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一例诊断为下咽癌的酒精性震颤谵妄病例报告:精神科医生在顺利诊断和治疗中发挥了重要作用。

A case report of an alcoholic with delirium tremens diagnosed with hypopharyngeal cancer: Psychiatrists played important roles in the smooth diagnosis and treatments.

作者信息

Ishida Tetsuro, Murayama Tomonori, Kobayashi Seiju

机构信息

Department of Psychiatry Japan Health Care College Sapporo Japan.

Department of Psychiatry Asahikawa Keisenkai Hospital Asahikawa Japan.

出版信息

PCN Rep. 2022 Nov 9;1(4):e54. doi: 10.1002/pcn5.54. eCollection 2022 Dec.

Abstract

BACKGROUND

Alcohol use increases the risk of developing several types of cancer. Of these, hypopharyngeal cancer has one of the worst prognoses. Moreover, treating an alcoholic patient with hypopharyngeal cancer is often difficult. There are various treatments for hypopharyngeal cancer, including surgery, chemotherapy, and radiotherapy, depending on the state of the cancer and the patient's quality of life. Patients need physical, psychological, and social support in decision-making and post-treatment follow-up. This is especially true for alcoholic patients.

CASE PRESENTATION

A 59-year-old man was admitted to our hospital with complaints of fatigue, loss of appetite, and tremor of the upper limbs. He was single, alcoholic, and had no family. After treatment for delirium tremens, he complained of throat pain. After endoscopy, magnetic resonance imaging, and examination with 18F-fluorodeoxyglucose positron emission tomography/computed tomography, he was diagnosed with Stage 4 A (T2 N2c M0) hypopharyngeal cancer. The psychiatrist and otolaryngologist discussed the patient's decision-making capacity and the various risks associated with treatment. Shared decision-making with the patient was considered most important in determining the treatment strategy. As a result, the patient decided to receive endoscopic laryngopharyngeal surgery in combination with lymphadenectomy, a challenging surgical treatment. The operation was successful, and the patient is now ready for a new life after discharge.

CONCLUSION

Psychiatrists have a significant role to play in the oncological treatment of patients with alcoholism and other psychiatric disorders.

摘要

背景

饮酒会增加患多种癌症的风险。其中,下咽癌的预后最差。此外,治疗患有下咽癌的酗酒患者往往很困难。根据癌症状况和患者生活质量,下咽癌有多种治疗方法,包括手术、化疗和放疗。患者在决策和治疗后随访中需要身体、心理和社会支持。酗酒患者尤其如此。

病例介绍

一名59岁男性因疲劳、食欲不振和上肢震颤入院。他单身、酗酒且无家人。在治疗震颤谵妄后,他抱怨喉咙疼痛。经过内镜检查、磁共振成像以及18F-氟脱氧葡萄糖正电子发射断层扫描/计算机断层扫描检查后,他被诊断为4 A期(T2 N2c M0)下咽癌。精神科医生和耳鼻喉科医生讨论了患者的决策能力以及与治疗相关的各种风险。在确定治疗策略时,与患者共同决策被认为最为重要。结果,患者决定接受内镜下咽喉手术联合淋巴结清扫术,这是一种具有挑战性的手术治疗。手术成功,患者现已准备好出院后迎接新生活。

结论

精神科医生在酗酒和其他精神障碍患者的肿瘤治疗中可发挥重要作用。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/bb20/11114356/bb5467c0d9a0/PCN5-1-e54-g001.jpg

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