Wu Chun-Gen, Li Yong-Dong, Li Ming-Hua, Gu Yi-Feng, Ji Bo-Qing, Li Min
Department of Diagnostic and Interventional Radiology, The Sixth Affiliated People's Hospital, Shanghai Jiao Tong University, No. 600, Yi Shan Road, Shanghai, China.
J Vasc Interv Radiol. 2007 Sep;18(9):1162-8. doi: 10.1016/j.jvir.2007.06.008.
Anterior approaches to the lumbosacral spine have become increasingly common in spine surgery, but transabdominal percutaneous lumbar discectomy (TPLD) is challenging. This study describes TPLD and evaluates safety and early clinical results in the management of L5-S1 disc herniation.
Between October 2001 and October 2006, 58 consecutive patients with L5-S1 disc herniations were treated with TPLD of the L5-S1 discs, and nine of the patients with L4-L5 disc herniations were treated with posterolateral percutaneous lumbar discectomy (PPLD) soon after TPLD. The patients were divided into two groups according the operator who performed the procedures. The patients were evaluated with a visual analog scale (VAS) and the Oswestry Disability Index (ODI) at 5 years of follow-up. Logistic regression was used to analyze significant risk factors for complications.
Mean hospital stay was 6.38 days +/- 8.48. VAS scores for leg pain and ODI scores showed significant improvement at last follow-up. All patients showed favorable results with no recurrent herniations. Major and minor complications occurred in eight (13.79%) and seven cases (12.06%), respectively, during and after the procedure. Major complications occurred in seven patients treated by operator A and one treated by operator B, a significant difference between operators (P = .044). Multivariate analysis revealed that only bowel preparation remained a significant predictor of complications (P = .040).
TPLD was a safe and effective procedure for the removal of disc herniations at the L5-S1 level when total bowel preparation was performed.
腰骶部脊柱前路手术在脊柱外科中已越来越常见，但经腹经皮腰椎间盘切除术（TPLD）具有挑战性。本研究描述了TPLD，并评估其在治疗L5-S1椎间盘突出症中的安全性和早期临床效果。
2001年10月至2006年10月，连续58例L5-S1椎间盘突出症患者接受了L5-S1椎间盘的TPLD治疗，9例L4-L5椎间盘突出症患者在TPLD后不久接受了后外侧经皮腰椎间盘切除术（PPLD）。根据实施手术的操作者将患者分为两组。在随访5年时，采用视觉模拟量表（VAS）和Oswestry功能障碍指数（ODI）对患者进行评估。采用逻辑回归分析并发症的显著危险因素。
平均住院时间为6.38天±8.48天。在最后一次随访时，腿痛的VAS评分和ODI评分均有显著改善。所有患者均取得良好效果，无复发性椎间盘突出。手术期间和术后分别有8例（13.79%）和7例（12.06%）发生了主要和次要并发症。A操作者治疗的7例患者和B操作者治疗的1例患者发生了主要并发症，操作者之间存在显著差异（P = 0.044）。多变量分析显示，只有肠道准备仍然是并发症的显著预测因素（P = 0.040）。
当进行全肠道准备时，TPLD是一种安全有效的治疗L5-S1节段椎间盘突出症的手术方法。
