经皮腰椎内镜不同入路方式的围术期失血分析

Perioperative blood loss in different approaches by percutaneous endoscopic discectomy

目的比较经皮内镜下腰椎椎板间隙入路与椎间孔入路髓核摘除术的围手术期失血情况,为临床手术方式的恰当选择提供借鉴。方法回顾性分析2019年6月至2020年11月行经皮内镜下腰椎髓核摘除术治疗的160例患者的临床资料,其中经椎板间隙入路组与经椎间孔入路组各80例。根据Gross公式计算失血量。结果经椎板间隙入路组的围手术期总失血量(mL)、隐性失血量(mL)和血红蛋白损失量(g/L)均小于经椎间孔入路组(119.73±179.26 vs.158.6±190.65、109.73±179.53 vs.148.78±190.19、3.76±8.12 vs.4.31±7.62),差异有统计学意义(P<0.05)。但两组显性失血量差异无统计学意义。结论经皮内镜下腰椎髓核摘除术围手术期隐性失血占总失血量比例大,而经椎板间隙入路患者失血量少于经椎间孔入路患者。

Objective To compare the perioperative blood loss between interlaminar and transforaminal approaches by percutaneous endoscopic discectomy in order to provide more reference for guiding the proper choice of surgical methods clinically.Methods We retrospectively analyzed the clinical data of 160 patients who underwent percutaneous endoscopic lumbar discectomy from June 2019 to November 2020,with 80 patients in interlaminar approach group and 80 in transforaminal approach group.The blood loss was calculated according to Gross formula.Results The perioperative total blood loss(mL),hidden blood loss(mL)and hemoglobin loss(g/L)were significantly lower in interlaminar approach group than in transforaminal approach group(119.73±179.26 vs.158.6±190.65,109.73±179.53 vs.148.78±190.19,3.76±8.12 vs.4.31±7.62)(P<0.05).However,there was no significant difference in visible blood loss between the two groups.Conclusion The perioperative hidden blood loss accounts for a large proportion in percutaneous endoscopic lumbar discectomy.In addition,the interlaminar approach causes less blood loss than the transforaminal approach.