Ahn Yong, Kim Jin Uk, Lee Byung Hoi, Lee Sang-Ho, Park Jong Dae, Hong Dong Hyun, Lee June Ho
Department of Neurosurgery, Wooridul Spine Hospital, Seoul, Korea.
J Neurosurg Spine. 2009 Jun;10(6):595-602. doi: 10.3171/2009.2.SPINE08227.
The purpose of this study was to demonstrate the clinical characteristics of postoperative retroperitoneal hematoma (RPH) following transforaminal percutaneous endoscopic lumbar discectomy (PELD) and to discuss how to prevent the complication of unintended hemorrhage.
The medical records of 412 consecutive patients treated with transforaminal PELD between January 2005 and May 2007 were reviewed. A total of 4 patients (0.97%) experienced symptomatic postoperative RPH. The clinical outcomes were evaluated using the visual analog scale and the Oswestry Disability Index.
The common symptom in all patients with a hematoma was inguinal pain. The mean hematoma volume was 527.9 ml (range 53.3-1274.1 ml). Two patients with massive diffuse-type RPHs compressing the intraabdominal structures required open hematoma evacuation performed by general surgeons, and the other 2 patients with small, localized RPHs of < 100 ml were treated conservatively. The mean follow-up period was 21.3 months (range 13-29 months). The mean visual analog scale score for radicular leg pain improved from 7.6 to 1.8 and that for back pain improved from 4.3 to 2. The mean Oswestry Disability Index improved from 58.8 to 9.1%. The preoperative symptoms improved after the second treatment without significant neurological sequelae in all patients.
Although transforaminal PELD is a minimally invasive and safe procedure, the possibility of RPH should be kept in mind. Adequate technical and anatomical considerations are important to avoid this unusual hemorrhagic complication, especially in the patient with underlying medical problems or previous operative scarring. A high index of suspicion and early detection is also important to avoid the progression of the hematoma.
本研究旨在阐述经椎间孔入路经皮内镜下腰椎间盘切除术（PELD）术后腹膜后血肿（RPH）的临床特征，并探讨如何预防意外出血并发症。
回顾2005年1月至2007年5月间连续接受经椎间孔PELD治疗的412例患者的病历。共有4例患者（0.97%）术后出现有症状的RPH。使用视觉模拟量表和Oswestry功能障碍指数评估临床结果。
所有血肿患者的常见症状为腹股沟区疼痛。血肿平均体积为527.9毫升（范围53.3 - 1274.1毫升）。2例巨大弥漫型RPH压迫腹腔内结构的患者需要由普通外科医生进行开放性血肿清除术，另外2例血肿小于100毫升的局限性小RPH患者接受保守治疗。平均随访期为21.3个月（范围13 - 29个月）。腿部神经根性疼痛的平均视觉模拟量表评分从7.6改善至1.8，背部疼痛评分从4.3改善至2。平均Oswestry功能障碍指数从58.8%改善至9.1%。所有患者在第二次治疗后术前症状均有改善，且无明显神经后遗症。
尽管经椎间孔PELD是一种微创且安全的手术，但应牢记发生RPH的可能性。充分的技术和解剖学考量对于避免这种不寻常的出血并发症很重要，尤其是对于有基础疾病或既往有手术瘢痕的患者。高度的怀疑指数和早期发现对于避免血肿进展也很重要。
