经皮内镜下腰椎间盘切除术围手术期并发症的临床研究

A clinical research on perioperative complications of percutaneous endoscopic lumbar discectomy

[目的]研究分析经皮内镜下腰椎间盘切除术治疗腰椎间盘疾病的围手术期并发症发生情况及预防措施。[方法]对2013年3月~2016年3月接受经皮内镜下腰椎间盘切除术的478例腰椎间盘疾病患者的临床资料进行回顾性分析。将术中及术后1个月内发生的与手术直接相关的不良事件纳入围手术期并发症范畴,手术导致患者新的损害于术后30 d内改善者定义为短暂并发症,超过30 d无改善者定义为持久并发症。统计分析并发症发生情况,并总结原因及对策。[结果]478例患者中共有78例患者发生围手术期并发症82项,围手术期并发症发生率为16.32%(78/478);82项并发症中4例发生4项持久并发症,74例发生短暂性并发症78项;不同腰椎间盘病变并发症发生率分别为:旁中央或中央型突出13.47%(26/193),椎间盘突出并椎管狭窄15.19%(12/79),腰椎术后复发33.96%(18/53),腰椎双节段突出者15.22%(7/46),脱出游离型13.95%(6/43),极外侧型突出14.29%(5/35),椎间盘源性腰痛者13.79%(4/29)。[结论]经皮内镜下腰椎间盘切除术围手术期并发症主要有下肢感觉异常、下肢肌力减退、术后局部血肿形成、椎体终板炎、硬膜破裂、导丝断裂、术中休克等,其中下肢感觉异常是最常见并发症,腰椎术后复发者围手术期并发症发生率较高。

[Objective] To study the occurrence and preventive measures of perioperative complications of percutaneous en- doscopic lumbar discectomy for treatment of lumbar intervertebral disc disease. [Methods] A retrospective study was conducted on the clinical data of 478 patients who were treated by percutaneous endoscopic lumbar discectomy for lumbar disc disease from March 2013 to March 2016. The adverse events directly related to the surgery, happened during surgery or within a month after operation, were defined as the perioperative complications. The new damages by surgery lasted for less than or equal to 30 days after surgery were termed as the transient complications, whereas those more than 30 days without improvement were termed as persistent complications. The incidence various complications happened in the 478 patients was statistically ana- lyzed. [Results] Among the 478 patients, 82 perioperative complications happened in 72 patients, with incidence of 16.32%. Of the 82 complications, 4 were persistent, whereas the remaining 74 proved transient complications. In term of lesion types, the in- cidence of perioperative complications was 13.47% in paramedian or central herniation, 15.19% in intervertebral disc hernia- tion combined with spinal stenosis, 33.96% in recurrent lumbar disc herniation after the primary operation, 15.22% in lumbar double segment herniation, 13.95% in prolapsed and sequestered herniation, 14.29% in extremely lateral herniation, and 13.79% in lumbar discogenic pain. [Conclusions] The common complications of percutaneous endoscopic lumbar discectomy include lower limb sensory abnormalities, muscle weakness, hematoma formation, vertebral endplate inflammation, dural tear, guidewire fracture, and intraoperative shock and so on. Of them, the lower limb sensory abnormality is the most common complication. The incidence of perioperative complications is higher in patients with recurrent lumbar disc herniation.