血管内修复腰椎间盘切除术后医源性髂动静脉瘘——1例报道与文献回顾

Endovascular repair of iatrogenic iliac arteriovenous fistula occurring after lumbar discectomy: report of one patient with literature review

目的回顾遂宁市中心医院1例及国内外文献中腰椎间盘切除术后医源性髂动静脉瘘(IAVF)患者临床资料,提高对该疾病的认识。方法系统检索国内外主要数据库中有关腰椎间盘切除术后医源性IAVF文献并报道遂宁市中心医院1例患者,重点收集患者临床资料。结果共纳入31篇中英文文献。44例患者临床资料分析显示,椎间盘受累以L4~5和/或L5~S1水平最常见(28/44,63.6%),其中28例(63.6%)患者在腰椎间盘切除术后数月至数年出现临床症状,39例(88.6%)患者经覆膜支架植入腔内隔绝术治疗成功。结论腰椎间盘切除术后医源性IAVF罕见,但应引起足够重视,给予准确诊断和合适治疗。

Objective To analyze the clinical data of one patient with iatrogenic iliac arteriovenous fistula(IAVF) occurring after lumbar discectomy,who was encountered at Suining Municipal Central Hospital, and to review the relevant literature at home and abroad in order to improve the understanding of the disease.Methods Systematic search of literature concerning iatrogenic IAVF after lumbar discectomy in main databases at home and abroad was conducted.The clinical data of one patient with IAVF occurring after lumbar discectomy,who was encountered at Suining Hospital,were retrospectively analyzed.Results A total of 31 Chinese and English publications(44 patients in total) were included in this study.The clinical analysis of 44 patients showed that the intervertebral disc involvement at the levels of L4-5 and/or L5-S1(28/44,63.6%) was most commonly seen.Among the 44 patients,28(63.6%) appeared clinical symptoms in several months or years after lumbar discectomy,and 39 (88.6%) were cured with endovascular isolation therapy by using implantation of covered stent.Conclusion Clinically,iatrogenic IAVF after lumbar discectomy is a rare finding,but enough attention should be paid to its occurrence,and,when it occurs,accurate diagnosis should be promptly made and appropriate treatment should be adopted with no delay.