鞘内意外注射长春新碱导致的致命性脑脊髓病：两例报告
Fatal myeloencephalopathy due to accidental intrathecal vincristin administration: a report of two cases.
作者信息
Dettmeyer R, Driever F, Becker A, Wiestler O D, Madea B
机构信息
Department of Forensic Medicine, University of Bonn, Bonn, Germany.
出版信息
Forensic Sci Int. 2001 Oct 15;122(1):60-4. doi: 10.1016/s0379-0738(01)00394-2.
We report on two fatal cases of accidental intrathecal vincristine instillation in a 5-year old girl with recurrent acute lymphoblastic leucemia and a 57-year old man with lymphoblastic lymphoma. The girl died seven days, the man four weeks after intrathecal injection of vincristine. Clinically, the onset was characterized by the signs of opistothonus, sensory and motor dysfunction and ascending paralysis. Histological and immunohistochemical investigations (HE-LFB, CD-68, Neurofilament) revealed degeneration of myelin and axons as well as pseudocystic transformation in areas exposed to vincristine, accompanied by secondary changes with numerous prominent macrophages. The clinical course and histopathological results of the two cases are presented. A review of all reported cases in the literature is given. A better controlled regimen for administering vincristine and intrathecal chemotherapy is recommended.
我们报告了两例鞘内误注长春新碱的致死病例，一例是一名5岁复发性急性淋巴细胞白血病女童，另一例是一名57岁的淋巴细胞性淋巴瘤男性。女童在鞘内注射长春新碱7天后死亡，男性在注射4周后死亡。临床上，发病表现为角弓反张、感觉和运动功能障碍以及上行性麻痹。组织学和免疫组织化学检查（苏木精-伊红-丽春红染色、CD-68、神经丝）显示，暴露于长春新碱的区域出现髓鞘和轴突变性以及假囊肿形成，并伴有大量显著巨噬细胞的继发性改变。本文介绍了这两例病例的临床过程和组织病理学结果，并对文献中所有报道的病例进行了综述。建议采用更严格控制的长春新碱给药方案和鞘内化疗方案。
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