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中华骨科杂志  2016, Vol. 36 Issue (17): 1126-1132    DOI: 10.3760/cma.j.issn.0253-2352.2016.17.007
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脊柱结核术后并发症的危险因素分析
邱小明,王亚朋,胡志军,安纪龙,孙亚澎,丁文元,申勇,张为,张建锋
310016 杭州,浙江大学医学院附属邵逸夫医院骨科(邱小明、胡志军、张建锋); 050051 石家庄,河北医科大学第三医院脊柱外科(王亚朋、安纪龙、孙亚澎、丁文元、申勇、张为)
Post-discectomy pseudocyst after transformimal percutaneous endoscopic discectomy: two cases reports and related literature review
Qiu Xiaoming,Wang Yapeng,Hu Zhijun,An Jilong,Sun Yapeng,Ding Wenyuan,Shen Yon,Zhang Wei,Zhang Jianfeng
Department of Orthopaedics, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou 310016, China(Qiu XM, Hu ZJ, Zhang JF); Department of Spine Surgery, the Third Hospital of Hebei Medical University, Shijiazhuang 050051, China(Wang YP, An JL, Sun YP, Ding WY, Shen Y, Zhang W)
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摘要 目的探讨椎间孔镜术后并发症状性椎间盘假性囊肿的临床特点和治疗方法。方法回顾性分析2家医院分别诊治的2例椎间孔镜术后并发症状性椎间盘假性囊肿患者的病历资料,男1例,26岁;女1例,34岁。2例均为L 4,5节段单侧椎间盘突出导致的单侧神经根病,第1次椎间孔镜术后症状均得到即刻缓解,但术后症状均再次发作,VAS评分8分,平均术后再发时间1.5个月(1~2个月)。术后MRI均显示原手术区域T2加权像呈高信号(同脑脊液)、T1加权像呈低信号占位影,并与椎间盘内相通。结果1例行小切口部分椎板切除假性囊肿切除术,术中见暗红色囊性肿块,内含陈旧性血性液体;术后囊壁病理组织学检查提示髄核样组织,局部可见炎性肉芽组织增生,内含新生血管和炎性细胞浸润。1例再次行椎间孔镜手术,术中见暗红色肉芽组织增生;术后囊壁病理组织学检查提示纤维结缔组织。2例患者术后症状均得到明显缓解;术后3个月随访,MRI示原假性囊肿消失。结论症状性椎间盘假性囊肿是椎间孔镜术后罕见并发症,常发生于术后早期,MR检查可明确诊断;当保守治疗无效时可行手术治疗,预后佳。
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作者相关文章
邱小明
王亚朋
胡志军
安纪龙
孙亚澎
丁文元
申勇
张为
张建锋
关键词椎间盘切除术   内窥镜检查   手术后并发症     
Abstract: ObjectiveTo investigate the clinical features and treatment of post-discectomy pseudocyst after transformimal percutaneous endoscopic discectomy. MethodsTwo patients from two different hospitals were retrospectively studied. One was male whose age was 26 years old, and the other was female whose age was 34 years old. Both cases presented with radiating unilateral leg pain and were diagnosed with ipsilateral herniated nucleus pulposus at L 4,5 based on MRI. They both experienced recurrent symptoms after successful transformimal percutaneous endoscopic discectomy. The mean time to relapsing radiculopathy was 1.5 months (1-2 months) with 8 on the visual analogue scale scores. On the postoperative MRI, cystic lesion of T2WI high (similar to cerebrospinal fluid) and T1W low at discectomy site was found in both patients. ResultsOne case was conducted with partial hemilaminectomy and discectomy. A dark red cystic mass containing old bloody fluid was found intra-operatively, and the histology of the cyst wall showed nucleus-like tissue, and inflammatory granulation tissue containing neovascularization and inflammatory cell infiltration in some area. The other case was conducted transformimal percutaneous endoscopic discectomy again, and dark red granulation tissue was found intra-operatively, and the histology of capsule wall showed fibrous connective tissue. Both cases achieved successful pain relief after the second surgeries. And MRI demonstrated the pseudocysts disappeared 3 months follow-up postoperatively. ConclusionSymptomatic post-discectomy pseudocyst is a rare complication after transformimal percutaneous endoscopic discectomy. It usually occurs in the early period postoperatively. MRI can confirm the diagnosis. Patients with failed conservative treatment can treat with surgery, and the prognosis is good.
Key wordsDiskectomy   Endoscopy   Postoperative complications   
收稿日期: 2016-06-06;
作者简介: 张为,E-mail:zwspine866@163.com;张建锋,E-mail: zhangjianfengxs@163.com
引用本文:   
邱小明,王亚朋,胡志军等. 脊柱结核术后并发症的危险因素分析[J]. 中华骨科杂志, 2016, 36(17): 1126-1132.
Qiu Xiaoming,Wang Yapeng,Hu Zhijun et al. Post-discectomy pseudocyst after transformimal percutaneous endoscopic discectomy: two cases reports and related literature review[J]. Chin J Orthop, 2016, 36(17): 1126-1132.
链接本文:  
http://www.chinjorthop.com/Jwk_zhgkzz/CN/10.3760/cma.j.issn.0253-2352.2016.17.007      或     http://www.chinjorthop.com/Jwk_zhgkzz/CN/Y2016/V36/I17/1126
 
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