扩大操作口电视辅助内窥镜下脊柱前路手术的探讨(附14例报告)

Video assisted thoracoscopic surgery of enlarged manipulative incision for spinal surgery through anterior approach:a report of 14 cases

目的：探讨借助影像内窥镜扩大操作切口直视下脊柱前路手术的安全性和适用性。方法：双腔导管气管内插管麻醉下侧卧位，操作切口５ｃｍ长，采用电视辅助内窥镜系统光源，直视下操作，完成８例脊柱胸椎结核病灶清除及植骨融合，３例脊柱肿瘤瘤体切除椎间植骨术，２例脊柱骨折脊髓减压及内固定术，１例后凸畸形矫正内固定及植骨融合术。结果：手术均获成功。术中平均出血量４６０ｍｌ，平均手术时间２４２ｍｉｎ，术后平均引流量３９４ｍｌ。术后影像学评价病灶清除减压彻底。术后并发肺不张２例，胸腔积液１例，右肢体麻木１例，经治疗痊愈。结论：扩大操作口借助影像内窥镜系统直视下脊柱前路手术安全，创伤较小。

Objective:To discuss the security and suitability of the anterior approach of spinal surgery with vedio assisted thoracoscopy.Method:Fourteen patients were treated with the anterior approach of spinal surgery with vedio assisted thoracoscopy,including eight cases of thoracic tuberculosis,three of spinal tumor,two of vertebral fracture and one case of hyphosis,under double cavity intratrachea incubation anesthesia.The length of the incision was only 5cm.Result:All these operation were successful and the mean bleeding was 460ml,the mean operative duration was 242 minutes and mean drainage volume 394ml,drainage time 3 3days and mean duration of pain after operation was 2 3 days.The radio evaluation was excellent except complication of two atelectasisand,one thoracic hydrops and one extremity numbness.Conclusion:Video assisted thoracoscopic surgery of enlarged manipulative incision for spinal surgery through anterior approach has the advantage of security less tauma and bleeding. Authors address\ Orthopedics of 2nd Hospital of Wenzhou Medical College,Wenzhou,Zhejiang,325027