全麻下可视化椎间孔镜技术治疗腰椎间盘突出症

Visualized percutaneous endoscopic technique for lumbar disc herniation under general anesthesia

[目的]探讨全麻下可视化椎间孔镜技术治疗腰椎间盘突出症的可行性及安全性。[方法] 2015年1月～2017年1月本科收治腰椎间盘突出症患者94例,均采用椎间孔镜技术进行治疗。其中,常规组30例,采用局麻、常规定位和椎间孔镜操作;可视化组64例,采用全麻,可视化定位与操作技术。评估患者的术中疼痛、手术时间、透视时间、住院时间、术后并发症及恢复情况。[结果]两组患者均顺利完成手术,两组均未出现脊髓及神经根损伤等并发症。两组在手术时间、伤口大小、术中出血量、住院天数的差异均无统计学意义(P>0.05)。然而,常规组患者多数术中有不同程度的疼痛,而可视化组患者因全麻术中无疼痛,常规组术中射线曝露时间明显长于可视化组,差异有统计学意义[(10.12±3.24) s vs (1.06±0.18) s,P<0.05]。两组患者平均随访6～12个月,末次随访时,两组的VAS和ODI均显著减少,与术前相比差异有统计学意义(P<0.05),但末次随访时,两组间VAS和ODI的差异均无统计学意义(P>0.05)。[结论]全麻下可视化椎间孔镜技术可显著减轻患者术中疼痛,减少术中X线透视量,提高患者围手术期舒适度。

[Objective] To evaluate the clinical results of visualized percutaneous endoscopic surgeries for lumbar disc herniation under general anesthesia. [Methods] A total of 94 patients underwent percutaneous endoscopic discectomy for lumbar intervertebral disc herniation in our department from January 2015 to January 2017. Of them, 30 patients who had operation performed by routine endoscopic technique under local anesthesia were termed as the routine group, while the remaining 64 patients who operated by visualized endoscopic technique under general anesthesia were enrolled into the visualized group. Intra- operative pain, operation time, intraoperative radioactive exposure time, hospital stay, functional recovery and postoperative complications were compared between the two groups. [Results] All the patients in both groups had surgery conducted smoothly without serious complication, such as nerve root injuries. There were no significant differences between the two groups regarding to operation time, incision length, intraoperative blood loss and hospital stay （P〉0.05） . However, most patients in the routine group experienced some extent of pain, while all patients in the visualized group were painless due to general anesthesia. The routine group had significantly longer radiographic exposure time than the visualized group [（10.12±3.24） see versus （1.06±0.18） sec, P〈0.05] . The patients were followed up from 6 to 12 months. At the latest follow up, the VAS and ODI considerably decreased in both groups compared with those before operation, where were statistically significant （P〈0.05）, despite the facts that no statistical differences were noted between the two groups at any of corresponding time points （P〉0.05）. [Condusion] The visualized percutaneous endoscopic technique under general anesthesia takes advantages of painless operation, reduced radioactive exposure and improved comfortable experience over the routine technique.