Vaidyanathan Subramanian, Soni Bakul M, Hughes Peter L, Singh Gurpreet, Watt John W H, Oo Tun, Sett Pradipkumar
Regional Spinal Injuries Centre, District General Hospital, Southport, PR8 6PN, UK.
BMC Urol. 2002 Sep 10;2:9. doi: 10.1186/1471-2490-2-9.
We present a case to illustrate controversies in percutaneous drainage of infected, perinephric haematoma in a tetraplegic patient, who had implantation of baclofen pump in anterior abdominal wall on the same side as perinephric haematoma.
A 56-year-old male with C-4 tetraplegia had undergone implantation of programmable pump in the anterior abdominal wall for intrathecal infusion of baclofen to control spasticity. He developed perinephric haematoma while he was taking warfarin as prophylactic for deep vein thrombosis. Perinephric haematoma became infected with a resistant strain of Pseudomonas aeruginosa, and required percutaneous drainage. Positioning this patient on his abdomen without anaesthesia, for insertion of a catheter from behind, was not a realistic option. Administration of general anaesthesia in this patient in the radiology department would have been hazardous.
Percutaneous drainage was carried out by anterior approach under propofol sedation. The site of entry of percutaneous catheter was close to cephalic end of baclofen pump. By carrying out drainage from anterior approach, and by keeping this catheter for ten weeks, we took a risk of causing infection of the baclofen pump site, and baclofen pump with a resistant strain of Pseudomonas aeruginosa. The alternative method would have been to anaesthetise the patient and position him prone for percutaneous drainage of perinephric collection from behind. This would have ensured that the drainage track was far away from the baclofen pump with minimal risk of infection of baclofen pump, but at the cost of incurring respiratory complications in a tetraplegic subject.
我们报告一例病例，以说明在一名四肢瘫痪患者中经皮引流感染性肾周血肿时的争议情况，该患者在肾周血肿同侧的前腹壁植入了巴氯芬泵。
一名56岁的男性，患有C-4级四肢瘫痪，曾在前腹壁植入可编程泵，用于鞘内注射巴氯芬以控制痉挛。他在服用华法林预防深静脉血栓形成时发生了肾周血肿。肾周血肿被耐甲氧西林铜绿假单胞菌感染，需要进行经皮引流。在不进行麻醉的情况下让该患者俯卧，从后方插入导管，这是不现实的选择。在放射科对该患者实施全身麻醉会有风险。
在丙泊酚镇静下通过前路进行经皮引流。经皮导管的进入部位靠近巴氯芬泵的头端。通过前路进行引流，并将该导管留置十周，我们冒着导致巴氯芬泵部位感染以及巴氯芬泵被耐甲氧西林铜绿假单胞菌感染的风险。另一种方法是对患者进行麻醉并使其俯卧，以便从后方经皮引流肾周积液。这将确保引流路径远离巴氯芬泵，使巴氯芬泵感染的风险降至最低，但代价是四肢瘫痪患者会出现呼吸并发症。
