Hung Pei-Ching, Fan Kuo-Tung, Lai Hui-Chi, Shen Ching-Hui, Luk Hsiang-Ning
Department of Anesthesiology, Taichung Veterans General Hospital, Taichung, Taiwan, ROC.
J Chin Med Assoc. 2007 Oct;70(10):456-9. doi: 10.1016/S1726-4901(08)70039-X.
Postoperative paraplegia is a rare complication after epidural analgesia and often occurs with spinal hematoma or cord injury. We present the case of a 16-year-old girl who suffered from a tumor mass in the neck and abdomen who underwent gynecologic operation. Preoperatively, liver metastasis was found by computed tomography. Pathologic findings revealed that the abdominal mass was an ovarian dermoid cyst. After the operation, the patient complained of paraplegia while receiving epidural analgesia for postoperative pain control. A peripheral primitive neuroectodermal tumor in the thoracic and lumbar spines with spinal cord compression was later detected using magnetic resonance imaging. Learning from this case, we suggest that when a patient is preoperatively diagnosed with tumor metastasis, back pain and soreness, spinal cord compression from tumor metastasis should be excluded before epidural analgesia is implemented.
术后截瘫是硬膜外镇痛后一种罕见的并发症,常与脊髓血肿或脊髓损伤有关。我们报告一例16岁患有颈部和腹部肿瘤肿块的女孩,她接受了妇科手术。术前通过计算机断层扫描发现肝转移。病理结果显示腹部肿块为卵巢皮样囊肿。术后,患者在接受硬膜外镇痛以控制术后疼痛时出现截瘫症状。后来通过磁共振成像检测到胸腰椎存在周围性原始神经外胚层肿瘤并伴有脊髓受压。从该病例中我们建议,当患者术前被诊断为肿瘤转移时,在实施硬膜外镇痛前应排除因肿瘤转移导致的背痛、酸痛及脊髓受压情况。