Author: admin
「通波仔」風險低康復快 若有這原因需考慮「搭橋」
心臟病是本港第三大致命疾病,而其中冠心病(冠狀動脈心臟病,指因冠狀動脈收窄或閉塞,造成心臟肌肉缺血,引致心臟功能受損)佔超過一半,本港每年就有超過3,000人因冠心病死亡。患病率會隨年齡而增加,不過近年患者有年輕化的趨勢。
心臟科專科醫生聶天霖表示,近年市民對冠心病的治療方法可能都有所聽聞,「例如當確診了冠心病,他們會問:係咪要通波仔?使唔使搭橋?」
聶醫生指出,「通波仔」和「搭橋手術」都是冠心病的治療方法,即除了藥物之外,利用手術去造成「再血管化」,令冠狀動脈有充足的血流供應心臟肌肉。但通波仔和搭橋的原理和做法卻大不相同。
「通波仔其實是微創的『經皮冠狀動脈介入治療』,病人經皮下注射局部麻醉藥後,醫生會於右手脈門部位(小部分人會於右邊腹股溝部位)放入導管,沿血管去到冠狀動脈的入口,繼而將手術器材放置到冠狀動脈內,擴闊已收窄的血管部分,包括利用氣囊去將收窄位置擴闊,再以藥物塗層支架鞏固血管內壁,使血管保持暢通。由於是微創手術,傷口只有2至3毫米,大大減低手術後康復的時間。」
而搭橋手術的理念則是創造血管的繞道,是大型開胸手術,「做法是先取出小腿的靜脈,再接駁到大動脈和冠狀動脈收窄位置後方,形成繞道。另一種做法是利用胸腔內的左內乳動脈,接駁到冠狀動脈後方,直接為其供血。其實兩者的理念是一樣的,都是繞過血管阻塞的位置,直接為後方的血管提供血液。由於是大型手術,手術和麻醉的風險較高,康復時間亦比較長。」聶醫生說。
那麼,幾時該通波仔,幾時該搭橋呢?
聶醫生表示,一般而言,對冠狀動脈輕微至中等收窄,會先嘗試利用藥物治療去穩定情況。但對於嚴重收窄(例如收窄70%以上),以及經過藥物治療仍持續有症狀者,醫生會安排微創手術如心臟導管檢查去確認病情,若認為需要手術治療話,首先會考慮通波仔,「不過,亦有部分比較嚴重的病人,例如多重血管收窄或主幹血管收窄等情況,需考慮搭橋手術等其他治療方法。醫生會先衡量各種手術的風險,同時亦會根據國際指引,考量到不同手術的效果和好處。當然,病人的意願亦是重要的考慮因素之一,醫生會和病人分析討論各種治療方案,從而作出最適合病人的決定。」
對於通波仔的病人,聶醫生特別提醒,「很多人以為通波仔後就完全解決問題,不需要再用藥,甚至繼續吸煙等不良嗜好,其實是錯的。首先,通波仔時放置的支架,對鞏固療效十分重要,但始終是外物,身體需要藥物再加上一段時間才能適應它,所以術後首六個月(或一年, 因應病情所需),一般會處方兩種抗血小板藥以減低血塊形成的機會,從而減少突發性支架阻塞。六個月或一年過後,仍需要長期服用阿士匹靈,減低復發的風險。另外,健康飲食、多運動、控制三高都是不可忽略的。」
他分享了以下一些印象深刻的個案:一位只有十八歳的青年,因嚴重血管收窄引致心臟病發,心臟功能只剩下正常人的一半。由於心臟肌肉壞死之後不會復原,這位青年只能以剩下的「半顆心」去繼續漫長的人生。另外有一位婆婆,一向都關注健康,從無不良嗜好,但由於丈夫長期吸煙,經歷三十年的二手煙生涯後,亦患上嚴重冠心病,最後撒手人寰。丈夫當時追悔莫及,但可惜已經太遲了。
「所以提醒大家,注意健康,留心身體的病徵,最重要是病向淺中醫。」聶醫生說。
原文網址: 「通波仔」風險低康復快 若有這原因需考慮「搭橋」 | 香港01
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