下腔靜脈損傷，可以縫合

Vascular suture as a treatment of inferior vena cava injury during paraaortic lymph node dissection

台北榮民總醫院婦產部，在1983-1998年間，組織確認子宮頸癌而行手術治療，有2106例。手術包括子宮根除手術和骨盆淋巴(pelvic lymph node, PLN)摘除。有下列兩種情形，任何一種，我們會追加主動脈旁淋巴(para-aortic lymph node, PALN)摘除：(1)子宮頸癌IIB；(2)手術時，PLN或PALN有腫大。這個期間，我們共做了404例。PALN摘除沒有增加手術時以及手術後的合併症。僅有1例，54歲，子宮頸癌IIA，行PALN摘除時，在右側性腺靜脈(right gonadal vein)的地方，發生下腔靜脈(inferiorvena cava, IVC)損傷和出血。溼紗布久壓無效，結紮後又鬆脫，最後才用黑絲線4-0，縫了四針，便止了血。血管由於血液循環不歇，便一直鼓鼓的。一旦受損，是動脈則有脈動，不容易壓縮，因此，也不容易止血；每每又因為彈性，因為脈動，也不容易結紮而會自己鬆開，無法止血。靜脈比動脈血管更糟，縫針是見針出血；縫好又不容易綁起來，又容易撕裂。IVC損傷，要單純將血管縫合起來，亟需外科和血管外科的訓練。

The para-aortic lymph nodes are in close proximity to the abdominal aorta and inferior vena cava (IVC) which are the largest blood vessels of the body. Therefore, great care is undertaken during lymphadenectomy. A woman of 54 who was in stage IIA of cervical cancer underwent an operation. An injury issued from the IVC at the junction of right gonadal vein during lymph node dissection. One milliliter of heparin, 2000 u/ml, diluted with 20 ml of normal saline, was injected into the IVC for a short prevention of clotting before the application of two vessel clamps. After the relief of tension in IVC, the injured wound was repaired by vascular sutures with 4-0 black silk. The post-operative course was uneventful. Success of treatment for an injured IVC lies in a thorough knowledge of abdominal vascular anatomy and a familiarity with the techniques of vascular reconstructive operations.