【一例硬膜外导管插入部位出血导致造血恶性肿瘤患者推迟择期手术】。

Akiko Hiramatsu, Hiromasa Kida, Hideaki Tsuchida
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摘要

一位29岁的男性怀疑有造血系统恶性肿瘤,计划接受视频辅助脾切除术。由于他的全身情况在麻醉前评估良好,因此选择全身和硬膜外联合麻醉。然而,在手术室插入硬膜外导管后,由于导管插入部位出血,手术不得不推迟。延迟治疗后立即进行血液学检查,发现血液吞噬综合征,患者迅速发展为弥散性血管内凝血。本病例提示造血恶性肿瘤患者应在手术当天进行血液学检查;此外,由于患者病情的变化可引起急性出血,应避免行轴突阻断术。
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[Elective Surgery was Postponed in a Patient with Hematopoietic Malignancy due to Bleeding from the Insertion Site of an Epidural Catheter: A Case Report].

A 29-year-old man suspected of having a hematopoietic malignancy was scheduled to undergo video- assisted splenectomy. Because of his good general con- dition on a preanesthetic evaluation, combined general and epidural anesthesia was selected. However, after insertion of an epidural catheter in the operating room, surgery had to be postponed due to bleeding from the catheter insertion site. The hematological examination done right after the postponement revealed hemo- phagocytic syndrome and the patient rapidly developed disseminated intravascular coagulation. This case suggested that in a patient with hematopoietic malig- nancy a hematological examination should be carried out on the day of surgery; besides, neuraxial blockade should be avoided because bleeding could be acutely induced due to changes in the patient's condition.

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