Brewster D C, May A R, Darling R C, Abbott W M, Moncure A C
Arch Surg. 1979 Sep;114(9):1026-30. doi: 10.1001/archsurg.1979.01370330048008.
Major vascular injury is an unusual but well-recognized complication of lumbar disk surgery. Clinical manifestation of such injuries may be extremely variable. Isolated arterial laceration is most common, with early manifestation due to retroperitoneal hemorrhage. There are often few external signs of blood loss, however, and the diagnosis may not be recognized initially. Formation of an arteriovenous fistula or false aneurysm produces even fewer early signs, and diagnosis is often delayed for weeks or years. Six cases are described that illustrate the full spectrum of acute and chronic manifestations of such injuries. Two cases of acute hemorrhage due to arterial trauma were seen; one case was recognized intraoperatively and one in the recovery room. In four cases arteriovenous fistulae developed and were diagnosed from eight hours to eight years postoperatively. Two cases also had associated false aneurysms, one the probable source of pulmonary emboli and one the principal manifestation of the vascular injury.
严重血管损伤是腰椎间盘手术中一种不常见但已被充分认识的并发症。此类损伤的临床表现可能极为多样。孤立性动脉撕裂最为常见，早期表现为腹膜后出血。然而，失血的外部体征往往很少，最初可能无法做出诊断。动静脉瘘或假性动脉瘤的形成产生的早期体征更少，诊断常常延迟数周或数年。本文描述了6例病例，展示了此类损伤的急性和慢性表现的全貌。观察到2例因动脉创伤导致的急性出血；1例在术中被识别，1例在恢复室被识别。4例发生了动静脉瘘，在术后8小时至8年被诊断。2例还伴有假性动脉瘤，1例可能是肺栓塞的来源，1例是血管损伤的主要表现。
