摘要
目的报道3例经皮椎间孔镜下腰椎间盘切除术后罕见的腹膜后血肿并发症,并结合文献探讨其原因及防治策略:方法回顾性分析2016年3月-2018年1月厦门大学附属福州第二医院脊柱外科和北京大学国际医院骨科收治的3例经皮椎间孔镜下腰椎间盘切除术后并发腹膜后血肿患者的临床资料。在中国知网、万方数据、维普数据库及PubMed中,以“经皮内镜下腰椎间盘切除术/percutaneous lumbar endoscopic discectomy”和"腹膜后血肿/retroperitoneal hematoma”为关键词,检索2018年7月之前有关经皮椎间孔镜下腰椎间盘切除术后并发腹膜后血肿的文献,共检出4篇7例英文文献报道和1篇1例中文文献报道;结合本文3例诊治过程,总结该并发症临床及影像学表现、预防及处置方法。结果本组3例均为经皮椎间孔镜下腰椎间盘切除术后并发腹膜后血肿,1例并发低血容量性休克者行介入腰动脉栓塞术,1例伴术侧下肢肌力进行性下降者行腰椎后路血肿清除及神经根探查术,1例病情稳定者予以保守对症处理。随访6~24个月,2例痊愈,1例残存神经功能障碍。结合文献报道的8例,计11例经皮椎间孔镜下腰椎间盘切除术后并发腹膜后血肿,多表现为术后短暂无症状期后出现腹股沟区疼痛不适;2例并发低血容量性休克行超选择腰动脉造影并栓塞术治疗,2例弥漫型血肿(血肿量M500mL)行剖腹血肿清除术,1例术侧下肢肌力进行性下降者行腰椎后路血肿清除术,6例病情稳定者予以保守对症处理;经恰当处置,总体预后良好。结论腹膜后血肿是经皮椎间孔镜下腰椎间盘切除术后的一种罕见但严重的并发症,早期识别并恰当处理尤为关键。熟悉椎间孔区域解剖和提高手术操作技巧是减少此类并发症的前提.
Objective To present 3 cases of retroperitoneal hematoma(RPH)following transforaminal percutaneous endoscopic lumbar discectomy and to discuss how to prevent the complication of unintended hemorrhage by reviewing literatures. Methods The clinical data of 3 patiets admitted in 2 hospitals from March 2016 to January 2018 were retrospectively studied. The literatures about the RPH following transforaminal percutaneous endoscopic lumbar discectomy before July 2018 were searched in CNK1, Weipu, Wanfang and PubMed databases by using 44 percutaneous lumbar endoscopic discectomyM and “retroperitoneal hematoma” as key words. Seven cases reported in English and one case reported in Chinese were detected. The clinical and imaging features, prevention and treatment of the complication were observed and analyzed. Results All 3 cases were undertaken transforaminal percutaneous endoscopic lumbar discectomy under local anesthesia. The patient with hypovolemic shock was treated by lumbar vertebral segment arterial embolization. The case with progressive weakness of her right leg underwent open hematoma evacuation via posterior lumbar approach. The last case was treated conservatively. In 6 - 24 months followup, 2 cases recovered without any neurological or vascular sequelae, but 1 case presented residual neurological deficits. Eleven cases of RPH after percutaneous transforaminal lumbar discectomy were involved, including 3 cases in this paper and 8 cases reported in references. Most of them presented with pain and discomfort in the groin area after a short period of asymptomatic operation. Two cases of hypovolemic shock were treated with lumbar vertebral segment arterial embolization, two cases with diffuse hematoma(henuitoma volume≥500 mL) were treated with laparotomy hematoma removal, one case with progressive weakness of right leg underwent open hematonui evacuation via posterior lumbar approach, and the other 6 cases were treated conservatively. With proper treatments, overall prognosis was good. Conclusions RPH is an
作者
王华锋
周福山
温冰涛
梁珪清
吴建军
Wang Huafeng;Zhou Fushan;Wen Bingtao;Liang Guiqing;Wu Jianjun(Department of Spine Surgery, Fuzhou Second Hospital of Xiamen University, Fuzhou 350007, China;Fujian University of Traditional Chinese Medicine, Fuzhou 350122, China;Department of Orthopedics,Peking University International Hospital, Beijing 102206, China)
出处
《中华解剖与临床杂志》
2019年第1期65-70,共6页
Chinese Journal of Anatomy and Clinics
关键词
椎间盘切除术
经皮
腹膜后血肿
并发症
Diskectomy, percutaneous
Retroperitoneal hematoma
Complications
