【摘要】 目的 :最近在脊柱手术中出现了一种胸腔镜手术法。本文重点介绍脊柱前路胸腔镜手术法的运用及其临床疗效。方法 :从 1995年 11月～ 1999年 12月 ,136名患者 (T2 ～L1损伤 )接受胸腔镜手术治疗 ,患者年龄 5～ 89岁 ,平均 5 0 .3岁 ,包括 5 7例脊椎转移瘤 ,2 2例爆裂性骨折 ,16例脊柱侧凸 ,16例结核性脊椎炎 ,12例化脓性脊椎炎 ,5例胸椎间盘突出 ,3例伴有椎间盘炎的强硬性脊椎炎 ,2例脊柱后凸 ,2例骨质疏松性压缩骨折及 1例血管瘤。操作中包括引流(1) ,活组织检查 (3) ,胸椎间盘切除术 (5 ) ,前路松解及融合 (16 ) ,减压 (6 ) ,移植物融合 (5 0 )及运用内部设施 (5 5 )。结果 :出血量 5 0～ 3 70 0ml,平均 833ml,手术时间为 1～ 7.2h ,平均 3 .2h ,随访 4～ 5 3个月 ,平均 32个月。总体来说 2 6个病人中出现 31种并发症 (19.1% ) ,3个致命并发症 1例由术后肺部感染造成 ,1例因呼吸功能障碍而导致大出血 ,1例脓毒血症 ,其它非致命性并发症包括 5例术中出血量过大 (>2 0 0 0ml) ,4例短时间肋间神经痛 ,3例表面伤口感染 ,3例咽疼痛 ,2例肺膨胀不全 ,2例残余气胸 ,2例皮下气肿 ,2例硬膜破裂 ,1例心包穿透 ,1例乳靡胸 ,1例椎骨钉错位 ,1例入口处血肿 ,1例移植物不着位 (此例需重新手术 )。 6例失败的手术中包括更多还原

【Abstract】 Objective: Video-assisted thoracoscopic surgery(VATS)has only recently been applied in a variety of spinal procedures.In the current study,we aim to analyze and report our evolving concept of applying VATS technique in managing anterior spinal disorders and its clinical results.Methods:From 1995、11 to 1999、12,136 patients underwent thoracoscopic spine technique for lesions from T2 to L1 levels.The patients’ages ranged 5～89 years(mean 50.3).The definite diagnosis included 57 spinal metastases,22 burst fractures,16 scoliosis,16 tuberculous spondylitis,12 pyogenic spondylitis,5 thoracic disc herniations,3 ankylosing spondylitis with discitis,2 kyphosis,2 osteoporotic compression fractures,and 1 hemangioma.The operative procedures included drainage only (1),biopsy only (3),thoracic discectomy(5),anterior releasing and fusion (16),corpectomy for decompression (6),corpectomy and interbody fusion (50),and with internal instrumentation (55),Results:The estimated blood loss ranged 50～3,700 mL(mean 833),and the total operation length ranged 1～7.2 hrs(mean 3.2).Followup ranged 4～53 months (mean 32).Totally,there were 31 complications noted in 26 patients(19.1%).Three fatal complications were due to 1 postoperative pneumonia,1 massive blood transfusion associated with respiratory failure,and 1 uncomtrolable sepsis.Other non-fatal complications included 5 intra-operative bleeding>2,000mL,4 transient intercostal neuralgia,3 superficial wound infections,3 pharyngeal pain,2 lung atelectasis,2 residual pneumothorax,2 subcutaneous emphysema,2 dural ters,1 inadvertent pericardial penetration,1 chylothorax,1 vertebral screw malposition,1 portal hematoma,and 1 graft dislodgement that needed a late revison surgery.Six procedure failures cocsisted of 3 severe pleural adhesions,2 poorly to lerated one-lung ventilation and 1 bleeding due to thrombocytopenia and were comverted to open procedures.Conclusion:We conclude that the use of the extended manipulating channel method and a combination of thoracoscopy and conventional spinal instruments as presented in thos report is anideal method for performing VATS spinal procedures and also drrective for a wide range of spinal procedures.Well-selected patients and attention to details are essential in optimizing surgical results.Surgeons had better experience with standard open spinal technique,and no hesitation in converting a procedure to an open one whenever needed.A procedure failure does not mean a treatment failure.More application of these approaches is applicable,and has replaced some standard anterior spinal techniques in our puactices.更多还原