Tariq Kanza, Das Joe M, Monaghan Sasha, Miserocchi Anna, McEvoy Andrew
National Hospital for Neurology and Neurosurgery, Queen's Square, London, UK.
National Hospital for Neurology and Neurosurgery, Queen's Square, London, UK.
Int J Surg Case Rep. 2021 Jan;78:219-222. doi: 10.1016/j.ijscr.2020.12.023. Epub 2020 Dec 16.
Intractable hiccups frequently result from an underlying pathology and can cause considerable illness in the patients. Initial remedies such as drinking cold water, induction of emesis, carotid sinus massage or Valsalva manoeuvre all seem to work by over stimulating the Vagus nerve. Pharmacotherapy with baclofen, gabapentin and other centrally and peripherally acting agents such as chlorpromazine and metoclopramide are reserved as second line treatment. Medical refractory cases even indulge in unconventional therapies such as hypnosis, massages and acupuncture. Surgical intervention, although undertaken very rarely, predominantly revolves around phrenic nerve crushing, blockade or pacing. A novel surgical strategy is emerging in the form of Vagus nerve stimulator (VNS) placement with three cases cited in literature to date with varying degrees of success. Here the authors report a case of VNS placement for intractable hiccups with partial success, in accordance with SCARE-2018 guidelines.
An 85-year-old gentleman with a 9-year history of intractable hiccups secondary to pneumonia came to our hospital. The hiccups were symptomatic causing anorexia, insomnia, irritability, depression, exhaustion, muscle wasting and weight loss. The patient underwent countless medical evaluations. All examinations and investigations yielded normal results. The patient underwent aggressive pharmacotherapy, home remedies and unconventional therapies for intractable hiccups but to no avail. He also underwent left phrenic nerve blocking and resection without therapeutic success. The patient presented to our hospital and decision for VNS insertion was taken for compassionate reasons considering patient morbidity. The patient demonstrated significant improvement in his symptoms following VNS insertion.
A temporary hiccup is an occasional happening experienced by everyone. However, intractable hiccups are associated with significant morbidity and often mortality. Several medical, pharmacological, surgical and novel treatment options are available for intractable hiccups.
VNS insertion is a novel surgical option for the treatment of intractable hiccups.
顽固性呃逆常由潜在病理状况引起，可给患者带来相当大的痛苦。诸如饮用冷水、催吐、颈动脉窦按摩或瓦尔萨尔瓦动作等初始疗法，似乎都是通过过度刺激迷走神经起作用。使用巴氯芬、加巴喷丁以及其他中枢和外周作用药物如氯丙嗪和甲氧氯普胺进行药物治疗，作为二线治疗手段。药物治疗无效的病例甚至采用诸如催眠、按摩和针灸等非常规疗法。手术干预虽然很少进行，但主要围绕膈神经挤压、阻滞或起搏展开。一种新的手术策略正以植入迷走神经刺激器（VNS）的形式出现，迄今为止文献中报道了3例，取得了不同程度的成功。在此，作者依据SCARE - 2018指南报告1例植入VNS治疗顽固性呃逆且部分成功的病例。
一位85岁男性，有9年因肺炎继发顽固性呃逆的病史，前来我院就诊。呃逆引发了诸如食欲不振、失眠、易怒、抑郁、疲惫、肌肉萎缩和体重减轻等症状。患者接受了无数次医学评估。所有检查和检验结果均正常。患者针对顽固性呃逆接受了积极的药物治疗、家庭疗法和非常规疗法，但均无效。他还接受了左侧膈神经阻滞和切除术，但治疗未成功。患者前来我院就诊，出于对患者发病率的考虑，出于同情决定为其植入VNS。植入VNS后，患者症状有显著改善。
偶尔打嗝是每个人都会经历的事情。然而，顽固性呃逆与显著的发病率相关，且常常导致死亡。对于顽固性呃逆，有多种医学、药物、手术和新的治疗选择。
植入VNS是治疗顽固性呃逆的一种新的手术选择。
