鞘内化疗相关的脊髓病1例并文献复习

A case of myelopathy due to intrathecal chemotherapy and literature review

目的:探讨鞘内化疗相关脊髓病的临床表现、诊断与治疗,以提高临床医生对鞘内化疗相关脊髓病的认识。方法:总结1例男性急性髓系白血病患者,在多次鞘内化疗后继发脊髓病,表现为脊髓损害平面以下感觉异常、下肢无力及大小便困难等,给予抗神经毒治疗后,观察其病情演变及转归,并复习相关文献。结果:在营养神经、物理及针灸等治疗后患者脊髓病的相关症状逐渐减轻。结论:脊髓病是鞘内化疗的一种少见却严重的神经系统并发症,无特效治疗方案,预后不一,临床应加以重视。

Objective：To discuss the clinical presentations,diagnosis and therapies of myelopathy due to intrathe- cal chemotherapy,and to improve the understanding of the disease for clinicians. Methods：The authors describe a male patient with acute myeloid leukemia, who developed myelopathy following intrathecal chemotherapy. Initial pres- entation was sensory disturbances below the level of spinal cord injury,lower limbs weakness and urine and fecal re- tention. We report the disease evolution and outcome after anti - neurotoxicity treatment, and review the related litera- ture. Results： The symptoms of myelopathy gradually were improved after neuro nutrition drugs, physical and acupunc- ture therapy. Conclusion： Myelopathy is a kind of rare but severe neurologic complication following intrathecal chemo- therapy ,without very effective treatment strategies. The clinical prognosis is variable. Physicians should be wary of this rare complication.