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一名接受斜外侧腰椎椎间融合手术的左侧下腔静脉患者:病例报告。

A patient with left-sided inferior vena cava who received oblique lumbar interbody fusion surgery: a case report.

作者信息

Liu Chen, Zhai Jian, Yuan Quan, Zhang Yu, Xu Hongguang

机构信息

Spine Research Center of Wannan Medical College, Wuhu, 241001, Anhui, China.

Department of Orthopaedics, Yijishan Hospital of Wannan Medical College, No. 2 Zheshan West Road, Wuhu, 241001, Anhui, China.

出版信息

J Med Case Rep. 2020 Jan 27;14(1):21. doi: 10.1186/s13256-020-2342-y.

Abstract

BACKGROUND

Oblique lateral interbody fusion surgery has become increasingly popular for lumbar degenerative diseases. The oblique corridor is between the psoas muscle and the retroperitoneal vessels, and its use could result in decreased tissue trauma, minimal blood loss, and short operation times. Patients who undergo oblique lateral interbody fusion surgery are always placed in the right lateral position to avoid damage to the inferior vena cava, which is typically a right-sided vessel. There is a substantial risk of vascular injury during the operation if there are anatomical variations in the vessels.

CASE PRESENTATION

A 77-year-old man, of the Han nationality, with lumbar spinal stenosis underwent stand-alone oblique lateral interbody fusion surgery. Transverse magnetic resonance imaging of the lumbar spine indicated that his inferior vena cava was left-sided. A three-dimensional reconstructed image of abdominal computed tomography angiography showed that the inferior vena cava was located on the left side. Finally, the surgeon decided to change the position of our patient from a right lateral position to a left lateral position before the surgery.

CONCLUSIONS

To date, this is the first reported case where a patient underwent oblique lateral interbody fusion surgery in a left lateral decubitus position due to a left-sided inferior vena cava. This case demonstrates that carefully reading radiological results is important for operation planning and avoiding anatomical complications.

摘要

背景

斜外侧椎间融合手术在腰椎退行性疾病治疗中越来越受欢迎。斜行通道位于腰大肌和腹膜后血管之间,采用该通道可减少组织创伤、减少失血并缩短手术时间。接受斜外侧椎间融合手术的患者通常采用右侧卧位以避免损伤下腔静脉,下腔静脉通常是右侧的血管。如果血管存在解剖变异,手术期间存在血管损伤的重大风险。

病例介绍

一名77岁汉族男性,患有腰椎管狭窄症,接受了单纯斜外侧椎间融合手术。腰椎横轴位磁共振成像显示其下腔静脉位于左侧。腹部计算机断层扫描血管造影三维重建图像显示下腔静脉位于左侧。最后,外科医生决定在手术前将患者的体位从右侧卧位改为左侧卧位。

结论

迄今为止,这是首例因下腔静脉左侧移位而在左侧卧位接受斜外侧椎间融合手术的病例报告。该病例表明,仔细阅读影像学结果对于手术规划和避免解剖并发症很重要。

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