Fruhwirth J, Koch G, Amann W, Hauser H, Flaschka G
Department of Surgery, University of Graz Medical School, Austria.
Acta Neurochir (Wien). 1996;138(8):912-6. doi: 10.1007/BF01411278.
Over a period of seven years nine patients with vascular complications after lumber discectomy received medical care at the Clinic of Vascular Surgery, University of Graz Medical School. We report five acute bleeding complications occurring during the operation and four late manifestations of vascular lesions. Five patients presented with acute life-threatening iatrogenic haemorrhages from pelvic vessels. Three patients made a complete recovery, one patient died from acute haemorrhagic shock, one further patient died from sepsis due to an associated complication-an injury to the ureter. Over a period of two to ten years after primary surgery we corrected late complications such as 1 case of posttraumatic aneurysm of the aortic bifurcation found to have eroded the body of the fifth lumbar vertebra, and three cases of arteriovenous fistula between the common iliac artery and the common iliac vein. The four cases described below are an attempt to document the vascular surgical procedures involved and to provide typical findings. The risk of injuring the pelvic vessels intra-operatively can be explained by the close anatomical relation between the retroperitoneal vessels and the vertebral column and furthermore not only by the fact that pre-existent deficiencies but also injury to the anterior longitudinal ligament give access to the retroperitoneal space.
在七年的时间里，九名腰椎间盘切除术后出现血管并发症的患者在格拉茨医科大学血管外科诊所接受了治疗。我们报告了五例术中发生的急性出血并发症以及四例血管病变的晚期表现。五名患者出现了来自盆腔血管的急性危及生命的医源性出血。三名患者完全康复，一名患者死于急性失血性休克，另一名患者因相关并发症——输尿管损伤——死于败血症。在初次手术后的两到十年内，我们纠正了晚期并发症，如1例发现侵蚀第五腰椎椎体的创伤后主动脉分叉处动脉瘤，以及3例髂总动脉与髂总静脉之间的动静脉瘘。以下描述的四个病例旨在记录所涉及的血管外科手术过程并提供典型的发现。术中损伤盆腔血管的风险可以通过腹膜后血管与脊柱之间紧密的解剖关系来解释，此外，不仅是因为先前存在的缺陷，而且前纵韧带的损伤也会导致进入腹膜后间隙。
