Tunali Yusuf, Kaya Guner, Tunali Gulden, Solakoglu Seyhun, Yenice Sedef, Bahar Mois
Department of Anesthesiology and Reanimation, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey.
Reg Anesth Pain Med. 2006 Nov-Dec;31(6):539-45. doi: 10.1016/j.rapm.2006.06.251.
Epithelial tissue coring by spinal needles during subarachnoid injections may cause intraspinal epidermal tumors. Previous studies have investigated tissue transfer with different needle types during subarachnoid or epidural injection. This study deals with the transfer of epithelial tissue during combined spinal-epidural (CSE) anesthesia.
We studied 68 American Society of Anesthesiologists I to III adult patients. CSE anesthesia was induced under aseptic conditions at the L2-3 or L3-4 interspace with patients in the lateral decubitus position. Cerebral spinal fluid, spinal needle stylet, fluid used to flush the interior of the spinal needle, fluid used to wash the exterior of the spinal needle, fluid used to flush the interior of the epidural needle, and fluid used to wash the exterior tip of the epidural needle were examined under light microscopy (n = 30 patients) or incubated in a cell-culture medium (n = 38 patients). Samples were incubated in cell-culture medium alone (n = 13) or in a cell-culture medium for 3 weeks and then in a medium with epidermal growth factor (n = 25). As a positive control, skin tissue samples were taken by punch biopsy from 10 randomly chosen patients who underwent CSE interventions. These samples were incubated in an enriched medium serum.
Light microscopy revealed that there was cell transfer in all phases in various rates: samples 1, 2, 3, 4, 5, and 6 contained epithelial cells and debris in ratios of 6.9%, 20.7%, 6.9%, 20.7%, 26.7%, and 33.3%, respectively. Epithelial cell colonization was detected in the cell-culture samples taken from the control group but not in the samples taken from the CSE group.
We could not reproduce the cells or cell debris obtained during the CSE interventions in vivo, which can be explained by a possible structural deformation of cells or the inadequacy of the amount of cells that were transferred.
蛛网膜下腔注射时脊髓穿刺针取上皮组织芯可能导致椎管内表皮样肿瘤。既往研究调查了蛛网膜下腔或硬膜外注射时不同类型穿刺针的组织转移情况。本研究探讨腰麻-硬膜外联合麻醉（CSE）过程中上皮组织的转移。
我们研究了68例美国麻醉医师协会I至III级成年患者。患者侧卧位，在L2-3或L3-4椎间隙无菌条件下实施CSE麻醉。对脑脊液、脊髓穿刺针针芯、用于冲洗脊髓穿刺针内部的液体、用于冲洗脊髓穿刺针外部的液体、用于冲洗硬膜外穿刺针内部的液体以及用于冲洗硬膜外穿刺针外部尖端的液体进行光学显微镜检查（n = 30例患者），或在细胞培养基中培养（n = 38例患者）。样本单独在细胞培养基中培养（n = 13），或在细胞培养基中培养3周，然后在含有表皮生长因子的培养基中培养（n = 25）。作为阳性对照，从10例随机选择接受CSE干预的患者中通过打孔活检获取皮肤组织样本。这些样本在富含培养基血清中培养。
光学显微镜检查显示，各阶段均有不同比例的细胞转移：样本1、2、3、4、5和6中上皮细胞和碎片的比例分别为6.9%、20.7%、6.9%、20.7%、26.7%和33.3%。在对照组的细胞培养样本中检测到上皮细胞定植，但在CSE组的样本中未检测到。
我们无法在体内重现CSE干预过程中获得的细胞或细胞碎片，这可能是由于细胞可能的结构变形或转移细胞数量不足所致。
