Slotman G J, Stein S C
Division of General Surgery, Cooper Hospital/University Medical Center, University of Medicine and Dentistry of New Jersey, Robert Wood Johnson Medical School at Camden, USA.
Am Surg. 1996 Jan;62(1):64-8.
Laparoscopic L5-S1 diskectomy (LLD) is a promising new technique for managing disabling pain from herniated lumbar disks. It is unknown, however, whether the clinical results of LLD are superior to those of traditional laminectomy (LAM). This study was undertaken, therefore, in order to compare LLD and LAM in the management of L5-S1 disk herniation unresponsive to conservative treatment measures. Clinical records of 22 patients who underwent 23 LLD procedures and of 23 LAM patients were reviewed with respect to demographics and median age, operative blood loss, operative time, hospital stay, and time of rehabilitation to work/normal activity, as well as postoperative morbidity, recurrent symptoms, long-term functional status, and inhospital patient charges. Two LLD patients had undergone LAM previously, and one had a percutaneous microdiskectomy. All LLD patients had relief of disk pain immediately after surgery. Morbidity after LLD included transient brachial plexus neuropraxia (1), urinary retention (1), and rectus hematoma (1). No LAM complications were reported. Among LLD patients, compared with LAM, median age (34.5 years versus 40 years), estimated blood loss (12 mL versus 68 mL), hospital length of stay (1 day versus 3 days), time to normal activity (17 days versus 79 days) and mean inhospital patient charges ($5,737 +/- 283 versus $7,762 +/- 662) were reduced significantly (P < 0.05). LLD operating time was significantly longer than LAM (210 versus 160 minutes median, P < 0.01). With a median follow-up time of 11.0 months (range, 2 to 23 months) all LLD patients had returned to normal activity, whereas 7 of the LAM group (30%) remained disabled (P < 0.01). Sixty-eight per cent of LLD patients were pain-free during follow-up, compared with 39 per cent of the LAM group (P < 0.05). Sixty-four per cent of LLD patients and 57 per cent of the LAM group needed postoperatively physical therapy. One LLD and 4 LAM patients required reoperation, by LLD and LAM, respectively, for recurrent disk herniation. LLD is a safe, cost-effective, minimally invasive operation for managing disabling L5-S1 disk herniation. Compared with LAM, LLD reduces blood loss, length of stay, rehabilitation time, and patient charges, and improves long-term functional and pain-free status. LLD should be considered as an alternative to LAM for patients with herniated L5-S1 intervertebral disks unresponsive to conservative management.
腹腔镜L5 - S1椎间盘切除术（LLD）是一种用于治疗腰椎间盘突出所致致残性疼痛的很有前景的新技术。然而，LLD的临床效果是否优于传统椎板切除术（LAM）尚不清楚。因此，本研究旨在比较LLD和LAM在治疗对保守治疗措施无反应的L5 - S1椎间盘突出症中的效果。回顾了22例行23次LLD手术患者及23例LAM患者的临床记录，内容包括人口统计学和年龄中位数、术中失血量、手术时间、住院时间、恢复工作/正常活动的时间，以及术后发病率、复发症状、长期功能状态和住院患者费用。2例LLD患者曾接受过LAM手术，1例曾接受过经皮显微椎间盘切除术。所有LLD患者术后立即缓解了椎间盘疼痛。LLD术后的并发症包括短暂性臂丛神经失用症（1例）、尿潴留（1例）和腹直肌血肿（1例）。未报告LAM的并发症。在LLD患者中，与LAM相比，年龄中位数（34.5岁对40岁）、估计失血量（12 mL对68 mL）、住院时间（1天对3天）、恢复正常活动时间（17天对79天）和平均住院患者费用（5737美元±283对7762美元±662）均显著降低（P < 0.05）。LLD的手术时间明显长于LAM（中位数210分钟对160分钟，P < 0.01）。中位随访时间为11.0个月（范围2至23个月），所有LLD患者均恢复了正常活动，而LAM组有7例（30%）仍有功能障碍（P < 0.01）。68%的LLD患者在随访期间无疼痛，而LAM组为39%（P < 0.
