慢性胰臟炎病患接受經皮內臟神經熱凝固神經阻斷術治療後發生糖尿病肌萎縮症──病例報告

Diabetic Amyotrophy post Splanchnic Nerve Radiofrequency Ablation in a Chronic Pancreatitis Patient Case Report

背景：經皮內臟神經熱凝固神經阻斷術已成功治療慢性牌臟炎所導致的疼痛和改善生活品質。糖尿病肌萎縮症或是糖尿病腰骻神經根病變都是一種糖尿病神經病變，病徵為突然的疼痛、不對稱近端肌肉無力和萎縮。儘管正確的病理機轉尚未明確，免疫引起的微血管炎造成腰骻神經叢缺血是可能原因。我們報告一個有慢性胰臟炎和糖尿病的病患，在利用經皮內臟神經阻斷術治療慢性腹痛後發生糖尿病肌萎縮症。個案報告：一位43歲合併有慢性胰臟炎和糖尿病的男性病患因慢性腹痛和背痛而接受雙側T11一12 內臟神經熱凝固神經阻斷術，在手術後隔天，他主訴右下肢麻痛且無力。立刻安排胸椎核磁共振和腹部電腦斷層來排除手術造成的血管或神經傷害，並沒有發現不正常。感覺神經檢查顯示大腿和膝蓋內側有異常；因為神經科醫師懷疑是糖尿病肌萎縮症，所以安排神經傳導檢查。結果發現右側總腓神經的複合肌肉動作電位波減少和右側腓腸神經感覺神經反應電位減少，顯示軸型感覺運動多發性神經病變合併右側腓腸神經病變。肌電圖顯示在前腔肌、股內側肌和髂腰肌有亞急性神經病變。這些結果符合多發性神經根病變。最終臨床診斷為糖尿病肌萎縮症。在疼痛處理和血糖控制下，九個月後無力的症狀逐漸好轉。結論：在慢性胰臟炎的病人身上施行內臟神經熱凝固神經阻斷術時須謹慎小心外，必須注意是否有其他疾病，例如糖尿病。在感覺神經檢查、肌電圖和影像檢查的幫助下，糖尿病肌萎縮症應列入鑑別診斷。

Percutaneous splanchnic nerve radiofrequency ablation (RFA) has been an increasingly useful alternative in the management of patients with chronic pancreatitis, both alleviating pain and improving the quality of life. Diabetic amyotrophy or diabetic lumbosacral radiculoplexus neuropathy (DLRPN) is a form of diabetic neuropathy that is characterized by an abrupt onset of pain and asymmetric proximal weakness and atrophy of the legs. Despite its exact mechanism is still unknown, immune-mediated inflammatory microvasculitis resulting in secondary ischemia of the lumbosacral plexus is thought to be a favorable cause. Here we present a diabetic patient with chronic pancreatitis who was coincidentally diagnosed with diabetic amyotrophy after being treated with percutaneous splanchnic RFA for chronic abdominal pain.