微创腹膜外入路技术在腰椎前路手术中的应用  

MinMnvasive extraperitoneal approach for anterior lumbar surgery

作　　者：苗军[1] 夏群[1] 胡永成[1] 张继东[1] 徐宝山[1] 白剑强[1] 周静[1] 

机构地区：[1]天津医院脊柱外科,300211

出　　处：《中华医学杂志》2009年第23期1607-1610,共4页National Medical Journal of China

摘　　要：目的研究微创腹膜外入路技术应用在腰椎前路手术中。方法采用微创腹膜外入路对52例患者进行腰椎前路手术，术前诊断有腰椎退变性失稳23例，腰椎间盘源性疼痛25例，腰骶部椎体先天畸形2例，腰椎后路髓核摘除术后翻修2例。手术方式包括前路椎间Cage融合32例，人工腰椎间盘置换20例。手术间隙均为L4-5或L5-S1间隙，单间隙47例，两间隙5例。记录手术时间、出血量、并发症、术后下地时间、切口长度、腹部切口疼痛情况、术后住院时间。结果全部患者均顺利完成手术，并没有因显露不充分而延长切口的。手术时间平均85min，失血量平均155ml，术后下地时间平均3d，切口长度平均6．5cm，术后切口部仅有轻度疼痛，术后住院时间7～10d。1例术中出现腔静脉分叉处撕裂，2例出现腹膜撕裂，3例出现术后腹胀，5例出现术后低热，男性病例没有出现逆行射精。结论微创腹膜外入路能很好的显露椎体和椎间盘，并发症发生率较低，脊柱周围组织损伤很小，利于患者早期康复。Objective To study a mini-invasive extraperitoneal approach to lumbar spine and discuss its exposure technique, complications and management. Method Anterior lumbar surgery was performed in 52 patients via the mini-invasive anterior extraperitoneal approach. Diagnoses included lumbar degenerative instability （ n = 23 ） , discogenic lumbar pain （ n = 25 ） , lumbosacral congenital deformity （ n = 2） and revision after posterior laminectomy ＆ disectomy （n =2）. The patients underwent anterior lumbar interbody fusion （ n = 32） and total disk replacement （ n = 20）. The operated disks included L4-5 and L5-Sr There were single level （ n = 47） and double level （ n = 5） . Operation time, blood loss, perioperative complications, postoperative bed-leaving time, incision length, pain of abdomen incision and postoperative hospitalization duration were recorded in details. Results All cases were exposed clearly and no one needed to prolong incision or change operation for an insufficient exposure. Average operation time was 85 min, average blood loss 155 ml, average postoperative bed-leaving time 3 days and average incision length 6. 5 cm. All cases felt very little pain of abdominal incision and postoperative hospitalization duration was 7-10 days. Perioperative complications included vena cava tear （ n = 1 ）, peritoneum tear （ n = 2）, postoperative abdominal distention （n = 3 ） and postoperative fever （n = 5 ）. No retrograde ejaculation was found in all male cases. Conclusion The technique of mini-invasive extraperitoneal approach to anterior lumbar has such multiple advantages as fewer complications, less trauma, excellent exposure to anterior vertebrae and disk and without destruction of posterior spinal component.

关 键 词：椎间盘 腰椎 脊柱融合术 

分 类 号：R686[医药卫生—骨科学]