放置引流管对经皮椎间孔镜TESSYS技术治疗腰椎间盘突出症术后疗效及安全性的影响研究

目的　比较放置与未放置引流管对经皮椎间孔镜TESSYS技术治疗腰椎间盘突出症术后的疗效及安全性。方法　选取2015年1月—2016年3月于新疆医科大学第一附属医院骨肿瘤外科行经皮椎间孔镜TESSYS技术治疗腰椎间盘突出症的110例患者，根据随机数字表法分为放置引流管组57例，未放置引流管组53例。观察放置引流管组术后引流量，比较两组手术时间、术中出血量、住院时间、术后并发症发生率及术后下地时间，术前1 d，术后1 d，术后1、3、6个月和术后1年疼痛视觉模拟评分（VAS）及Oswestry功能障碍指数（ODI）。结果　放置引流管组术后引流量为（50±10）ml，引流管放置时间为（26.0±2.2）h；两组手术时间、术中出血量及术后并发症发生率比较，差异均无统计学意义（P>0.05）；未放置引流管组住院时间及术后下地时间均短于放置引流管组（P<0.05）。处理方法与时间对VAS无交互作用（F交互=2.981，P>0.05）；处理方法对VAS的影响主效应显著（F组间=20.200，P<0.05）；时间对VAS的影响主效应不显著（F时间=4.241，P>0.05）；其中，术后1 d放置引流管组VAS高于未放置引流管组（P<0.05）。处理方法与时间对ODI无交互作用（F交互=2.298，P>0.05）；处理方法、时间对ODI的影响主效应均不显著（F组间=1.090，F时间=4.391，P>0.05）。结论　行经皮椎间孔镜TESSYS技术治疗腰椎间盘突出症术后不放置引流管，其并发症发生率未增加，且可减轻术后疼痛、缩短住院和术后下地时间。

Investigation of the Efficacy and Safety of Drainage Tube Placement Using TESSYS Technology during Percutaneous Transforaminal Endoscopic Discectomy in Postoperative Treatment of Lumbar Disc Herniation

Objective　To compare the clinical efficacy and safety of TESSYS technology in the treatment of lumbar disc herniation with and without a drainage tube.Methods　From January 2015 to March 2016，110 patients with lumbar disc herniation，who underwent percutaneous transforaminal endoscopy using TESSYS technology in the Department of Bone Tumor Surgery of the First Affiliated Hospital of Xinjiang Medical University were enrolled and divided into two groups：the no-drainage group with no drainage tube（n=53） and the drainage group with a drainage tube（n=57），according to the random grouping method of region group.The postoperative drainage volume of the drainage group was observed.The operation time，intraoperative blood loss，hospitalization time，incidence of postoperative complications and the postoperative activity time were compared between the two groups.A visual analogue scale（VAS） and the Oswestry Disability Index（ODI） were completed 1 day before operation，1 day after the operation，1，3 and 6 months after the operation，and 1 year after the operation.Results　The postoperative drainage volume of the drainage group was（50±10） ml，and the duration of drainage tube placement of this group was（26.0±2.2） h.There were no significant differences in operative time，intraoperative blood loss and surgical complications between the two groups（P>0.05）．The duration of hospitalization and the time to be able to stand on the groud after the operation of the patients in the no-drainage group were significantly shorter than those of the patients in drainage group（P<0.05）．There were no correlations between treatment methods or time and the VAS score（Finteraction=2.981，P>0.05）．The effect of treatment on VAS was significant（Ftreatment=20.200，P<0.05），but the effect of time on the VAS score was not significant（Ftime=4.241，P>0.05）．The VAS for the drainage group was significantly higher than that for the no-drainage group on the first day after the operation（P<0.05）．There was no correlation between treatment method and time according to the ODI（Finteraction=2.298，P>0.05）．The treatment method and time had no significant effects on the ODI score（Fgroup=1.090，Ftime=4.391，P>0.05）．Conclusion　Use of the TESSYS technology for percutaneous transforaminal endoscopic discectomy treatment in lumbar disc herniation without drainage tube placement does not increase the incidence of complications，indeed it can reduce postoperative pain as well as shortening the duration of hospitalization and improving postoperative activity.