显微内镜椎间盘摘除术并发症分析及处理.docVIP

显微内镜椎间盘摘除术并发症分析及处理 　　作者：蒋佑升，胡广健，冯锡光，陈俊柱 作者单位：513000 广东，英德市人民医院骨外科 　　【摘要】 目的 探讨显微内镜椎间盘摘除术(microendoscopic discectomy，MED)中并发症发生原因及防治措施。方法 总结我院2003年7月至2009年6月采用MED治疗腰椎间盘突出症患者38例的治疗经验，对术中并发症进行分析并提出防治措施。结果 7例中转开放手术，31例完成镜下操作，其中椎间隙定位错误8例，马尾神经损伤1例，硬膜损伤3例，损伤椎管内静脉丛4例。手术中转原因：马尾神经损伤转开放探查1例，硬膜及神经根黏连明显1例，硬膜损伤2例，损伤椎管内静脉丛出血不止3例。并发症发生与定位失误、操作不熟练、经验欠缺等有关。结论 正确的手术适应证、熟练精细的手术操作、丰富的手术经验可减少及预防并发症的发生。 　　【关键词】 椎间盘移位;显微内镜;椎间盘切除术;并发症 　　Analysis and treatment of complication in microendoscopic discectomy 　　JIANG You-sheng，HU Guang-jian，FENG Xi-guang，et al.Department of Orthopedics，Yingde Peoples Hospital，Yingde 513000，China 　　[Abstract] Objective To investigate the causes and countermeasures of the complication in the microendoscopic discectomy.Methods A summary of the surgical experiences was made on 38 cases of lumbar intervertebral disc protrusion treated by microendoscopic discectomy from July 2003 to June 2009.These cases and the countermeasures with complications in operation were analysed.Results 7 conversions to open surgery were required.31 cases completed by microendoscopic discectomy(MED).Wrong localization was in 8 patients.The cauda equina nerve damage was in 1 patient.Dural injury was in 3 patients.Vertebral venous plexus bleeding was in 4 patients.1 case of the cauda equina nerve damage was changed to open operation.1 case with the obvious accretion of the dura and nerve root was changed to open operation.2 cases of dural injury and 3 cases of the vertebral venous plexus bleeding were changed to open operation either.The complication was relating to wrong localization，unskilled operative procedure and without experience.Conclusion Accurate selection of operative indication，skilled operative procedure，richly operative experience are the key to prevent and reduce the complications of the lumbar intervertebral disc herniation using microendoscopic discectomy. 　　[Key words] lumbar intervertebral disc herniation;microendoscopic;discectomy;complication