日间手术模式下开展经皮椎间孔镜手术治疗腰椎间盘突出症的综合效益分析

Comprehensivebenefit analysis of percutaneous intervertebral foramen surgery for prolapse of lumbar intervertebral disc under day operation mode

目的探讨日间手术模式下开展经皮内窥镜下腰椎间盘摘除术(percutaneous endoscopic lumbar discectomy,PELD)的可行性和综合效益。方法回顾性分析本院于2018年3月-2019年3月接受PELD手术(日间手术模式45例,常规住院模式58例)的腰椎间盘突出症(lumbar disc herniation,LDH)患者临床资料,对两组患者的手术疗效、住院时间、医疗费用、术后并发症等情况进行比较分析。结果日间手术组的住院时间显著短于常规住院组、医疗费用明显少于常规住院组,差异有统计学意义(P<0.05)。日间手术组有2例、常规住院组1例术后出现患侧下肢感觉障碍,均经对症治疗后好转;两组患者均无其他严重并发症出现。两组患者术后3个月和1年的下肢痛VAS评分、腰痛VAS评分和ODI指数均获得显著改善(P<0.05),且组间差异无统计学意义(P>0.05);术后1年按Macnab标准评价总体疗效,日间手术组和常规住院组的优良率分别为88.9%和91.4%,差异无统计学意义(P>0.05)。结论日间手术模式下开展PELD的疗效与常规住院模式相近,并未增加手术并发症,显著缩短了患者住院时间、减轻了医疗费用,有推广应用前景。

Objective To explore the feasibility and comprehensive benefits of percutaneous endoscopic lumbar discectomy(PELD)under day surgery mode.Methods The clinical data of patients with lumbar disc herniation(LDH)who underwent PELD surgery(45 cases in day surgery mode and 58 cases in routine hospitalization mode)from March 2018 to March 2019 were retrospectively analyzed.The surgical efficacy,hospital stay,medical expenses,postoperative complications and other conditions of the two groups were compared and analyzed.Results The hospitalization time of the day surgery group was significantly shorter than that of the conventional hospitalization group,and the medical expense was significantly less than the conventional hospitalization group.The differences were statistically significant(P<0.05).There were 2 patients in the day surgery group and 1 patient in the routine hospitalization group who experienced postoperative sensation of the lower extremities after the symptomatic treatment.All patients in the two groups showed no other serious complications.The VAS score of lower limb pain,VAS score of lower back pain and ODI index of the two groups were significantly improved at 3 months and 1 year after operation(P<0.05),and there were no statistically significant differences between the two groups(P>0.05).One year after operation,the overall efficacy was evaluated according to Macnab criteria.The excellent and good rates of the day surgery group and the routine hospitalization group were 88.9% and 91.4%,respectively,with no statistically significant difference(P>0.05).Conclusion The efficacy of PELD under the day surgery mode is similar to the conventional hospitalization mode.It does not increase the surgical complications,significantly shortens the hospitalization time of the patients,reduces the medical expenses,and has the prospect of promotion and application.