全身麻醉与硬膜外麻醉下经椎板间入路脊柱内镜治疗L_(5)/S_(1)椎间盘突出症的疗效比较

Comparison of the Efficacy of Percutaneous Endoscopic Interlaminar Lumbar Discectomy Under Epidural and General Anesthesia for L_(5)/S_(1) Lumbar Disc Herniation

目的对比全身麻醉与硬膜外麻醉下经椎板间入路经皮脊柱内镜腰椎间盘切除术(percutaneous endoscopic interlaminar lumbar discectomy,PEILD)治疗L_(5)/S_(1)椎间盘突出症(lumbar disc herniation,LDH)的疗效。方法回顾性分析2018年8月-2020年12月70例L_(5)/S_(1) LDH行PEILD的临床资料,患者术前随机分组,全身麻醉组35例,硬膜外麻醉组35例。比较2组手术时间、术后住院时间、住院费用,术前及术后第3、6、12个月采用视觉模拟评分(Visual Analogue Scale,VAS)、Oswestry功能障碍指数(Oswestry Disability Index,ODI)评价疼痛减轻和功能恢复情况,比较术后(出院当天)患者满意率、住院期间并发症及术后12个月复发率。结果与全身麻醉组相比,硬膜外麻醉组住院费用少[(1.3±0.1)万元vs.(1.5±0.1)万元,[t=8.27,P=0.00],患者满意率高[94%(33/35)vs.77%(27/35),χ^(2)=4.20,P=0.04]。2组手术时间、住院期间并发症发生率、术后各时点VAS和ODI、术后12个月复发率差异均无统计学意义(P>0.05)。2组术后各时点VAS、ODI均较术前明显改善(P<0.05)。结论全身麻醉与硬膜外麻醉下PEILD治疗L_(5)/S_(1) LDH疗效相当,但后者可降低住院费用,术后患者满意率更高。

Objective To compare the short-term clinical efficacy of general anesthesia(GA)and epidural anesthesia(EA)for treatment of L_(5)/S_(1) lumbar disc herniation(LDH)by percutaneous endoscopic interlaminar lumbar discectomy(PEILD).Methods The clinical data of 70 cases of L_(5)/S_(1) LDH undergoing PEILD from August 2018 to December 2020 were analyzed retrospectively,including 41 males and 29 females,aged from 17 to 86 years old,with an average age of(44.9±13.0)years old.Patients were randomly divided into a general anesthesia group of 35 cases and an epidural anesthesia group of 35 cases before surgery.The operation time,postoperative hospital stay,hospital cost,visual analog score(VAS)and Oswestry disability index(ODI)were used to evaluate pain relief and functional recovery at 3,6 and 12 months before and after operation.The postoperative(discharge day)patient satisfaction rate,hospitalization complications,and postoperative recurrence rate at 12 months were compared.Results Compared with the general anesthesia group,the epidural anesthesia group had lower hospitalization expenses[(1.3±0.1)thousand yuan vs(1.5±0.1)thousand yuan],[t=8.27,P=0.00],and a higher patient satisfaction rate[94%(33/35)vs 77%(27/35),χ^(2)=4.20,P=0.04].All patients were followed up for 12 months.The postoperative VAS score and ODI of the two groups were significantly improved compared with those preoperative(P<0.05).There was no statistically significant difference in surgical time,incidence of complications during hospitalization,VAS and ODI at each postoperative time point,and recurrence rate at 12 months between the two groups(P>0.05).Both groups showed significant improvement in VAS and ODI at all time points after surgery compared to before surgery.Conclusion GA group had the same clinical efficacy as EA group for treatment of L_(5)/S_(1) LDH by PEILD.However,compared with GA group,EA group had lower hospitalization cost and higher satisfaction rate.