经腹穿刺腰椎椎间盘髓核摘除术的临床应用  

Clinical application of transabdominal lumbar discectomy

作　　者：姜文进[1] 生琦瑞[1] 郑延波[1] 宋雪鹏[1] 刘胜[1] 孙博琳[1] 王涛[1] 

机构地区：[1]青岛大学医学院附属烟台毓璜顶医院介入放射科,山东烟台264000

出　　处：《介入放射学杂志》2009年第2期132-135,共4页Journal of Interventional Radiology

摘　　要：目的评价经腹穿刺腰椎椎间盘髓核摘除术(TALD)的疗效和安全性。方法522例腰椎椎间盘突出症患者采用压腹定位仪腹部施压避开肠管及血管,空心针穿刺椎间盘前缘,逐级套管建立手术通道,经反复钳取髓核组织及负压切吸,实现椎间盘突出部位直接减压。术后随访6～48个月并对随访结果进行统计学分析。结果522例患者中520例完成TALD,2例因严重肠粘连无法压开肠管而放弃手术,1例术后并发乙状结肠损伤及椎间盘感染。手术穿刺成功率99.4%,无血管及神经损伤等并发症,总有效率93.3%。结论经腹穿刺腰椎椎间盘髓核摘除术能直接摘除突出部位的椎间盘组织,达到直接减压的效果,手术安全性高,创伤小,疗效好。TALD可作为L5～S1椎间盘突出的常规术式,为L2～L5椎间盘突出的一种补救方式,L1～L2椎间盘不宜行TALD治疗。Objective To evaluate the safety and efficacy of transabdominal lumbar diskectomy （TALD）. Methods Digestive tract radiography was performed in 522 patients with intervertebral disc herniation before TALD. In order to keep the needle away from the bowel and vessels, pressure was exerted on the abdomen when puncture with hollow needle was carried out. Operative passage was established by successive exchange of cannula. Under fluoroscopic or CT guidance, the nucleos pulposus was directly taken out from the site of herniation by clamping and suction of it. The patients were followed up for 6 - 48 months and therapeutic results were statistically analyzed. Results Of 522 eases, technical success was achieved in 520 （99.4%） and failure due to severe intestinal adhesion caused by previous abdominal surgery occurred in 2. One patient developed sigmoid colon injury and intervertebral disc infection after the procedure. No complications affecting vessels or nerves occurred. Conclusion As a safe, less invasive and reliable technique, TALD is of value in treating intervertebral disk herniation. TALD may be regarded as a routine alternative for the treatment of L5 - S1 disk herniation, or as a retrieval measure for L2 - L5 disk herniation, although it is not suitable for the treatment of L 1 - L2 disk herniation. （J Intervent Radiol, 2009, 18：132-135 ）

关 键 词：腰椎间盘 髓核摘除术 经腹穿刺 放射学 介入性 

分 类 号：R687[医药卫生—骨科学]