• 第21卷第1期

Cerebrospinal Fluid Hygroma Following Implantation of an Intrathecal Pump System: A Case Report of Successful Therapy with Epidural Blood Patch


台灣疼痛醫學雜誌第21卷第1期(2011-03-01)
 楊勝淳(Sheng-Chun Yang);施宗孝(Tsung-Hsiao Shih);林中仁(Chung-Ren Lin)
摘要
A 45-year-old man had a case of Buerger's disease with intractable digital ischemia pain, and conventional multimodal analgesic therapy was unsuccessful. After intrathecal morphine pumps were implanted, the patient had excellent pain relief without significant side effects. However, a large subcutaneous hygroma of cerebrospinal fluid (CSF) developed around the pump and was not improved after bed resting with compressive dressing put around the waist. We performed epidural blood patch for occlusion of spinal leakage in the presence of an intrathecal catheter. The CSF hygroma ceased after the epidural blood patch. In conclusion, epidural blood patch was a successful therapy of lumbar cerebrospinal fluid fistula after intrathecal morphine pump.
並列摘要
前言:對於多種傳統疼痛治療無效的病人,無法忍受的慢性疼痛使我們尋找更積極的療法,脊髓內嗎啡幫浦是個不錯的選擇。雖然脊髓內嗎啡幫浦已經例行久遠,但還是有一些併發症,像是腦脊髓液囊腫。我們報告一個成功治療腦脊髓液囊腫的病例報告。病例報告:一位45歲男姓患有布爾格氏症,經過雙腳與兩手手指多處截肢後,劇烈難忍的肢端痛還是無法在傳統疼痛治療下緩解,故我們執行脊髓內嗎啡幫浦置放。由腰椎第四五節置放導管,在病人的右下腹部埋設幫浦。但在裝置後第三天發現在導管與幫浦周圍有腦脊體夜囊腫產生,我們嘗試用抽吸合併束腹帶的方式,但還是會復發。故我們想到使用硬脊膜外血液注射的方式來治療,從腰椎第一二節近針,在硬脊膜外將往尾部打入15毫升的自體血液,在一個星期後囊腫自行吸收,目前為止半年後都不再復發。討論:硬脊膜外血液注射是在麻醉科中常用來治療硬脊膜穿刺後頭痛的老方法,有著高安全陸與高成功率,只有極少的副作用。在之前研究中,硬脊膜外血液注射的量大約15毫升便可以使所注射的血液填充滿9個脊柱高度的硬脊膜外層。因為擔心意外傷害到在之前所放置的導管(導管大約於腰椎第2-3節才進入脊體腔),故我們選擇從腰椎第一節來做硬脊膜外血液注射避免傷害導管,而腰椎第一節距離之前放置導管傷口較遠,亦可避免硬脊膜外注射後意外感染後而沿著導管造成中樞神經感染。總結來說,硬脊膜外血液注射不只可以治療硬脊膜穿刺後頭痛,還可以用來消除幫浦周圍腦脊髓液囊腫。我們提供了一種方法即使在有導管的情況下,治療置放脊髓內嗎啡幫浦所造成的腦脊體液囊腫,而且沒有產生併發症。

 

回頂端