脊椎手術中下腔靜脈破裂之病例報告

Inferior Vena Cava Tear during Posterior Spinal Fusion Surgery

脊椎手術中發生下腔靜脈破裂是一個罕見但卻致命的併發症。早期發現並及時手術修補可以降低病患死亡率及產生合併症。這是一個行脊椎固定手術病患，於術中意外傷及下腔靜脈的病例報告。病患在術中突然血壓下降呈現休克狀態。經緊急搶救後，生命跡象稍微穩定。當由俯臥轉為平躺時，赫然發現病患原本平坦的腹部變得異常鼓漲。在懷疑為後腹腔血管破裂的前提下，進行緊急腹部探查手術，證實為下腔靜脈破裂。經及時手術修補後，病患於穩定狀況下，轉送加護病房做後續照料。不幸，兩週後，病患因多發性器官衰竭病逝。

Inferior vena cava tear is a rare but potentially lethal event associated with spinal surgery. Early recognition and repair are mandatory to minimize morbidity and mortality. Here we report a case of inferior vena cava tear which occurred during posterior spinal fusion surgery. Without marked bleeding from the surgical field, the patient was suddenly seized with a profound shock. Abdominal distension was found after resumption of the supine position from prone. Emergent exploratory laparotomy disclosed inferior vena cava tear. After repairing of the torn vessel, the patient was transferred to ICU. Unfortunately, patient expired two weeks later due to multiple-organ failure.