Slotman G J, Stein S C
Department of Surgery, Cooper Hospital/University Medical Center, University of Medicine and Dentistry of New Jersey, Robert Wood Johnson Medical School-Camden, 08103, USA.
J Laparoendosc Adv Surg Tech A. 1998 Oct;8(5):261-7. doi: 10.1089/lap.1998.8.261.
The objective of this study was to evaluate the clinical efficacy and cost effectiveness of inpatient and outpatient laparoscopic lumbar diskectomy (LLD) compared with laminectomy (LAM) in the surgical treatment of disabling L5-S1 disk herniation. Sixty-two adults underwent surgery for herniated L5-S1 intervertebral disks (31 LLD and 31 LAM). Operative blood loss (EBL) (milliliters), operative time (ORT) (minutes), hospital stay (LOS), and rehabilitation time to normal activity (REHAB) (days), recurrent symptoms, postoperative morbidity, percent pain free, and hospital patient charges were calculated. Thirty LLD patients (97%) had immediate relief of disk pain. Morbidity after LLD included transient urinary retention (one) and rectus hematoma (one). One LAM patient had a pseudomeningocele. Among patients observed for > or =6 months, with a median follow up time of 34 months, 22 of 25 LLD patients (88%) returned to normal activity, while 12 of the LAM group (52%) were disabled (p = 0.004). Functional outcome was improved by LLD for workers compensation patients followed > or =6 months, with 86% LAM disabled, vs. 10% LLD (p = 0.001). Sixteen LLD patients (52%) and 18 (58%) of the LAM group needed postoperative physical therapy. Four LLD patients recurred; three required reoperation. Four LAM patients had surgery for recurrent disk herniation. ORT was longer for LLD than LAM (210 vs. 158 minutes, median, p < 0.05). EBL and REHAB time were significantly reduced with LLD, vs. LAM. With a median follow-up of 34 months, 58% of LLD and 39% of LAM patients followed > or =6 months were pain free. Outpatient LLD (n = 9) reduced LOS (1 day vs. 2 days and 4 days, p < 0.01) and lowered patient charges ($4,405 vs. $5,723 and $7,192, p < 0.01) compared with inpatient LLD (n = 23) and LAM, respectively. LLD is a safe, cost-effective, minimally invasive alternative to LAM for treating herniated L5-S1 disks. Compared with LAM, LLD reduces EBL, LOS, REHAB time, and patient charges, improves function, and increases long-term pain relief. Cost effectiveness is optimized when LLD is performed as outpatient surgery.
本研究的目的是评估在手术治疗致残性L5 - S1椎间盘突出症时，与椎板切除术（LAM）相比，住院和门诊腹腔镜腰椎间盘切除术（LLD）的临床疗效和成本效益。62名成年人接受了L5 - S1椎间盘突出症手术（31例行LLD，31例行LAM）。计算手术失血量（EBL，毫升）、手术时间（ORT，分钟）、住院时间（LOS）以及恢复正常活动的康复时间（REHAB，天）、复发症状、术后发病率、无痛百分比和医院患者费用。30例LLD患者（97%）椎间盘疼痛立即缓解。LLD术后的并发症包括短暂性尿潴留（1例）和腹直肌血肿（1例）。1例LAM患者出现假性脑脊膜膨出。在观察时间≥6个月、中位随访时间为34个月的患者中，25例LLD患者中有22例（88%）恢复正常活动，而LAM组中有12例（52%）仍有功能障碍（p = 0.004）。对于随访时间≥6个月的工伤患者，LLD改善了功能结局，LAM组中有86%有功能障碍，而LLD组为10%（p = 0.001）。16例LLD患者（52%）和LAM组中的18例（58%）需要术后物理治疗。4例LLD患者复发；3例需要再次手术。4例LAM患者因复发性椎间盘突出症接受手术。LLD的ORT比LAM长（中位数分别为210分钟和158分钟，p < 0.05）。与LAM相比，LLD显著减少了EBL和REHAB时间。中位随访时间为34个月时，随访时间≥6个月的LLD患者中有58%无痛，LAM患者中有39%无痛。与住院LLD（n = 23）和LAM相比，门诊LLD（n = 9）缩短了LOS（分别为1天与2天和4天，p < 0.01）并降低了患者费用（分别为4405美元与5723美元和7192美元，p < 0.01）。LLD是治疗L5 - S1椎间盘突出症的一种安全、经济有效且微创的替代LAM的方法。与LAM相比，LLD减少了EBL、LOS、REHAB时间和患者费用，改善了功能，并增加了长期疼痛缓解。当LLD作为门诊手术进行时，成本效益得到优化。
