显微内窥镜下腰椎间盘摘除和传统开放手术治疗腰椎间盘突出症的Meta分析

Microendoscopy discectomy versus open lumbar disectomy for lumbar disc herniation:A Meta-analysis

背景:显微内窥镜手术系统将传统开放手术和显微内镜技术相结合,将传统的髓核摘除内镜化、微创化。与传统开放手术相比,显微内窥镜腰椎间盘摘除可放大手术野、有良好的照明系统,术者视野更清晰,操作更为精细,对周围组织的损伤也较小。目的:对显微内窥镜下腰椎间盘摘除和传统开放手术治疗腰椎间盘突出症的疗效及临床价值进行评价。方法:按照Cochrane系统评价的方法,计算机检索Medline(1990-01/2010-03)、Embase(1990-01/2010-03)、Cochrane图书馆及中国生物医学数据库(1990-01/2010-03),并采用手工检索等方法收集会议文献。文献检索无语种限制。收集所有相关随机对照试验,采用Cochrane协作网提供的软件Revman5.0进行Meta分析,以获得显微内窥镜下腰椎间盘摘除和开放手术治疗腰椎间盘突出症的疗效是否有差异的相关证据。结果与结论:共纳入12个研究,包括1748例腰椎间盘突出症患者。进行Meta分析结果显示,显微内窥镜手术的操作时间与传统开放手术无明显差异,但在术中出血量、术后卧床时间和住院时间上优于传统开放手术。提示显微内窥镜手术是一种治疗腰椎间盘突出症理想的微创手术方式。

BACKGROUND：Microendoscopy system combines traditional open surgery and microendoscopy and is minimally invasive.Moreover,compared with traditional open operation,microendoscopy discectomy can enlarge operating field,enhance illumination system,and reduce surrounding tissue injury.OBJECTIVE：To compare the surgical outcome and investigate the clinical value between microendoscopy discectomy and open lumbar disectomy in the treatment of lumbar disc herniation.METHODS：A computer-based online search of Medline（1990-01/2010-03）,PubMed,Embase（1990-01/2010-03）,Cochrane Library,and Chinese Biomedical Literature Database was performed,and conference references were manually searched.Using the Cochrane Collaboration guidelines,all randomized controlled trials comparing open lumbar disectomy and microendoscopy discectomy were systematically reviewed.The Cochrane Collaboration＇s RevMan 5.0.1 software was used for data analyses.RESULTS AND CONCLUSION：A total of 12 studies involving 1 748 patients were included.The results of meta-analyses showed that there were no significant differences in the treatment outcome and the operation time between open lumbar disectomy and microendoscopy discectomy;microendoscopy discectomy was superior to open lumbar disectomy in intraoperative blood loss,time in hospital and the time out of bed after operation.Microendoscopy discectomy is an ideal minimally invasive surgery to treat lumbar disc herniation.