椎间孔镜术后放置引流管的临床对比研究

Clinical comparative study of drainage tube placement after the operation of percutaneous endoscopic lumbar discectomy

目的探究椎间孔镜术后放置引流管的临床意义及有效性。方法将2019年1月~2019年9月于本院脊柱微创科接受椎间孔镜手术的151例腰椎间盘突出症患者作为研究对象,依据椎间孔镜术后是否放置引流管,分为A、B两组:A组32例术后放置单根引流管,B组119例未放置引流管。对比两组患者术前和术后随访期间的腰腿痛VAS、JOA评分,并比较两组伤口皮下及周围出现瘀斑例数、出院时伤口按压疼痛例数、出院当天MRI手术区域T2加权高信号相对比值及面积占比、住院时间等指标。结果两组患者术后腰腿痛VAS评分、JOA评分均有显著改善(P<0.05),两组患者出院时的腰腿痛VAS评分及JOA评分存在统计学差异(P<0.05);两组伤口皮下及周围出现瘀斑例数、伤口压痛例数、术后MRI T2加权手术区域高信号比值及面积占比等比较,有统计学差异(P<0.05)。两组均未出现伤口感染,A组1例放置引流管后,观察为脑脊液漏;B组出现1例症状性血肿。结论椎间孔镜术后有的放矢放置引流管,可早期改善腰腿痛症状,并减少手术并发症,符合快速康复外科理念。

Objective To investigate the clinical significance and effectiveness of drainage tube placement after percutaneous endoscopic lumbar discectomy(PELD).Methods From January 2019 to September 2019,151 patients with lumbar disc herniation who received PELD operation in the minimally invasive department of spine in our hospital,were divided into two groups according to whether to place drainage tubes after the operation of PELD.Group A(32 patients)was placed a single drainage tube after the operation,group B(119 patients)was not placed drainage tube after the operation.VAS of lumbago and leg pain and JOA scores were recorded before operation,at discharge,1 month after operation and at the last follow-up.The number of ecchymosis cases under the skin and around the wound,the number of wound compression pain cases at discharge,and the T2 weighted high signal relative ratio of MRI operation area on the day of discharge,the proportion of area volume,and the length of stay were compared between the two groups.Results The postoperative VAS score and JOA score of two groups were significantly improved(P<0.05).There were statistically significant differences in VAS score and JOA score between the two groups at the time of discharge(P<0.05).There were statistically significant differences in the number of ecchymosis cases,the number of tenderness cases,the high signal ratio and area proportion of T2 weighted operation area between the two groups(P<0.05).There was no wound infection in both two groups.One patient in group A had cerebrospinal fluid leakage after drainage tube was placed,and one patient in group B had symptomatic hematoma.Conclusion The placement of drainage tube after PELD can improve the symptoms of lumbago and leg pain in the early stage,and reduce the complications of the operation,which is in line with the concept of enhanced recovery after surgery.