内窥镜下髓核摘除术常见问题与对策(附570例分析)

Complications and the solution of microendoscopy discectomy: a 570 cases report

[目的]分析内窥镜下后路椎间盘髓核摘除术常见的并发症并探讨对策。[方法]对570例腰椎间盘突出症患者,经临床症状、体征和影像资料明确诊断且具有手术指征采用后路内窥镜下髓核摘除术治疗,对其中出现的并发症进行原因分析。[结果]570例中出现并发症的有26例,包括损伤椎体前方大血管、神经症状加重、脑脊液漏、感染等近期并发症和复发、腰椎失稳等远期并发症。术后神经症状加重5例,占19.1%,复发8例,占30.7%。主要与手术适应证选择正确与否、影像学资料阅读能力高低、术者操作技能熟练程度等因素有关。[结论]内窥镜下后路髓核摘除术是外科治疗椎间盘突出症的一种优良方法,术后神经症状加重和复发是最常见的并发症,正确把握手术适应证、熟练掌握操作技巧、提高并发症的诊断和处理能力是顺利开展该技术、提高临床疗效的关键。

[ Objective] To analyze the reason of complications of microendoscopy discectomy （MED） and to research the solution. [ Method ] Twenty two cases of complications were found in a total of 570 cases of lumbar disc herniation （ LDH ）, the reasons were investigated. [ Result] Complications included bleeding, neural deficit worsening, infection, reoccurring, dural tears, instability of lumber. Neural deficit worsening occurred in 5 cases （ 19. 1% ） ; the reoccurring involved 8 cases （30. 7% ）. The reasons of complications involved failure of indication selection, insufficient image reading capability and lack of practiced skill. [ Conclusion] MED is an effective treatment for LDH, while postoperative worsening of neural function and reoccurring are common complications. It is key point to choose proper indicating, having practiced skill and improve the level of diagnosing and managing relevant complications.