经皮内窥镜下腰椎间盘切除术治疗腰椎间盘突出症的并发症

【摘要】 目的：回顾性分析经皮内窥镜下腰椎间盘切除术（percutaneous endoscopic lumbar discectomy，PELD）治疗腰椎间盘突出症的并发症及其相关因素。方法：自2006年3月~2010年10月共行经皮内窥镜下腰椎间盘切除术治疗162例腰椎间盘突出症患者，男82例，女80例；年龄21~71岁，平均36.5岁。统计术中、术后早期及术后长期并发症的发生情况。结果：162例患者均获得3~60个月的随访，平均随访30个月。本组患者出现手术并发症共12例，发生率为7.2%。术中发生并发症4例，其中节段定位错误1例，术中活动出血1例，硬膜囊损伤1例，钬激光器械金属头部断裂1例；术后早期发生并发症5例，其中髓核遗漏2例，椎间隙感染1例，神经感觉异常2例；术后中长期并发症3例，2例为同节段椎间盘突出复发，术后遗留活动后明显慢性腰部疼痛1例。结论：经皮内窥镜下腰椎间盘切除术治疗腰椎间盘突出症有一定的并发症，术者的手术经验及技巧、术前准备与术后处理、手术适应证的选择与手术并发症有关。

The clinical analysis of the complications of percutaneous endoscopic lumbar discectomy for lumbar disc herniation

Objectives:To analyze the complications and reasons of percutaneous endscopic lumbar discectomy(PELD) for lumbar disc herniation(LDH).Methods:From March 2006 to October 2010,a total of 162 patients underwent PELD for LDH in our hospital.There were 82 males and 80 females,with a mean age of 36.5 years(range 21-71 years).The complications in intraoperative period and at early or long-middle term in post-operative period were observed.Results:The mean follow-up period was 30 months(range 3-60 months).The total incidence rate of operative complications was 7.2%.There were 4 patients with intraoperative complications:Wrong localization was in 1 patient,Bleeding was in 1 patient,Dural tear was in 1 patient,the head of small laser equipment was broken in 1 patient.There were 5 patients with early postoperative complications,including 1 patient with infection of intervertebral disc and 2 patients had nerve root paraesthesia,2 patients with nucleus remain.There were 3 patients with medium-term complications after surgery including 2 patients had recurrent herniations at same level,1 patient had chronic mobile back pain after surgery.Conclusions:Preoperative proper technical considerations,intraoperative skillful manipulation and the strict selection of the indication are the key point to decrease and prevent operative related complication of PELD.