肝癌病患在施行髖關節置換手術後突發的半身癱瘓－－病例報告

Sudden Onset of Paraplegia after Total Hip Replacement Surgery in a Patient with Hepatocellular Carcinoma-- A Case Report

手術後癱瘓無論是對病患或是醫療團隊而言，皆是悲劇性的嚴重併發症。其病因通常複雜而與多種因子相關。在此病例中提出了一位穩定的肝癌患者，在施行髖關節置換手術後，術後12小時後突然發生下半身癱瘓的罕見病例。患者在術後核磁共振檢查中發現脊椎中多處腫瘤轉移及合併脊髓腔壓迫，因而造成患者下肢癱瘓。因此我們報告此罕見的，以術後立即發生下肢癱瘓為表現的肝癌脊椎轉移病例，並討論可能適當的術前檢查及處理，以期避免此災難性術後併發症的發生。

Postoperative paraplegia is a major complication, of which the pathogenesis is usually multifactorial. This report is to discuss the case of a 36-year-old male patient who, after total hip replacement (THR), right, sustained a sudden-onset postoperative paraplegia. On subsequent examination, it was discovered that the patient had multiple vertebral metastases from hepatocellular carcinoma (HCC) resulting in thecal sac compression at L1 and S1 levels. This instance of distal spinal metastasis from HCC, with initial presentation of a sudden onset of paraplegia immediately after THR surgery, is worth reporting because of its being a rare occurrence and traumatizing effects on the patient, family members, and the surgical team. More importantly, we bring forth this case in order to advance an opinion concerning prevention of this devastating complication. Hence, we discuss the contributory factors and the appropriate perioperative survey and management relevant to cancer patients who are to undergo a non-cancer surgery.