椎板开窗与椎间孔镜治疗腰椎间盘突出症术后隐性失血比较分析

目的比较分析椎板开窗减压髓核摘除术(fenestration discectomy,FD)与经皮椎间孔镜技术(percutaneous transforaminal endoscopic discectomy,PTED)治疗腰椎间盘突出症患者术后隐性失血情况。方法选取2015年1月至2018年10月腰椎间盘突出症患者共200例,其中FD、PTED组患者各为100例,记录两组患者一般情况、手术相关指标(手术时间、预计失血量)及手术前后血红蛋白(hemoglobin,Hb)、血细胞比容(hematocrit,HCT),依据Gross循环血量线性方程计算患者总失血量及隐性失血量,对两组患者术后隐性失血进行统计学比较。结果两组患者住院时间差异无统计学意义,PTED组手术时间长于FD组(82.80±20.153)min vs.(70.50±21.009)min](P < 0.05),两组术后血红蛋白PTED组(126.29±15.685)g/L,FD组(134.22±16.046)g/L]较术前PTED组(140.20±16.004)g/L,FD组(140.23±16.422)g/L]均明显降低,差异有统计学意义(P < 0.05);FD组患者术中失血量(127.87±67.120)ml、总失血量(188.25±113.343)ml、总血红蛋白丢失量(13.94±8.492)g/L均多于PTED组术中失血量(5.38±0.700)ml、总失血量(83.18±45.963)ml、总血红蛋白丢失量(5.98±3.725)g/L](P < 0.05),但两组术后隐性失血比较差异无统计学意义(P > 0.05)。结论在治疗腰椎间盘突出症方面,虽然PTED较FD更为微创,但不能显著减少术后隐性失血的发生;术中仔细操作、彻底止血可有效减少术后隐性失血。

Effects of fenestration discectomy and percutaneous transforaminal endoscopic discectomy on postoperative hidden blood loss in the treatment of lumbar disc herniation

Objective To explore effects of fenestration discectomy (FD) and percutaneous transforaminal endoscopic discectomy (PTED) on postoperative hidden blood loss in the treatment of lumbar disc herniation.Methods A total of 200 patients with lumbar disc herniation were enrolled from January 2015 to October 2018,including 100 patients in PD group and 100 patients in PTED group.General conditions,surgery-related indexes(operation time,estimated bleeding volume),hemoglobin (Hb) before and after surgery,and hematocrit (HCT)before and after surgery were recorded.Total blood loss and hidden blood loss were calculated according to Gross linear equation to compare the differences of postoperative hidden bleeding between the two groups.Results There were no significant differences in hospital stay between the two groups.Operation time of the PTED group (82.80±20.153 min) was longer than that of the FD group (70.50±21.009 min) (P < 0.05).Postoperative Hb levelsPTED (126.29±15.685 g / L),FD (134.22±16.046 g / L)]of the two groups were significantly lower than those preoperativelyPTED (140.20±16.004 g / L),FD (140.23±16.422 g / L)](P < 0.05).The intraoperative blood loss (127.87±67.120 ml),total blood loss (188.25±113.343 ml) and total Hb loss (13.94±8.492 g / L) of the FD group were significantly more than that of the PTED group(5.38±0.700 ml),(83.18±45.963 ml),(5.98±3.725 g / L)](P < 0.05).No significant differences in the postoperative hidden blood loss were noted between the two groups(P > 0.05).Conclusions PTED is more minimally invasive than FD,but it can not significantly reduce postoperative hidden blood loss in the treatment of lumbar disc herniation.Careful operation and hemostasis can effectively reduce postoperative hidden blood loss.