摘要
目的比较分析微创通道手术和传统开放手术在椎管肿瘤、包括椎管内外沟通肿瘤患者的手术疗效。方法纳入复旦大学附属华山医院神经外科在2017至2019年应用微创通道[Quadrant通道或MLD(Micro Lumbar Discectomy)后路微创牵开器系统]切除椎管肿瘤的31例患者(微创通道组),同时选择同期应用传统后路椎板咬除的开放手术切除椎管肿瘤的38例患者作为对照(开放手术组)。从术中情况、手术疗效、术后肌肉损伤程度、术后并发症及术后脊柱稳定性等方面对微创通道组与开放手术组进行对比分析。结果微创通道组术中出血量(70.2 ml±4.9 ml)、手术时间(164.7 min±16.0 min)及患者住院时间(9.5 d±2.5 d)均显著低于开放手术组(P<0.001)。微创通道组术后1d血肌酸激酶(CK)显著低于开放手术组,两组分别为(363.9±51.6)U/L及(514.2±68.3)U/L,P<0.001。微创通道组术后5 d及6个月的McCormick评分(1.56±0.17;1.21±0.15)、疼痛视觉模拟评分(VAS)为(3.3±0.76;2.3±0.55)均低于开放手术组(P<0.05),根据Panjabi标准,术后6个月脊髓稳定性影响显著低于开放手术组(P<0.001),同时微创通道组症状显著改善率高于开放手术组(P<0.05)。结论椎管肿瘤患者选择微创通道手术较同期开放手术相比,术中出血量、切口长度、手术时间以及住院时间明显较开放手术缩短,肌肉破坏程度亦显著减轻,并发症的发生率更低,脊柱稳定性的影响更小,总体优势明显。但需注意把握指征,选择合适的病例。
Objective To compare and analyze the effect of minimally invasive surgery and traditional open surgery in patients with spinal canal tumors,including intraspinal and extraspinal communication tumors.Methods From 2017 to 2019,31 patients(minimally invasive channel group)were included in the neurosurgery department of Huashan Hospital Affiliated to Fudan University,and 38 patients(open operation group)were selected as the control group.From the aspects of intraoperative condition,operative effect,postoperative muscle injury,postoperative complications,postoperative spinal stability,the minimally invasive access group and the open operation group were compared and analyzed.Results The bleeding volume(70.2 ml±4.9 ml),operation time(164.7 min±16.0 min)and hospitalization days(9.5±2.5)in the minimally invasive access group were significantly lower than those in the open operation group(P<0.001).The creatine kinase CK(363.9 U/L±51.6 U/L)in the minimally invasive group was significantly lower than that in the open group(514.2 U/L±68.3 U/L)(P<0.001).According to Panjabi standard,the effect of spinal cord stability in minimally invasive group was significantly lower than that in open operation group(P<0.001),and the symptom improvement rate in minimally invasive group was significantly higher than that in open hand group(P<0.05).Conclusions Compared with the open surgery,the amount of bleeding,the length of incision,the time of operation and the days of hospitalization were significantly shorter,the degree of muscle damage was also significantly reduced,the incidence of complications was lower,the impact of spinal stability was smaller,and the overall advantage was obvious.
作者
谢嵘
寿佳俊
陈功
陈星宇
董银辉
李金全
车晓明
Xie Rong;Shou Jiajun;Chen Gong;Che Xingyu;Dong Yinhui;Li Jinquan;Che Xiaoming(Department of Neurosurgery,Huashan Hospital,Fudan University,Shanghai 200040,China)
出处
《中华医学杂志》
CAS
CSCD
北大核心
2020年第4期265-269,共5页
National Medical Journal of China
关键词
椎管肿瘤
微创通道
手术切除
Intraspinal tumor
Minimal invasive channel
Surgical resection
作者简介
通信作者:车晓明,Email:xmche@163.com。
