脊柱内镜腰椎间盘突出髓核摘除术后早期非计划二次手术原因分析

Analysis of the causes of early unplanned secondary surgery after percutaneous endoscopic lumbar discectomy

目的探究脊柱内镜腰椎间盘突出髓核摘除术(percutaneous endoscopic lumbar discectomy,PELD)后早期非计划第二次手术的发生率及原因。方法回顾分析了2014年12月至2019年2月于北京大学第三医院行PELD的1627例患者,筛选并分析接受早期非计划二次手术的患者的临床资料。结果1627例手术中,有58例接受了早期非计划二次手术,发生率为3.56%。早期非计划二次手术的原因主要为术后症状持续不缓解或持续缓解不明显和术后早期复发。本研究中早期非计划二次手术的发生率随着手术年份的增加与手术例数的积累呈现下降趋势,且早期非计划二次手术发生率与手术累计例数有统计学意义。结论PELD术后早期非计划第二次手术发生率为3.56%。其原因与减压不充分、压迫物残留导致的症状持续不缓解或持续缓解不明显相关,也与术后症状早期复发相关。术者经验是影响早期非计划二次手术的因素。

Objective To explore the incidence and causes of early unplanned secondary surgery after percutaneous endoscopic lumbar discectomy.Methods The clinical data of 1627 patients who underwent percutaneous endoscopic lumbar discectomy in Peking University Third Hospital from Dec.2014 to Feb.2019 were retrospectively analyzed,and the patients who underwent early unplanned secondary surgery were screened out.Results Early unplanned secondary surgery was performed in 58 patients(3.56%).The main reasons for early unplanned secondary surgery are the persistent non-remission of postoperative symptoms or the lack of obvious remission and early postoperative recurrence.In this study,the incidence of early unplanned secondary surgery decreased with the increase of operation year and the accumulation of surgical cases,and the incidence of early unplanned secondary surgery was statistically significant with the number of surgical cases.Conclusions The incidence of early unplanned second surgery after was 3.56%.Early unplanned secondary surgery is associated with residual pressure and early recurrence.The experience of the surgeon is a factor that affects the early unplanned secondary surgery.