Rosenthal D, Dickman C A
Division of Neurological Surgery, Barrow Neurological Institute, Phoenix, Arizona 85013-4496, USA.
J Neurosurg. 1998 Aug;89(2):224-35. doi: 10.3171/jns.1998.89.2.0224.
The authors began using thoracoscopy to treat pathological conditions of the spine in 1992. In this study they delineate their clinical experience in which this procedure was used to resect herniated thoracic discs.
Fifty-five patients underwent thoracoscopy for the resection of herniated thoracic discs. Thirty-six patients presented with myelopathies and 19 with incapacitating thoracic radicular pain. Forty-three patients underwent a single-level, 11 a two-level, and one a three-level discectomy. The mean operative time for thoracoscopic microdiscectomy was 3 hours and 25 minutes (range 80-542 minutes) and the mean blood loss was 327 ml (range 124-1500 ml). Compared with thoracotomy, which was performed in 18 patients, thoracoscopy was associated with a mean of 1 hour less operative time and less than one-half of the blood loss, duration of chest tube drainage, usage of pain medication, and length of hospitalization. Compared with costotransversectomy, which was performed in 15 patients, thoracoscopy permitted more complete resection of calcified and midline thoracic discs because it provided a direct view of the entire anterior surface of the dura. Thoracotomy was associated with a significantly greater incidence of prolonged, disabling intercostal neuralgia compared with the mild transient episodes of intercostal neuralgia associated with thoracoscopy (50% compared with 16%). Thoracotomy also was associated with a significantly higher incidence of postoperative atelectasis and pulmonary dysfunction than thoracoscopy (33% compared with 7%). Clinical and neurological outcomes were excellent (mean follow-up period 15 months). Among the 36 myelopathic patients, 22 completely recovered neurologically; five improved functionally but had some residual myelopathic symptoms; and nine stabilized. Among the 19 patients with isolated thoracic radiculopathies, 15 recovered completely and four improved moderately; no patient had worsened radicular pain.
Thoracoscopic microdiscectomy is a reliable surgical technique that can be performed safely with excellent clinical and neurological results.
作者于1992年开始使用胸腔镜治疗脊柱疾病。在本研究中，他们阐述了使用该手术切除胸椎间盘突出症的临床经验。
55例患者接受胸腔镜下胸椎间盘切除术。36例患者表现为脊髓病，19例患者表现为严重的胸神经根性疼痛。43例患者接受单节段椎间盘切除术，11例接受双节段椎间盘切除术，1例接受三节段椎间盘切除术。胸腔镜下显微椎间盘切除术的平均手术时间为3小时25分钟（范围80 - 542分钟），平均失血量为327毫升（范围124 - 1500毫升）。与18例接受开胸手术的患者相比，胸腔镜手术的平均手术时间少1小时，失血量、胸管引流时间、止痛药物使用量和住院时间均减少一半以上。与15例接受肋骨横突切除术的患者相比，胸腔镜手术能够更完整地切除钙化和位于中线的胸椎间盘，因为它可以直接观察硬脊膜的整个前表面。与胸腔镜手术相关的轻度短暂肋间神经痛相比，开胸手术导致持续性、致残性肋间神经痛的发生率显著更高（50% 比16%）。开胸手术术后肺不张和肺功能障碍的发生率也显著高于胸腔镜手术（33% 比7%）。临床和神经学结果良好（平均随访期15个月）。在36例脊髓病患者中，22例神经功能完全恢复；5例功能改善但仍有一些残留脊髓病症状；9例病情稳定。在19例孤立性胸神经根病患者中，15例完全恢复，4例中度改善；没有患者的神经根性疼痛加重。
胸腔镜下显微椎间盘切除术是一种可靠的手术技术，可以安全地进行，临床和神经学效果良好。
