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題名 | Vascular Injury during a Lumbar Laminectomy=腰椎板切開術所引起的血管傷害 |
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作者 | 許汝寧; 鍾志豪; 劉偉明; 伍乙棠; 余振翔; | 書刊名 | 長庚醫學 |
卷期 | 26:3 2003.03[民92.03] |
頁次 | 頁189-192 |
分類號 | 416.16 |
關鍵詞 | 腰椎板切開; 血管傷害; Spinal surgery; Vascular injury; |
語文 | 英文(English) |
中文摘要 | 腰椎板切開術是一種很普遍,而且又是常規的手術,但有時卻會發生不可預料而且是危及生命的併發症,這些意外需要迅速有效的治療,麻醉醫師不可輕忽,要時時謹慎注意。在此報告我們所遇到的2個病例。一個34歲男病人,因為HIVD來住院,要作L5-S1 Disectomy,麻醉與手術準備和一般情形一樣。在手術開始45分鐘後,突然發現end-tidal CO2逐漸下降,心跳加快,血壓由100/60下降到70/40,而且血由手術地方湧出,外科醫師馬上停止手術,用紗布壓住傷口,麻醉醫師加速補充大量點滴,同時靜脈注射麻黃素,15分鐘後血壓回到100/60mmHg,傷口的血也不再流,趕快縫合傷口,將病人送加護病房觀察。第二天因為發現有內出血現象,作開腹探查,發現是right common ilian artery拉裂傷,約有700 ml的血,經縫合後病人很快就恢復出院。另一個61歲的女性病人,曾開過lamiectomy,現在是腰椎間板突出復發要做腰椎間切除,麻醉與手術和一般情形一以樣。在手術進行了90分鐘後,突然發現有鮮血由傷口噴出,血壓馬上下降,心跳變慢,Pulse oximeter的含氧量由100下降到85,馬上停止手術立即灌血及補充水份,同時緊急開腹探查,發現是右邊common iliac artery裂傷,有2100的血在腹腔,經縫合後,病人很快就恢復。 |
英文摘要 | A lumbar laminectomy is a common and routine operation. Damage to abdominal vascular structures during surgery is a relatively infrequent complication; however, when it does occur, it is sudden and life-threatening. We herein report on 2 cases of abdominal vascular injury which occurred during lumbar microdiscentomies. The first case was a 34-year-old man. A bloody surgical field was noted 45 min into the operation along with an increase in heart rate and a decrease in blood pressure. After fluid resuscizatation and an ephedrine injection, his vital signs stabilized. The patient was then sent to the surgical intensive care unit for observation. An emergent abdominal computer tomography scan revealed right retroperitoneal hematoma, and an urgent exploratory laparotomy was performed to check for bleeding and to remove the hematoma. The second case was a 61-year-old woman with recurrent disc herniation. The operation was proceeding smoothly for 90 min, when a large amount of fresh blood suddenly gushed out. Her blood pressure immediately dropped to that of a state of shock. The patient was turned back to a supine position, and an emergent laparoscopy was done to repair the injured vessels. Both patients had uneventful recoveries. |
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