两种经皮脊柱内镜术式治疗腰椎管狭窄症的并发症分析  

Analysis and preventive measures of complications of percutaneous spinal endoscopic decompression for patients with lumbar spinal stenosis in two procedures: transforaminal or posterior approach

作　　者：辛志军 郑国权[1] 廖文波[2] 张西峰[1] 黄鹏[1] Xin Zhijun;Zheng Guoquan;Liao Wenbo;Zhang Xifeng;Huang Peng(Department of Orthopaedic Surgery, Chinese People＇s Liberation Army General Hospital, Beijing 100853, China;Department of Orthopaedic Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi 563000, China)

机构地区：[1]解放军总医院骨科,北京100853 [2]遵义医学院附属医院骨科,563000

出　　处：《中华腔镜外科杂志（电子版）》2018年第2期107-112,共6页Chinese Journal of Laparoscopic Surgery(Electronic Edition)

摘　　要：目的统计经椎间孔入路与经后路脊柱内镜减压术式(percutaneous spinal endoscopic decompression,PSED)治疗腰椎管狭窄症的并发症,分析原因并探讨其防治策略。方法选取2014年6月至2016年5月解放军总医院单一脊柱外科日间手术中心行PSED治疗的276例(男147例、女129例)腰椎管狭窄症患者为研究对象,其中经椎间孔入路脊柱内镜减压术(transforaminal percutaneous spinal endoscopic decompression,t-PSED)治疗193例(A组),经后方入路脊柱内镜环神经减压术(posterior approach percutaneous spinal endoscopic decompression,p-PSED)治疗83例(B组),统计两组的并发症情况并比较其发生率,分析并发症原因,探讨其防治策略。结果共15例(5.4%,A组8例、B组7例)患者发生并发症,其中包括硬脊膜破裂3例(A组1例、B组2例),均术毕严密缝合切口后愈合;不完全性神经损伤3例(A组1例、B组2例),对症治疗后6个月内症状缓解;术中严重出血2例及术后血肿形成1例(A组),加压包扎后控制并愈合;术中类脊髓高压综合征2例(B组),经调整冲洗液灌注压及短暂停歇手术后,症状缓解并得以最终完成手术;减压不彻底4例(A组3例、B组1例),仅1例行PSED返修术。无死亡,无截瘫、感染等严重并发症发生。结论相比p-PSED术式,t-PSED术式的整体并发症发生率相似,但类脊髓高压综合征明显低于前者。术前明确诊断、精准评估并严格把握适应证,术中精细操作、仔细止血、彻底减压可以有效减少并发症的发生。另外,术中及术后的合理处理可有效控制或阻止并发症进一步恶化。Objective To analyze the reasons of complications of lumbar spinal stenosis（LSS）treated by transforaminal or posterior approach percutaneous spinal endoscopic decompression（PSED）,and explore the treatment and prevention strategies. Methods From Jun. 2014 to May 2016,the complications of 276 patients with LSS who treated with PSED were recorded and analyzed retrospectively. Among them,193 patients treated with transforaminal PSED（t-PSED） and 83 patients were treated with posterior approach PSED（p-PSED）. The treatment and preventive measures of the complications were summarized.Results With a mean of（14. 6 ± 1. 3） months＇ follow-up,neither mortalities nor any major neurologic complications were occurred in each patient. While,15 in 276（5. 4%） patients suffered complications have been encountered,included 3 cases dural tear,but no cerebrospinal fluid leakage was found after close the wound at the end of the operation; 3 cases nerve root injury,and all of them were got satisfactory results in six months; 2 cases of severe hemorrhage and 1 case of postoperative hematoma,all of the 3 cases were controlled after pressure dressing; venous hypertensive myelopathy was found in 2 cases, cured after intraoperative symptomatic treatment; 4 cases with imaging showed that the decompression was not complete,but only one of them underwent a second PSED and got satisfactory result. Conclusions PSED is a minimally invasive surgery option for treatment of patients with LSS. Whereas,as a technically demanding and complication-fraught procedure, especially for beginners, PSED should be precise evaluation and planning before operation,careful hemostasis and meticulous performance during operation,and careful management after operation to achieve satisfactory results while avoiding complications occurred.

关 键 词：微创脊柱外科 脊柱内镜 腰椎管狭窄症 并发症 防治策略 

分 类 号：R687.3[医药卫生—骨科学]