全输尿管撕脱导致早期肾切除术作为单纯腰椎间盘切除术的罕见并发症；一例报告。
Total ureteral avulsion leading to early nephrectomy as a rare complication of simple lumbar discectomy; a case report.
作者信息
Omidi-Kashani Farzad, Mousavi Seyed Mahdi
机构信息
Associate Professor of Orthopedic, Fellowship of Spine Surgery, MD, Orthopedic Department, Orthopedic Research Center, Imam Reza Hospital, Mashhad University of Medical Sciences Mashhad Iran.
Orthopedic Resident, Orthopedic Department, Orthopedic Research Center, Imam Reza Hospital, Mashhad University of Medical Sciences Mashhad Iran.
出版信息
SICOT J. 2015 Nov 6;1:30. doi: 10.1051/sicotj/2015031.
INTRODUCTION
Lumbar discectomy constitutes the most common and probably easiest spine surgery but it is not without complications. The aim of this work is to report a case with total ureteral avulsion during lumbar discectomy due to careless advancement of the pituitary rongeur.
METHODS
A 59-year-old male presented with refractory left L5-S1 lumbar disc herniation. During the surgery, left sided total ureteral avulsion occurred. Early postoperative progressive abdominal pain was the main clue for further investigation and diagnostic work-up.
RESULTS
Abdominal ultrasonography, intravenous pyelography, and abdominal contrast-enhanced computed tomography (CT) detected a left ureteral injury. Although the injury was detected early, ureteral repair or renal autotransplantation was not possible and nephrectomy was finally indicated, due to a significant ureteral loss.
DISCUSSION
Careful use of discectomy instruments, avoidance of excessive advancement of pituitary rongeurs (more than 3 cm), and thorough knowledge of the relevant anatomy are critical in preventing ureteral injury.
引言
腰椎间盘切除术是最常见且可能是最简单的脊柱手术，但并非没有并发症。本文旨在报告一例因垂体咬骨钳推进不当导致腰椎间盘切除术中输尿管完全撕脱的病例。
方法
一名59岁男性因左侧L5-S1腰椎间盘突出症难治而就诊。手术过程中，左侧输尿管发生完全撕脱。术后早期进行性腹痛是进一步检查和诊断评估的主要线索。
结果
腹部超声、静脉肾盂造影和腹部增强计算机断层扫描（CT）检测到左侧输尿管损伤。尽管损伤发现较早，但由于输尿管大量缺失，无法进行输尿管修复或肾自体移植，最终行肾切除术。
讨论
谨慎使用椎间盘切除器械、避免垂体咬骨钳过度推进（超过3厘米）以及全面了解相关解剖结构对于预防输尿管损伤至关重要。
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