摘要
目的总结经皮腰椎间孔镜技术治疗腰椎间盘突出症的早期并发症和处理体会。方法回顾性分析我院自2020年1月至2024年1月采用经皮椎间孔镜下椎间盘摘除术(percutaneous endoscopic lumbar discectomy,PELD)治疗腰椎间盘突出症243例,总结发生并发症的原因及处理措施,提出预防策略。结果243例患者共出现并发症19例,其中神经根损伤4例,硬膜撕裂2例,术中出血3例,类脊髓高压综合征1例,术后感觉异常5例,术后早期会阴部烧灼痛2例,椎间盘突出早期复发2例。结论PELD创伤小,出血少,恢复快,疗效确切,但术中和术后并发症不容忽视。术前选择好责任节段,先易后难,术中熟悉镜下三维解剖结构,操作轻柔,循序渐进,掌握围术期可能出现的并发症及应对措施,能在强调操作的微创性的同时,兼顾手术的安全性和疗效的持久性。
Objective To summarize the early complications and management experience of percutaneous transforaminal endoscopic discectomy in the treatment of lumbar disc herniation.Methods From January 2020 to January 2024,243 cases of lumbar disc herniation were treated by percutaneous endoscopic lumbar discectomy(PELD)in our department.The causes and treatment measures of complications were summarized,and the prevention strategies were put forward.Results A total of 19 cases of complications occurred in 243 patients,including 4 cases of nerve root injury,2 cases of dural tear,3 cases of intraoperative bleeding,1 case of spinal cord hypertension-like syndrome,5 cases of postoperative paresthesia,2 cases of early postoperative perineal burning pain,and 2 cases of early recurrence of intervertebral disc herniation.Conclusions PELD is characterized by minimal trauma,reduced blood loss,rapid recovery,and a proven therapeutic efficacy.However,intraoperative and postoperative complications should not be underestimated.The key procedural imperatives may lie in:precise preoperative identification of the responsible segment,adopting a stepwise approach from simple to complex,mastering the three-dimensional anatomical architecture under microscopic visualization,performing meticulous and gradual maneuvers,and acquiring comprehensive knowledge of potential complications and their perioperative management strategies.These various approaches can emphasize the minimally invasive nature of the procedure while balancing surgical safety and the durability of therapeutic effects.
作者
陈福扬
冯玉旭
徐晓明
周炜
任永信
CHEN Fuyang;FENG Yuxu;XU Xiaoming;ZHOU Wei;REN Yongxin(Department of Spinal Surgery,Nanjing Pukou People's Hospital(Liangjiang Hospital Affiliated to Southeast University),Nanjing 211800,Jiangsu,China;Department of Spinal Surgery,Jiangsu Provincial People's Hospital(the First Affiliated Hospital of Nanjing Medical University),Nanjing 211000,Jiangsu,China)
出处
《中国现代手术学杂志》
2025年第3期205-208,共4页
Chinese Journal of Modern Operative Surgery
关键词
腰椎间盘突出症
经皮椎间孔镜
早期并发症
lumbar disc herniation
percutaneous foraminoscopy
early complications
