关键词: chest tube hemothorax lateral retropleural approach pneumothorax thoracic disc herniation thoracostomy tube

来  源:   DOI:10.3171/2023.12.SPINE23128

Abstract:
OBJECTIVE: The mini-open lateral retropleural (MO-LRP) approach is an effective option for surgically treating thoracic disc herniations, but the approach raises concerns for pneumothorax (PTX). However, chest tube placement causes insertion site tenderness, necessitates consultation services, increases radiation exposure (requires multiple radiographs), delays the progression of care, and increases narcotic requirements. This study examined the incidence of radiographic and clinically significant PTX and hemothorax (HTX) after the MO-LRP approach, without the placement of a prophylactic chest tube, for thoracic disc herniation.
METHODS: This study was a single-institution retrospective evaluation of consecutive cases from 2017 to 2022. Electronic medical records were reviewed, including postoperative chest radiographs, radiology and operative reports, and postoperative notes. The presence of PTX or HTX was determined on chest radiographs obtained in all patients immediately after surgery, with interval radiographs if either was present. The size was categorized as large (≥ 3 cm) or small (< 3 cm) based on guidelines of the American College of Chest Physicians. PTX or HTX was considered clinically significant if it required intervention.
RESULTS: Thirty patients underwent thoracic discectomy via the MO-LRP approach. All patients were included. Twenty patients were men (67%), and 10 (33%) were women. The patients ranged in age from 25 to 74 years. The most commonly treated level was T11-12 (n = 11, 37%). Intraoperative violation of parietal pleura occurred in 5 patients (17%). No patient had prophylactic chest tube placement. Fifteen patients (50%) had PTX on postoperative chest radiographs; 2 patients had large PTXs, and 13 had small PTXs. Both patients with large PTXs had expansion on repeat radiographs and were treated with chest tube insertion. Of the 13 patients with a small PTX, 1 required 100% oxygen using a nonrebreather mask; the remainder were asymptomatic. One patient, who had no abnormal findings on the immediate postoperative chest radiograph, developed an incidental HTX on postoperative day 6 and was treated with chest tube insertion. Thus, 3 patients (10%) required a chest tube: 2 for expanding PTX and 1 for delayed HTX.
CONCLUSIONS: Most patients who undergo thoracic discectomy via the MO-LRP approach do not develop clinically significant PTX or HTX. PTX and HTX in this patient population should be treated with a chest tube only when there are postoperative clinical and radiographic indications.
摘要:
目的:微型开放外侧后胸膜(MO-LRP)入路是手术治疗胸椎间盘突出症的有效选择,但该方法引起了对气胸(PTX)的担忧.然而,胸管放置导致插入部位压痛,需要咨询服务,增加辐射暴露(需要多个射线照片),延迟护理的进展,并增加麻醉品需求。这项研究检查了MO-LRP方法后放射学和临床意义的PTX和血胸(HTX)的发生率,没有放置预防性胸管,用于胸椎间盘突出症.
方法:本研究是对2017年至2022年连续病例的单机构回顾性评估。审查了电子病历,包括术后胸片,放射学和手术报告,和术后记录。在所有患者术后立即获得的胸片上确定PTX或HTX的存在。如果有任何一个存在,请提供间隔射线照片。根据美国胸科医师学会的指南,大小分为大(≥3cm)或小(<3cm)。如果需要干预,则认为PTX或HTX具有临床意义。
结果:30例患者经MO-LRP入路行胸髓核切除术。包括所有患者。20名患者为男性(67%),10名(33%)是女性。患者的年龄范围为25至74岁。最常见的治疗水平是T11-12(n=11,37%)。术中侵犯顶叶胸膜5例(17%)。没有患者进行预防性胸管放置。15例患者(50%)在术后胸片上有PTX;2例患者有较大的PTX,13个有小PTX。两名患有大PTX的患者在重复X光片上均有扩张,并接受了胸管插入治疗。在13例患有小PTX的患者中,1个需要使用非呼吸面罩100%的氧气;其余的无症状。一个病人,术后胸部X光片没有异常发现,术后第6天出现了附带的HTX,并接受了胸管插入治疗。因此,3名患者(10%)需要胸管:2名用于扩张PTX,1名用于延迟HTX。
结论:大多数通过MO-LRP方法进行胸髓核切除术的患者没有发生临床上显著的PTX或HTX。只有在有术后临床和影像学适应症的情况下,该患者人群中的PTX和HTX才应使用胸管治疗。
公众号