背景:前路腰椎融合术具有许多益处,并且继续普及。该技术具有许多潜在的与方法和程序相关的并发症。有症状的腹膜后积液很少见,但在腰椎前路手术后可能会出现严重的并发症。集合类型包括血肿,尿瘤,乳糜腹膜,脑脊液收集物,和深层感染。
方法:作者介绍了一例罕见的患者,该患者在前路腰椎融合术后5年的时间内,出现了与腹膜后收集有关的持续症状。就作者所知,没有描述症状持续时间如此广泛的类似病例。患者具有受感染的包封的流体集合。该集合被认为是术后淋巴囊肿,在连续的经皮引流程序后再次感染。
结论:当腹膜后前路入路后发生腹膜后聚集时,临床线索,例如症状的时机,低血压,急性贫血,尿路感染,肾积水,血清肌酐和尿素氮升高,低压力头痛,厌食症,或全身感染的迹象,可以帮助缩小差异。腰椎前路手术多年后,腹膜后收集可能会继续出现症状。在连续经皮引流或长时间连续引流后,收集物可能会被感染。封装,受感染的液体收集通常需要对胶囊及其内容物进行手术清创。
BACKGROUND: Anterior lumbar fusion procedures have many benefits and continue to grow in popularity. The technique has many potential approach- and procedure-related complications. Symptomatic retroperitoneal fluid collections are uncommon but potentially serious complications after anterior lumbar procedures. Collection types include hematomas, urinomas, chyloperitoneum, cerebrospinal fluid collections, and deep infections.
METHODS: The authors present an unusual
case of a patient with persistent symptoms related to a retroperitoneal collection over a 5-year period following anterior lumbar fusion surgery. To the authors\' knowledge, no similar
case with such extensive symptom duration has been described. The patient had an infected encapsulated fluid collection. The collection was presumed to be a postoperative lymphocele that was secondarily infected after serial percutaneous drainage procedures.
CONCLUSIONS: When retroperitoneal collections occur after anterior retroperitoneal approaches, clinical clues, such as timing of symptoms, hypotension, acute anemia, urinary tract infection, hydronephrosis, elevated serum creatinine and blood urea nitrogen, low-pressure headaches, anorexia, or systemic signs of infection, can help narrow the differential. Retroperitoneal collections may continue to be symptomatic many years after anterior lumbar surgery. The collections may become infected after serial percutaneous drainage or prolonged continuous drainage. Encapsulated, infected fluid collections typically require surgical debridement of the capsule and its contents.