大腸癌手術後合併股神經損傷：病例報告

Post-hemicolectomy latrogenic Femoral Nerve Damage-Case Report

梅紹京(Sau-Chin Mei) ； 黃永賜(Yung-Szu Huang) ； 劉憶平(I-Ping Liu)

《中華民國復健醫學會雜誌》 23卷2期 (1995/12) Pp. 159-162

摘要

本文報告一位七十六歲男性，因罹患升結腸癌侵犯腰大肌，於接受手術後併發右側股神經傷害。理學檢查為右髖屈肌無力，右膝伸肌無力，右大腿前內側皮膚感覺麻木及右膝深腱反射消失。術後三週接受神經電氣檢測，無法誘發出傷側股神經之複合肌肉活動電位，且股神經支配之肌群如股四頭肌，腰樁肌等之針極檢查皆有重度之去神經現像。此病例可能是因部份腰大肌切除時，直接傷及股神經所致。術後三個月及六個月之系列肌電圖表徵及復健臨床檢查，發現患側下肢功能皆無絲毫恢復，預後不佳。文中同時討論各類手術如全髖關節置換術，後腹腔腫瘤切除術，子宮切除術及骨盆腔手術等併發股神經傷害之機轉。

關鍵字

大腸癌 ； 半結腸切除術 ； 股神經傷害

並列摘要

Iatrogenic femoral nerve damage has already been described after retroperitoneal tumor resection, hysterectomy, abdominal rectoplexy and total hip arthroplasty etc., but never after ascending colon carcinoma resection. We report the occurrence of femoral nerve injury in a 76 years old male patients after the procedure of right hemicolectomy and debulking of the tumor. Neurological symptoms appeared immediately after surgery. Sensory deficit was evident with reduced sensation of the anterior surface of right thigh and knee. Weakness of quadriceps and iliopsoas muscles was obvious. Serial post-surgical (3 weeks, 2 months, and 6 months respectively) EMG examinations revealed severe denervations of R’t iliopsoas, quadriceps and rectus femoris without volitional potential, thus poor prognosis was expected. We believe femoral nerve damage was caused by direct injury in the en bloc excision of the invaded adenocarcinoma over the psoas muscle in this case.

並列關鍵字

colon carcinoma ； hemicolectomy ； femoral nerve injury