Lieberman I H, Willsher P C, Litwin D E, Salo P T, Kraetschmer B G
Cleveland Clinic Foundation, Ohio, USA.
Spine (Phila Pa 1976). 2000 Feb 15;25(4):509-14; discussion 515. doi: 10.1097/00007632-200002150-00019.
A prospective clinical trial of the transperitoneal laparoscopic approach to the lumbar spine in a consecutive series of patients undergoing anterior lumbar interbody fusion.
To determine safety and effectiveness, and to document technique and perioperative complications of a laparoscopic exposure for lumbar interbody fusion.
With the widespread adoption of laparoscopic techniques, the benefits of minimal access surgery are now well recognized--in general, gynecologic and urologic surgery. Only recently have minimal access techniques been applied to spinal procedures.
Forty-seven patients with symptomatic degenerative disc disease underwent transperitoneal laparoscopic exposure of the lumbar spine to facilitate implantation of cylindrical threaded interbody fusion cages. These patients were prospectively followed and all perioperative considerations and complications were documented and analyzed. The surgical technique of laparoscopic exposure will be described.
The laparoscopic approach was attempted in 47 consecutive patients. Forty-four were completed laparoscopically--36 single level fusions, seven two level fusions, and one three level fusion. Early in the series, conversion to open surgery was required in one patient (case #3) because of bleeding from the presacral veins which hindered the view. In one case, mobilization of the great vessels proved to be difficult, and in one other case the patient could not tolerate abdominal insufflation. The mean blood loss for the entire group was 105 mls. Complications related to the endoscopic exposure were few. There were no injuries to major vascular structures or to bowel, and no mortalities. In two patients, the cages were malpositioned necessitating repeat endoscopic exposure for cage realignment. One patient required a laparotomy for a postoperative small bowel obstruction. The median postoperative stay was 4 days.
Transperitoneal laparoscopic exposure for single or multiple level, anterior lumbar interbody fusion can be performed with low risk. Experience in open anterior spinal surgery and laparoscopic general surgery is vital in minimizing the risks.
对一系列连续接受前路腰椎椎间融合术的患者采用经腹腹腔镜入路治疗腰椎的前瞻性临床试验。
确定安全性和有效性，并记录腹腔镜下腰椎椎间融合术的技术及围手术期并发症。
随着腹腔镜技术的广泛应用，微创外科手术的益处目前已得到广泛认可——总体而言，在妇科和泌尿外科手术中。直到最近，微创技术才被应用于脊柱手术。
47例有症状的退行性椎间盘疾病患者接受经腹腹腔镜下腰椎暴露，以利于植入圆柱形螺纹椎间融合器。对这些患者进行前瞻性随访，并记录和分析所有围手术期情况及并发症。将描述腹腔镜暴露的手术技术。
连续47例患者尝试采用腹腔镜入路。44例成功完成腹腔镜手术——36例单节段融合，7例双节段融合，1例三节段融合。在该系列研究早期，1例患者（病例#3）因骶前静脉出血影响视野而需要转为开放手术。1例患者，大血管的游离困难，另1例患者不能耐受腹部充气。整个组的平均失血量为105毫升。与内镜暴露相关的并发症很少。未发生主要血管结构或肠道损伤，也无死亡病例。2例患者的融合器位置不当，需要再次进行内镜暴露以重新调整融合器位置。1例患者因术后小肠梗阻需要剖腹手术。术后中位住院时间为4天。
经腹腹腔镜下进行单节段或多节段前路腰椎椎间融合术风险较低。开放前路脊柱手术和腹腔镜普通外科手术的经验对于将风险降至最低至关重要。
