经皮椎间孔镜下腰椎间盘摘除术并发症分析

目的:分析局麻下经皮椎间孔镜技术在治疗腰椎间盘突出症的并发症,探讨如何避免椎间孔镜手术并发症的发生。方法:对2013年10月至2015年6月采用经皮椎间孔镜下腰椎间盘摘除术治疗的132例腰椎间盘突出症患者进行回顾性分析,其中男85例,女47例;平均年龄42.9岁;L3,4突出6例,L4,5突出68例,L5S1突出58例。统计术中、术后并发症发生率,分析各类并发症发生原因。结果:132例患者中,术中发生硬膜损伤1例(硬膜与髓核粘连),术后未出现脑脊液漏,术后肌力感觉较术前无下降,创口愈合良好;术中减压不满意立即改为开放手术2例,为伴有椎间孔狭窄及髓核粘连患者,均取得满意疗效;短期(3个月)内复发2例,术后髓核残留3例,均通过翻修手术治疗,取得满意疗效;术后发生室上性心动过速1例,经询问原有心脏病史。术中发生高脑脊液压2例。结论:经皮椎间孔镜学习曲线陡峭,初学者在开始椎间孔镜手术前,必须有一定的开放手术经验,严格把握手术指征。在熟悉解剖和经皮椎间孔镜技术的前提下,经皮椎间孔镜下治疗腰椎间盘突出症是安全可靠的。

Analysis of complications of percutaneous endoscopic lumbar discectomy

Objective: To analyze the complications of lumbar intervertebral disc herniation treated with percutaneous endoscopic lumbar discectomy(PELD),and discuss how to avoid these complications.Methods: The data of 132 patients with lumbar intervertebral disc herniation underwent PELD from October 2013 and June 2015 were retrospectively analyzed,including 85 males and 47 females with an average age of 42.9 years old. There were 6 cases of L_3,4,68 of L_4,5 and 58 of L₅S₁. The incidences of intraoperative and postoperative complications were analyzed.Results: There was spinal dura mater injury in 1 patient,but no cerebrospinal fluid leakage and nerve function deficit was found,the muscle strength did not decrease postoperatively and the incision healed well. Two patients converted to open surgery ultimately because of stenosis of the intervertebral foramen and adhesion between nucleus pulposus and spinal dura mater;two patients complicated with early recurrence(in 3 months);nucleus pulposus residue developed in 3 patients;all of them were treated by open surgery and got satisfactory results. One patient with heart disease history complicated with supraventricular tachycardia after surgery and 2 patients with the increased cerebrospinal fluid pressure during surgery.Conclusion: PELD have a steep learning curve,and the technology is a safe and effective method in treating lumbar disc herniation,but the beginners must have enough open surgery experience,and to grasp indications strictly.