椎间盘镜下髓核摘除术的学习曲线.DOCVIP

临床医学论文-椎间盘镜下髓核摘除术的学习曲线 ??????????????作者：何勍，阮狄克，侯黎升，王德利，张超，丁宇 【摘要】? [目的]评估椎间盘镜下髓核摘除术不同阶段手术时间及并发症，探讨椎间盘镜下髓核摘除术的学习曲线问题。[方法] 回顾性分析2003年10月～2007年7月椎间盘镜下髓核摘除术治疗的单节段椎间盘突出症患者48例，主刀医师相同，按手术先后次序分为3组(A、B、C)，每组16例，比较各组手术时间及手术并发症发生情况。[结果]3组病例年龄、性别、突出节段等方面无显著性差别(P0.05)，A组手术时间(106±22.3) min，B组手术时间(94.1±29.3) mim，C组手术时间(81.6±22.3) min。A组和B组、B组和C组比较手术时间无显著性差异，A组和C组比较手术时间有显著性差异;A组有2例术中硬膜撕裂，1例改开放手术，B组3例术后复发，C组无并发症发生。[结论]椎间盘镜下髓核摘除术学习曲线大约需30例以上经验积累，即可达到较熟练程度。 【关键词】? 腰椎; 椎间盘突出; 内窥镜; 学习曲线　　Abstract: [Objective]To evaluate the outcome of lumbar microendoscopic discectomy(MED) and to define the learning curve of lumbar microendoscopic discectomy. [Method]Data from 48 cases of lumbar microendoscopic discectomy between october 2003 and July 2007 were reviewed.The cases were divided equally into 3 groups(groups A,B and C) according to the sequence of the operations.The operating time,intra-and postoperative complications were compared between the 3 groups.[Result]There were no significant differences between the 3 groups with respect to age,gender,segments of protrusion(P0.05).The operating time in group A was 106±22.3 min，94.1±29.3 min in group B and 81.6±22.3 min in group C.There were no significant differences between group A and B,or between group B and group C,but there was significant difference (P=0.009) between group A and group C.The was Two cases of dura tear occurred at operatiom and one case was converted to open discectomy in group A.There were three cases of reoperation in group B.There were no intra-and postoperation complications in group C.[Conclusion]From the learning curve of lumbar microendoscopic discectomy,surgeons can master such skill only after performing 30 or more cases of lumbar microendoscopic disecetomy. 　　Key words：lumbar vertebra; lumbar disc herniation; endoscopy; learning curve 　　1997年Foley和 Smith[1]介绍了他们应用椎间盘镜(microendoscopic discectomy，MED)治疗腰椎间盘突出症的经验。因为其具有手术创伤小、术后恢复快等优点，该技术得到广泛的应用，并有许多作者报道取得了良好的效果。但是，椎间盘镜手术操作是在直径为1.8 cm的管道内进行，手术者从常规的直视下操作改为通过电视监视器监视下操作，手术