Fessler R G, Sturgill M
Department of Neurological Surgery, University of Florida, Gainesville 21610-0265, USA.
Surg Neurol. 1998 Jun;49(6):609-18. doi: 10.1016/s0090-3019(97)00434-5.
Thoracic discectomy has evolved over the last 60 years from resection through standard laminectomy, to posterolateral procedures to open thoracotomy and finally thoracoscopy. Comparison of relative morbidity and mortality between these approaches is now possible.
Peer-reviewed publications reporting clinical data relating to thoracic discectomy, and which provided sufficient information to enable adequate assessment of mortality and morbidity were reviewed. These articles were determined via review of the results of MedLine searches and articles gathered through compilation of references from those articles.
Articles reviewed spanned a period of over 60 years. Surgical procedures used for thoracic discectomy included laminectomy, pediculectomy, costotransversectomy, lateral extracavitary, transverse arthropediculectomy, anterolateral thoracotomy, and thoracoscopy. Complications included death, paralysis, paresis, loss of bowel and/or bladder control, pulmonary embolism, pneumonia, atelectasis, compression fracture, infection, pleural tear, bowel obstruction, and anesthesia dolorosa. Mortality dropped to nearly zero after development of anterior and posterolateral approaches. Morbidity seems relatively similar between most procedures other than laminectomy. Not enough procedures have been reported using thoracoscopy to adequately assess its morbidity.
Comparison of relative rates of morbidity and mortality between surgical approaches to thoracic discectomy suggest that laminectomy does not provide adequate access for the safe removal of these lesions. Choice of approach among the alternatives should be based on the evacuation of the herniated fragment and experience of the surgeon. Thoracoscopy, although promising, has not had sufficient time for evaluation of morbidity to make definite statements regarding its safety.
在过去60年里，胸椎椎间盘切除术已从通过标准椎板切除术切除，发展到后外侧手术、开胸手术，最后是胸腔镜手术。现在可以比较这些手术方式之间的相对发病率和死亡率。
对同行评审的出版物进行综述，这些出版物报告了与胸椎椎间盘切除术相关的临床数据，并提供了足够的信息以充分评估死亡率和发病率。这些文章是通过回顾MedLine搜索结果以及通过汇编这些文章的参考文献收集的文章来确定的。
综述的文章跨越了60多年的时间。用于胸椎椎间盘切除术的手术方法包括椎板切除术、椎弓根切除术、肋横突切除术、外侧腔外手术、经关节突椎弓根切除术、前外侧开胸手术和胸腔镜手术。并发症包括死亡、瘫痪、轻瘫、肠道和/或膀胱控制丧失、肺栓塞、肺炎、肺不张、压缩性骨折、感染、胸膜撕裂、肠梗阻和麻醉后疼痛。在前路和后外侧手术方法出现后，死亡率降至几乎为零。除椎板切除术外，大多数手术的发病率似乎相对相似。使用胸腔镜手术报告的病例数不足，无法充分评估其发病率。
胸椎椎间盘切除术不同手术方式之间相对发病率和死亡率的比较表明，椎板切除术不能为安全切除这些病变提供足够的手术入路。在这些替代方法中选择手术方式应基于突出椎间盘碎片的清除情况和外科医生的经验。胸腔镜手术虽然前景广阔，但还没有足够的时间来评估其发病率，无法就其安全性做出明确的结论。
