TJ TCM.24(3) : 81-92, 2021
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脑膜瘤术後偏瘫之中西整合照护病例报告
A Case Report of Postoperative Hemiparalysis after Craniotomy for Meningioma with Integrated Treatment of Western and
Traditional Chinese Medicine
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王嘉莹1 简俊安1 黄仲谆1*
1 台中慈济医院中医部，台中，台湾
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【摘要】
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脑膜瘤是最常见的颅内原发性肿瘤，目前没有明确治疗指引，通常以手术为主，但是脑膜瘤术後新发局部神经功能缺损的机率约14.8%，新发癫癇的发生率大约12%，对於肿瘤属於良性且无症状的脑膜瘤患者而言，常困扰於治愈机会和手术风险之间的取舍。本病例是一名51 岁女性开颅肿瘤移除手术後左侧肢体偏瘫，并於三个月後新发癫癇，在这段过程中持续以中药及针灸偕同西医共同照护，现有文献中相对少见。文中探讨急性期「辨病」的治疗可能性，将术後脑组织修复过程中的炎性产物视为「痰」、「瘀」，以此为基础处方用药，恢复人体气机运行；另辅以经穴与头皮针之针灸治疗，协助患者改善肢体功能进而生活自理。对於术後癫癇，此次不若西药效果明显，因文献证据不足，难以确定是否病程使然。
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【关键词】开颅手术、偏瘫、脑膜瘤、中医、针灸
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Chia-Ying Wang1 Jun-An Jian1 Chung-Chun Huang1*
1Department of Chinese Medicine, Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical
Foundation, Taichung, Taiwan
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【Summary】
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Meningiomas are the most common primary brain tumors, however, there’s no specific guideline for treatment of meningiomas compared with other tumors, and surgery seems to be the main treatment modality for meningiomas. Due to 14.8% of patients developed new focal neurological deficits, and 12% occurred new-onset seizures, weighing the risk of postoperative complications against better chances of a cure is always a dilemma for those whom were asymptomatic with a benign meningioma. This article introduces a case of a 51-year-old female with postoperative hemiparalysis after a craniotomy for meningioma and occurred new-onset seizures 3 months later, who received Western medicine and traditional Chinese medicine—includes acupuncture and herbs combined therapy during the clinical course, and is relatively uncommon in the past studies. Our prescription was based on a concept that products such as inflammatory cells during the brain tissue healing are considered as phlegm stasis, thus, we could restore human qi circulation by decreasing phlegm stasis. Meanwhile, acupuncture treatment of meridian points and scalp acupuncture had been adopted to improve limb function, furthermore, self-care ability. On the other hand, increasing the dose of Depakine seemed to be more effective in new onset seizure control compared to TCM in this case, though we cannot sure the natural course of postoperative seizures.
【Keywords】Craniotomy; Hemiparalysis; Meningiomas; Traditional Chinese Medicine; Acupuncture
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243.6 脑膜瘤术後偏瘫之中西整合照护病例报告
