惡性腰大肌症候群：病例報告

Malignant Psoas Syndrome: A Case Report

余尚儒(Sang-Ju Yu) ； 陳鼎達(Ting-Tat Chan) ； 王嘉慧(Chia-Hui Wang)

《安寧療護雜誌》 17卷1期 (2012/03) Pp. 100-109

https://doi.org/10.6537/TJHPC.2012.17(1).8

摘要

本報告為一位63歲男士，於2008年罹患直腸癌侵犯骨盆腔及肝轉移，經根除性直腸切除術、大腸造廔以及肝臟部分切除手術後，持續在腫瘤科接受化學治療，陸續出現更廣泛的肝、肺、後腹壁轉移。2012年2月出現下背痛及下肢無力，住院診斷腰大肌膿瘍，外科醫師嘗試以pigtail導管引流膿瘍失敗，會診安寧緩和共同照護小組協助疼痛控制，3月初轉入安寧病房。然而，疼痛雖有部分控制，病情卻持續惡化，引流管路脫落，傷口滲出糞水，病人生活品質不佳，家屬焦慮和不捨，埋怨當初外科治療計畫，甚至期待再次手術，安寧團隊透過家庭會議方式同理家屬情緒，以共同決策模式引導家屬做適當決定。最後病人雖因腰大肌膿瘍併發敗血症，但家屬可安然接受安寧緩和療護而使病人獲得善終。惡性腰大肌症候群發生率極低，預後不佳，因此多數醫師並無治療經驗，希望藉由本個案報告，讓讀者認識惡性腰大肌症候群的診斷、治療和預後，並能早期發現、適當的疼痛控制和採取有效的決定過程，提供高品質的末期照護。類似MPS病情的複雜困難決策過程，建議採取「共同決策模式」，幫助病人與家屬做出以病人為中心、符合病人利益的決定，謀取病人最大的福祉。

關鍵字

惡性腰大肌症候群 ； 安寧緩和醫療 ； 共同決策模式

並列摘要

We report a 63-year-old man who was diagnosed to have rectal adenocarcinoma with pelvic and liver metastases in 2008. After radical proctectomy, protective colostomy, and partial hepatectomy, he received radiotherapy and chemotherapy at oncology department while there was progressive liver, lung and retroperitoneal metastases. In February, 2012, he developed low back pain and weakness of lower extremity, and was admitted to surgical ward due to psoas muscle abscess. Palliative shared care team was consulted for pain control since pigtail catheter drainage failed. This patient was transferred to hospice and palliative care ward in March, 2012. Although his pain was partially relieved, there was progressive deterioration of his illness. In addition to dislodgement of the psoas abscess drain tube, there was stool-like watery discharge dripping from the drain tube wound, accompanying with poor quality of life, and emotional distress of family members. They felt deep regret for previous conservative treatment plan in surgical department, and expected another surgical intervention. The palliative care team arranged family conference in which empathic support was provided and shared decision-making was utilized to guide appropriate decision by the family. Although the patient finally died of psoas abecess and sepsis, he and his family could understand, accept and benefit from the hospice palliative care they received. Malignant psoas syndrome (MPS) has very low incidence and poor prognosis, and most doctors are not familiar with this syndrome among cancer patients. This article summarized the epidemiology, treatment, and prognosis of MPS in order to help clinical practitioners be aware of this syndrome. Earlier diagnosis, appropriate pain management, and effective decision-making process are the best ways to promote quality care at the end of life. In complex and difficult situations like MPS, we suggested the application of ”shared decision-making” model to allow patient-centered decisions aiming for the best interest and well-being of our patients.

並列關鍵字

Malignant Psoas Syndrome ； Hospice and Palliative Care ； Shared Decision-making