腰椎间盘镜治疗腰椎间盘突出症术后并发症分析及其防治对策

目的：探讨后路腰椎间盘镜（Microendoscopic Discectomy，MED）治疗腰椎间盘突出症术后发生围手术期并发症的原因及其防治对策。方法：回顾分析我院2001年5月～2005年4月期间所有行MED手术的椎间盘突出症患者共412例，对其所发生的围手术期并发症进行归类统计并分析原因和对策。结果：各类围手术期并发症发生的总例数为26例，发生率为6．31％。其中椎管内血管破裂7例（其中术后发生迟发性血肿引起马尾神经压迫1例）；单纯硬脊膜撕裂6例（其中2例术后发生脑脊液漏）；硬脊膜破裂合并马尾神经束损伤2例；神经根损伤4例、（铅夹伤3例，牵拉伤1例）；突出椎间盘摘除和／或侧隐窝扩展不足3例；术后椎间隙感染2例；术中定位错误2例。按Nakai分级：优206例，良184例，可14例，差8例，优良率94．66％。结论：术者经验、技术水平、操作技巧以及手术适应症的选择与MED围手术期并发症有关，合理选择适应症、熟练掌握腰椎手术技巧及器械操作技术、术中充分显露仔细操作、C形臂X线机定位及彻底止血是减少并发症的关键。

Analyses of the Complications of Lumbar Disc Surgery with Microendoscopic Discectomy System

Objective:To investigate the causes and the prevention of perioperative complications after MicroEndoscopic Discectomy System(MED).Methods:Four hundred and twelve cases were treated by microendoscopic discectomy system from May 2001 to April 2005 in our hospital.Results:In all 26 cases with complication,lumbar epidural space vascular bleeding happened in 7 cases,dural rupture in 6,dural rupture accompanied with nerve injury in 2,nerve root damage in 4,operative omission in 3,postoperative infection in 2,and wrong localization in 2,respectively.Conclusion: Perioperative complications of MED are related to various factors,but surgens'clinical experiences of MED manipulation and the right indication are the most important factors for prevention of patients from the complications.