Chang Shih-Sheng, Fu Tsai-Sheng, Liang Yen-Chiu, Lia Po-Liang, Niu Chi-Chien, Chen Lih-Huei, Chen Wen-Jer
Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, Taipei, Taiwan.
Chang Gung Med J. 2009 Jan-Feb;32(1):89-97.
Microendoscopic discectomy (MED) is less invasive than conventional open discectomy, but the long-term benefits of this technique are still debated. Controversy also remains regarding the surgical indications, patient selection, effectiveness, learning curve and complications.
From Dec 2001 to Dec 2003, 26 patients with lumbar herniated disc disease received MED. The surgical indications included the following: (1) unilateral, single level lumbar disc herniation; (2) signs and symptoms compatible with the involved nerve root; (3) failure of conservative treatment. These cases were the initial MEDs performed by one of our senior authors (TS FU). Clinical symptoms and outcomes were assessed using the Japanese Orthopaedic Association Back Scores.
Treatment in two cases was changed to open discectomy because of irreparable dural tears during surgery. For the remaining 24 cases, the average intraoperative blood loss was 55.8 mL. The average operation length was 136.8 minutes and the average post-surgical hospital stay was 2.4 days. At 12 weeks after the operation, 22 achieved excellent or good results. The satisfactory rate was 91.7%. On final follow-up, 21 patients had excellent or good results. The satisfactory rate was 87.5%. Complications included two irreparable dural tears, two superficial wound infections and one pseudomenigocele.
Our data indicate that MED is an effective procedure for lumbar disc herniation. The result is satisfactory under adequate surgical indications and patient selection. Despite the low complication rate, dural tears still remain a concern during the learning stage.
与传统开放性椎间盘切除术相比，显微内镜下椎间盘切除术（MED）的侵入性较小，但该技术的长期益处仍存在争议。在手术适应症、患者选择、有效性、学习曲线和并发症方面也存在争议。
2001年12月至2003年12月，26例腰椎间盘突出症患者接受了MED治疗。手术适应症包括：（1）单侧、单节段腰椎间盘突出症；（2）与受累神经根相符的体征和症状；（3）保守治疗失败。这些病例是由我们的一位资深作者（TS FU）首次进行的MED手术。使用日本骨科协会背部评分评估临床症状和结果。
2例患者因手术中硬脊膜撕裂无法修复而改为开放性椎间盘切除术。其余24例患者，术中平均失血量为55.8毫升。平均手术时间为136.8分钟，术后平均住院时间为2.4天。术后12周，22例患者取得了优或良的效果。满意率为91.7%。在最后随访时，21例患者取得了优或良的效果。满意率为87.5%。并发症包括2例硬脊膜撕裂无法修复、2例浅表伤口感染和1例假性脑脊膜膨出。
我们的数据表明，MED是治疗腰椎间盘突出症的有效方法。在适当的手术适应症和患者选择下，结果令人满意。尽管并发症发生率较低，但在学习阶段硬脊膜撕裂仍然是一个令人担忧的问题。
