Gumbs Andrew A, Shah Rahul V, Yue James J, Sumpio Bauer
Department of Surgery, Yale University School of Medicine, New Haven, Conn 06504, USA.
Arch Surg. 2005 Apr;140(4):339-43. doi: 10.1001/archsurg.140.4.339.
With the advent of anterior lumbar interbody fusion and artificial disk replacement as common procedures for the treatment of many spinal problems, anterior exposure has become an increasingly popular procedure for general, thoracic, urologic, and vascular surgeons. Despite this, the body of literature describing this procedure, especially the general and vascular surgery literature, is lacking.
A retrospective review of medical records was performed for patients operated on from April 2002 to March 2004.
Tertiary care university hospital.
In total, 64 open retroperitoneal exposures for anterior spinal approaches were performed. Thirty-five (55%) were performed on men and 29 (45%) on women.
Fifty patients (78%) required lumbosacral approaches, and 14 (22%) required access to purely lumbar disk spaces. Forty-three patients underwent single-disk approaches, and 21 required access to either 2 or 3 levels. Forty patients (63%) underwent anterior lumbar interbody fusion, and 22 (34%) had a Prodisc disk replacement.
We analyzed intraoperative and early postoperative complications.
The average age was 43 years (range, 25-89 years), 42 and 44 years for men and women, respectively. Ninety-seven percent of all attempted retroperitoneal exposures were successful. Intraoperative complications occurred in 5 patients (8%) and included inability to mobilize the iliac veins, injury to the iliac vein, and ureteral tear. The postoperative course was complicated in 8 patients (14%) and included fever, urinary retention, spinal headache, Clostridium difficile colitis, and ileus.
Open retroperitoneal exposure to the lumbar and lumbosacral vertebral bodies can be performed safely with a multidisciplinary approach that maximizes the various surgical skills of the orthopedic and vascular or general surgeon, reducing complication rates in anterior spinal surgery.
随着腰椎前路椎间融合术和人工椎间盘置换术成为治疗多种脊柱疾病的常用手术，前路暴露已成为普通外科、胸外科、泌尿外科和血管外科医生越来越常用的手术方式。尽管如此，描述该手术的文献，尤其是普通外科和血管外科的文献却很匮乏。
对2002年4月至2004年3月接受手术的患者病历进行回顾性研究。
三级医疗大学医院。
共进行了64例开放性腹膜后前路脊柱手术暴露。男性35例（55%），女性29例（45%）。
50例（78%）患者需要腰骶部入路，14例（22%）需要单纯进入腰椎间盘间隙。43例患者接受单节段椎间盘入路，21例需要进入2个或3个节段。40例（63%）患者接受了腰椎前路椎间融合术，22例（34%）进行了Prodisc椎间盘置换。
我们分析了术中及术后早期并发症。
平均年龄43岁（范围25 - 89岁），男性平均年龄42岁，女性平均年龄44岁。所有尝试的腹膜后暴露手术成功率为97%。5例（8%）患者出现术中并发症，包括髂静脉无法游离、髂静脉损伤和输尿管撕裂。8例（14%）患者术后病程复杂，包括发热、尿潴留、脊柱头痛、艰难梭菌性结肠炎和肠梗阻。
采用多学科方法，最大限度地发挥骨科医生与血管外科或普通外科医生的各种手术技能，可安全地进行腰椎和腰骶椎体的开放性腹膜后暴露，降低前路脊柱手术的并发症发生率。
