电视胸腔镜辅助下小切口前路手术治疗胸椎疾病  

Video-assisted thoracoscopic mini-thoracotomy of anterior approach to treat thoracic spine diseases

作　　者：董健[1] 陈瑜[1] 李熙雷[1] 张磊[1] 周晓岗[1] 

机构地区：[1]复旦大学附属中山医院

出　　处：《脊柱外科杂志》2007年第4期213-217,共5页Journal of Spinal Surgery

摘　　要：　目的评价电视胸腔镜辅助下小切口胸椎前路手术的创伤、安全性、临床疗效和应用价值。方法回顾性分析2005年2月-2007年4月我院施行电视胸腔镜辅助下小切口胸椎前路手术17例。对照组在均衡年龄、性别和疾病构成的条件下，选择开胸脊柱前路手术22例。对两组的围手术期参数、并发症和临床疗效进行比较研究。结果①围手术期参数：小切口组在切口长度、术中出血量、胸痛持续时间、胸腔引流量和住院时间与开胸组有显著性差异（P〈0．05）；两组手术时间和胸腔引流时间无显著性差异（P〉0．05）。②术后并发症：小切口组2例（11．8％）；开胸组3例（13．6％），无显著性差异（P〉0．05）。③临床疗效：小切口组平均随访15．8个月，开胸组平均随访17．6个月。胸背痛缓解率两组均为100％。两组神经功能恢复比较无显著性差异（P〉0．05）。小切口组术后影像学显示病灶清除彻底，脊髓减压充分，内固定效果确切。随访期间未见上下椎体肿瘤及结核的复发或神经功能障碍的加重，未见内固定物松动或断裂。结论电视胸腔镜辅助下小切口胸椎前路手术，与传统开胸手术相比，具有对组织创伤小、术中出血少、恢复快等优势，能安全、有效地应用于胸椎疾病的前路手术治疗。Objective To evaluate the surgical trauma, safety, clinical outcome and clinical application of video-assisted thoracoscopic mini-thoracotomy for anterior thoracic spinal surgery. Methods Retrospectively analyze 17 cases of video-assisted thoracoscopic mini-thoracotomy in treating thoracic spine diseases by anterior approach in our hospital from February 2005 to April 2007. Twenty-two patients of open thoracotomy for anterior thoracic spinal surgery with the same range of age, sex and diseases were selected to comparing group. Perioprative parameters, complications and clinical outcome were compared between the two groups. Results （1） Perioprative parameters including the length of incision, the volume of blood loss, the duration of pain after surgery, the volume of drainage and hospital stay in mini-thoracotomy group were less than those in open thoracotomy group （ P 〈0.05）. However, there were no statistic differences in operating time and duration of wound drainage. （2） Complications： There were 2 cases in mini-thoracotomy group and 3 cases in open thoracotomy group （ P 〉 0. 05 ）. （3） Clinical outcome： The mean duration of follow-up was 15.8m in mini-thoracotomy and 17.6m in open thoracotomy. The relief of thoracic and back pain of all patients in the two groups was 100 percent, Recovery of neurological function was almost the same in two groups （ P 〉 0.05）. No recurrence of neoplasm or tuberculosis was found at follow-up, and no aggravation of neural deficit and no loosening or breakage of internal fixation was observed. Conclusion Video-assisted thoracoscopic mini- thoracotomy of the anterior approach to thoracic spine can decrease surgical trauma, bleeding volume and length of hospitalization and can be used safely and effectively in the treatment of thoracic spinal diseases.

关 键 词：胸椎 脊柱疾病 胸腔镜 内固定器 

分 类 号：R681.532[医药卫生—骨科学]