by pneumoperitoneum, while point-of-care ultrasound (PoCUS) offers real-time imaging guidance that enhances procedural accuracy and safety. An 84-year-old male with terminal lung cancer and brain metastases presented to the emergency department with a three-day history of abdominal pain. Computed tomography revealed extensive pneumoperitoneum and diffuse ileus, indicative of gastrointestinal perforation. The patient and family opted for palliative care. However, the patient experienced severe dyspnea due to abdominal distension. Bedside PoCUS confirmed the presence of a large volume of intra-abdominal free air. Ultrasound-guided needle aspiration was performed, evacuating approximately 2000 cc of gas from the peritoneal cavity. Post-procedure, the patient’s dyspnea significantly improved, and subjective comfort increased, with no immediate complications observed. PoCUS facilitated accurate and safe needle placement, reducing the need for more invasive interventions. Needle aspiration may be considered a symptom-relieving option for dyspnea caused by pneumoperitoneum in terminal cancer patients and can play an important role in palliative care. PoCUS provides real-time imaging guidance, enhancing the precision and safety of the procedure while minimizing unnecessary invasive treatments.