显微内镜下椎间盘摘除术中并发症原因分析及防治策略

目的探讨显微内镜下椎间盘摘除术（microendoscopic discectomy,MED）中并发症发生原因及防治策略。方法总结我院2003年7月-2012年6月采用MED治疗腰椎间盘突出症患者126例的临床经验,男性84例,女性42例;年龄25-83岁,平均41岁。分析术中并发症原因并提出防治策略。结果 10例中转开放手术,116例完成镜下操作,其中椎间隙定位错误9例,马尾神经损伤1例,硬膜损伤8例,椎管内静脉丛损伤6例。手术中转原因：马尾神经损伤转开放探查1例,硬膜及神经根粘连明显2例,硬膜损伤4例,损伤椎管内静脉丛出血不止3例。并发症发生原因与定位失误、操作不熟练、经验欠缺等有关。结论正确掌握手术适应证、熟练精细的手术操作、丰富的手术经验可减少及预防术中并发症的发生。

Causes and countermeasures of the intraoperative complications of microendoscopic discectomy for lumbar intervertebral disc herniation

Objective To investigate the causes and countermeasures of the intraoperative complications of microendoscopic discectomy（ MED ） for lumbar intervertebral disc herniation. Methods A retrospective analysis was made on 126 cases of lumbar intervertebral disc protrusion treated by microendoscopic discectomy from Jul. 2003 to Jun. 2012. There were 84 males and 42 females, with an average age of 41 years （ age ranged from 25 to 83 years）. The causes and countermeasures of the intraoperative complications were analyzed. Results Totally 10 cases were transferred to open surgery, 116 cases were completed by microendoscopic discectomy （ MED）. Wrong localization of intervertebral space occurred in 9 patients, cauda equina nerve damage in 1 patient, dural injury in 8 patients, and vertebral venous plexus bleeding in 6 patients. The causes of intraoperative conversion to open surgery were as follows ： cauda equina nerve damage in 1 case, obvious accretion of the dura and nerve root in 2 cases, dural injury in 4 cases and vertebral venous plexus bleeding in 3 cases. The occurrences of the intraoperative complications were associated with wrong localization, unskilled operative procedure and limited experience. Conclusion Accurate selection of operative indication, skilled operative procedure and rich operative experience are important to prevent and reduce the intraoperative complications of the lumbar intervertebral disc herniation treated by microendoscopic discectomy.