后路显微内窥镜下髓核摘除术中出血原因分析及处理措施Prevention and management of hemorrhage in the microendoscopic discectomy for lumbar disc herniation
李树文;杨哲;王宇鹏;孟格栋;杜志才;吴一民;银和平;
摘要(Abstract)：
[目的]探讨影响后路显微内窥镜下腰椎间盘切除术中出血的危险因素,为处理和预防术中出血提供依据。[方法]回顾分析2013年1月~2015年1月在本科接受腰椎MED术的患者620例。纳入标准:单节段突出。排除标准:肝功能异常者、凝血功能异常者、1个月内曾使用各种抗凝药者、L_(2、3)(含)及以上椎间盘突出。精确计量吸引器回流瓶中液体量,减去术中冲洗用水量,算出术中出血量,依据术中出血是否超过200ml将研究对象分为出血量少组与出血量多组,对两组病例年龄、病程、突出部位、病理分型、是否为游离(含脱出)、是否合并狭窄、同节段是否有手术史等指标进行比较分析,采用Logistic多因素回归分析寻找影响术中出血的危险因素。[结果]出血量<200 ml者564例,出血量≥200 ml者56例,其中>400ml者2例,>600 ml者1例,Logistic多因素回归分析结果显示突出部位、游离(含脱出)、合并椎管狭窄及同节段既往手术史是引起术中出血的高危因素,年龄、病程、病理分型不是引起术中出血的危险因素。[结论]L_(3、4)椎间盘突出、游离型椎间盘突出(含脱出)及既往手术史是引起术中出血的高危因素。
关键词(KeyWords)： 后路;显微内窥镜;腰椎间盘突出症;髓核摘除;出血
基金项目(Foundation):
作者(Author): 李树文;杨哲;王宇鹏;孟格栋;杜志才;吴一民;银和平;
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参考文献(References)：
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