大血管损伤再次手术五例

我院在 1998年对 5例首次急诊手术失败的大血管损伤患者行再次急诊手术 ,报告如下。本组均为男性 ,平均年龄 34岁 (2 2～ 46岁 ) ,均为锐器损伤血管 ,临床资料见表 1。表 1　血管损伤情况和治疗结果性别 年龄(岁 ) 损伤原因损伤部位 两次手术间隔时间第 2次手术术前情况术中所见手术方式 手术结果 随访时间(月 )男 2 2啤酒瓶爆炸左颈动脉 13ｄ 伤口裂开喷血失血性休克 左颈总动脉假性动脉瘤破裂 颈动脉修补　　痊愈　　 13男 37飞溅铁皮嵌入 左颈动脉 2ｄ巨大波动性血肿、严重压迫症状左颈动脉分叉处破损 ,假性动脉瘤形成 颈动脉修补　　痊…     

腰椎间盘突出症手术并发症及防治

本院自1993年9月至2002年6月,手术治疗腰椎间盘突出症258例,出现并发症为7.75%.现作一分析,探讨其原因及防治措施.     

腰椎间盘手术致右髂总动脉损伤伴多器官功能衰竭一例

腰椎间盘手术损伤腹侧大血管,这种失误非常少见,但后果却十分严重。笔者收治并抢救成功1例,现报告如下。     

大血管手术中的心脏保护

心脏并发症是构成大血管手术发病率和死亡率的主要部分。围术期5～10d是心脏应激期,术后2～3d是心血管并发症的高峰期,本文从大血管手术术前高危因素、围术期监测和管理、心脏并发症的处理诸方面着重作了介绍。     

颈部大血管开放性损伤的急诊救治

颈部开放性损伤伴大血管破裂虽较少见,一旦发生病情凶险,如急诊救治不当,致死率高。1999-2007年我院急诊救治颈部大血管开放性损伤12例,均成功救治,无一例死亡,无严重并发症。总结急诊救治经验报告如下。     

腰椎间盘手术中大血管损伤的诊断与预防(附2例报告)

目的：探讨腰椎间盘手术中大血管损伤的原因、诊断与预防。方法：复习２例腰椎间盘手术中发生大血管损伤的诊断及治疗过程。结果：２例在４ｈ内获及时诊断及外科干预,均抢救成功。结论：大血管损伤与操作、解剖、病理变化等因素有关,不能解释的椎间隙出血,术中突然血压下降等强烈提示操作中伤及大血管,及时诊断及外科干预是大血管损伤抢救成功的关键。术前常规折摄腰椎侧位片测定椎间隙深度,髓核钳进入椎间盘后及时完全张口推进,可减少大血管损伤机会。     

胸腔镜术中大血管损伤原因分析与处理

1996年 6月至 2 0 0 0年 12月我们共完成电视胸腔镜手术(ＶＡＴＳ ) 398例 ,术中发生大血管损伤 3例 (0 75 % ) ,均经及时妥善处理转危为安 ,现将经验教训总结如下。例 1　男 ,6 1岁。因左下肺癌 (Ｔ1Ｎ0 Ｍ0 )在双腔插管全麻下 ,经第 5肋间 8ｃｍ小切口 (未用撑开器 )行ＶＡＴＳ左下肺叶切除术。用切割缝合器切断下叶支气管取出病肺后 ,查看胸腔时发现下肺静脉结扎线松脱大出血。立即伸入夹持小纱块的长柄卵圆钳按压出血处 ,紧急加用胸撑扩大切口 ,钳夹下肺静脉残端 ,牢靠缝扎。失血约 70 0ｍｌ。例 2　女 ,6 0岁。肺结核病史 30余年 ,因…     

腰椎间盘突出症手术并发症的防治

探讨腰椎间盘突出症手术并发症的防治,方法分析近８年我科腰椎间盘突出症手术并发症的原因。讨论其防治和治疗措施。结果术中保留棘上韧带能避兔术后腰酸乏力,采用环锯去除椎板黄韧带省时,安全。Ｌ５和Ｓ１的术中确定可依据其形态,活动度,叩击音区别。     

妇科腹腔镜手术严重并发症的探讨

目的探讨妇科腹腔镜手术严重并发症的发生情况，以尽量减少严重并发症的发生。方法对我院2004年3月～2005年3月开展的215例妇科腹腔镜手术所发生的6例严重并发症进行回顾性分析。结果215例妇科腹腔镜手术，严重并发症6例，发生率2．79％，其中输尿管损伤2例，腹壁血管损伤3例，严重皮下气肿1例。结论正确、合理的选择手术适应证，不断提高手术技术水平，适时中转开腹，是减少和避免严重并发症的有力保障。     

Iatrogenic vascular injury during to lumbar disc surgery

Summary We report two patients who sustained vascular injury while undergoing intervertebral disc surgery at the lumbar four and five level. Each patient suffered from massive bleeding and shock, urgent laparatomy was performed, and the vascular injuries were successfully primarily repaired. The experience prompted us to review reports in the literature since 1965 of vascular complications associated with surgical excision of hernia disc via a posterior approach. From our analysis, we highlight the clinical features and management, emphasising that rapid diagnosis and immediate intervention can result in a favourable outcome, as in our patients.     

腰椎间盘突出症手术并发症临床分析与处理对策

1991年9月～2003年9月,我院手术治疗1226例腰椎间盘突出症患者,出现并发症57例,笔行针对并发症的原因和处理方法进行分析。     

腰椎间盘手术并发神经损伤的原因分析及预防

目的：提出预防腰椎间盘手术并发神经损伤的措施。方法：对近年来遇到的１０例腰椎间盘手术并发神经损伤的原因作了分析总结。结果：１例因腰骶神经要解剖异常而误切神经;１例切除黄韧带时损伤神经根,２例有钳撕裂硬脊膜;２例切椎间盘时,部分切断神经根;髓核钳误伤２例,２例因静脉丛出血而误伤神经。结论：熟悉腰骶神经根异常叫唤手术操作过程中失误,是预防腰椎间盘手术并发神经损伤的有效方法。     

腰椎毗邻血管的应用解剖及血管损伤并发症

下腰椎前入路手术,在治疗腰椎疾病方面扮演着非常重要的角色,其手术区域相关的临床解剖学研究也日益深入。腰椎局部区域的血管、神经对于术中的显露有着直接影响,熟悉这些结构不仅能减少术中创伤和术后并发症,也能为新的手术入路和技术的发展提供新思路。该文对腰椎前方血管的特点和减少血管并发症的研究现状进行综述。     

Vascular complications of lumbar disc surgery

Summary 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.     

人工腰椎间盘置换术的并发症及其防治

目的:探讨人工腰椎间盘置换术并发症的原因及防治方法。方法:1999年12月~2001年11月间,应用Link(r)SBCharitéⅢ型人工椎间盘假体对30例患者的33个椎间盘进行了置换术,男16例,女14例;年龄36~54岁,平均44岁。腰椎间盘突出症22例,腰椎间盘切除术后失败6例,腰椎间盘退行性变2例。统计并发症发生的例数,分析其发生原因并探讨预防处理方法。结果:随访4个月~2年3个月,平均16.7个月。共发生7例20例次并发症,术中并发症包括腹膜撕裂3例次,椎前静脉出血1例次,椎体后上缘骨折1例次,假体位置不良4例次;术后并发症包括切口裂开1例次,腹膜后血肿1例次,腹壁切口疝1例次,6个椎间盘假体无运动,关节突关节自发性骨融合1例次,术后16个月椎弓根断裂1例次。结论:人工椎间盘置换术虽可保留手术节段的运动功能,但存在其特有的并发症,应严格手术适应证、掌握手术操作原则及技术并完善围手术期处理,减少并发症的发生。     

Acute complications in patients with surgical treatment of lumbar herniated disc

The complications of surgical treatment for lumbar disc herniation (LDH) are important to know, but hard to measure because of their low incidence and varied pattern. Using data from the National Hospital Discharge Survey, which codes discharges and procedures according to the ICD-9-CM, we assessed acute complication rates for 3,289 surgically treated LDH patients and 4,025 nonoperative LDH patients, identifying complications from codiagnoses. The complication rates were significantly correlated with the postoperative length of stay and with the risk factors of obesity, hypertension, and diabetes. We found fewer instances of thrombophlebitis (0.3/1,000) and slightly lower mortality (0.9/1,000) than previously reported. Although the frequency of the cauda equina syndrome in the literature approximates our findings of 5/1,000, our data did not allow correction for the fraction of preexistent cauda equina syndromes. Our any-complication-rate is 3.7%. Even though LDH surgery is relatively safe, its complications should not be overlooked.