Taveira Mário Humberto Curado, Carneiro Antonio Fernando, Rassi Gustavo Gabriel, Moreira Marise Amaral Rebouças, Taveira Simone de Andrade Curado
Anesthesia Study Center, Goiânia, GO, Brazil.
Braz J Anesthesiol. 2013 Mar-Apr;63(2):193-6. doi: 10.1016/S0034-7094(13)70214-9.
Skin fragments during lumbar punctures may develop intraspinal epidermoid tumors. The aim of this study was to determine the incidence of epithelial cells that reflow along with the first and third drops of CSF of patients undergoing spinal anesthesia.
Samples of the first and third drops of cerebrospinal fluid were collected from 39 adult patients undergoing spinal anesthesia with a 25G Quincke needle. Four microscope slides were prepared: one for the first drop, one for third drop, one for the needle, and one with a drop of saline for control. A pathologist examined the slides randomly.
Squamous epithelial cells were identified in 35 (89.7%) samples from the first drop, 34 (87.2%) from the third drop, and 24 (61.5%) from spinal needle. The third drop showed a mean number of cells larger than the first drop (p=0.046). Nucleated epithelial cells were found in a sample of the first drop (2.56%), in four samples of third drop (10.25%), and in one spinal needle (2.56%). Third drop showed a mean number of nucleated cells higher than first drop with no statistical difference (p=0.257).
High percentage of epithelial cells was found in the first (89.7%) and third (87.2%) drops of CSF reflow and in used needles (61.5%). Skin cells were found even using small gauge disposable needles with well-adapted mandrel.
腰椎穿刺过程中的皮肤碎片可能会发展为脊髓内表皮样肿瘤。本研究的目的是确定在接受脊髓麻醉的患者中，随着脑脊液第一滴和第三滴回流的上皮细胞的发生率。
从39例使用25G Quincke针接受脊髓麻醉的成年患者中收集脑脊液的第一滴和第三滴样本。制备四张显微镜载玻片：一张用于第一滴样本，一张用于第三滴样本，一张用于穿刺针，一张用一滴生理盐水作为对照。由一名病理学家随机检查这些载玻片。
在第一滴样本的35份（89.7%）、第三滴样本的34份（87.2%）以及穿刺针样本的24份（61.5%）中发现了鳞状上皮细胞。第三滴样本中的细胞平均数高于第一滴样本（p = 0.046）。在第一滴样本的一个样本（2.56%）、第三滴样本的四个样本（10.25%）以及一个穿刺针样本（2.56%）中发现了有核上皮细胞。第三滴样本中的有核细胞平均数高于第一滴样本，但无统计学差异（p = 0.257）。
在脑脊液回流的第一滴（89.7%）和第三滴（87.2%）以及使用过的穿刺针（61.5%）中发现了高比例的上皮细胞。即使使用带有适配芯轴的小口径一次性针头也能发现皮肤细胞。
