- 期刊
Management of Superior Gluteal Artery Pseudoaneurysm after Iliac Crest Bone Marrow Biopsy-Case Report
骼骨脊骨髓穿刺產生上臀動脈假動脈瘤的處理─病例報告
摘要
背景：檢查和診斷病人是否罹患血液方面疾病時，骨髓切片是一種較安全的方法。文獻指出骨髓切片出現併發症的比例約是0.05%。其中又以假動脈瘤此種併發症的比例更為罕見。傳統的臀部血腫療方法是劃開臀部皮膚，直接切開臀大肌來移除血腫。本研究成功以血管栓塞合併內視鏡輔助將假動脈瘤結紮並移除血腫。目的及目標：我們報告一個因骨髓切片所造成的罕見併發症案例。此併發症成功經由血管栓塞及內視鏡血腫移除的方法治癒。材料及方法：本研究個案為一62歲慢性骨髓增生疾病（chronic idiopathic myelofibrosis）患者。個案接受骨髓穿刺（bone marrow biopsy）後發現血腫，且殘存血腫的情況持續約五個月之久；目視血腫大小約為長12公分、寬15公分、高12公分，初步採用保守治療但未見成效。以電腦斷層檢查發現假性動脈瘤（pseudoaneurysm）。在使用血管栓塞合併內視鏡輔助之後成功移除血腫。結果：術後病人未提及任何不適，也未發現任何併發症。病人很滿意極小的手術傷口。結論：在選擇性栓塞假動脈瘤後，採用造成手術傷口較小的內視鏡法進行殘留血腫移除術是另一項治療骨髓切片併發症的方法。此種藉由結紮假動脈瘤的營養血管及內視鏡輔助殘存血腫移除術，針對骨髓穿刺所造成的併發症，提供一個病人覺得滿意，有效且侵入性較小的治療方法。
關鍵字
無資料並列摘要
Background:Bone marrow biopsy (BMB) is the method for assessment of overall bone marrow cellularity. It is also used to screen for unidentified hematological diseases, different storage and infiltrative disorders. The reported complication rate of iliac crest BMB was only about 0.05%.Objectives:We reported the rare complication of pseudoaneurysm formation after iliac crest BMB. The complication was successfully treated by combining endovascular embolization with an endoscope-assisted technique for hematoma removal. We also reviewed the related literature.Patient and Method:A 62-year-old man complained of the formation of a large and tender mass over the right gluteal area after BMB. The mass had persisted even after 4-month conservative treatment. Enhanced computed tomography (CT) scan revealed contrast extravasation within the lesion. Pseudoaneurysm was highly suspected. Selective endovascular coil embolization was performed following endoscope-assisted removal of the residual hematoma.Result:The radiologist successfully embolized the pseudoaneurysm. On the next day, the surgeon evacuated the hematoma and clamped the surrounding vessels on the gluteal maximus muscle via a single small incision. No postoperative sequelae were noted. The patient was highly satisfied with the result.Conclusion:In conclusion, pseudoaneurysm formation after BMB is a rare complication which can be successfully treated with combination of selective endovascular coil embolization and endoscope-assisted hematoma removal. Clamping the surrounding vessels which were embedded in the muscle may prevent the recurrence of hematoma. Endoscopicassisted removal of the hematoma was effective in this case and may reduce the risk of gluteal muscle destruction. (J Taiwan Soc of Plast Surg 2011; 20: 316∼323)
延伸閱讀
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