ObjectiveTo review and evaluate the technical advantages and disadvantages and research progress of percutaneous endoscopic lumbar interbody fusion. MethodsThe domestic and foreign related research literature on percutaneous endoscopic lumbar interbody fusion was extensively consulted. The advantages, disadvantages, and effectiveness were summarized. And the development trend of this technology was prospected. ResultsCompared with minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF), percutaneous endoscopic lumbar interbody fusion has less intraoperative and postoperative bleeding, better improvement of low back pain in the early stage after operation, and similar long-term effectiveness, fusion rate, and incidence of complication, but a longer learning curve. The operation time of biportal and large-channel uniportal endoscopic lumbar fusion is close to that of MIS-TLIF, but the operation time of small-channel uniportal endoscopic fusion is longer than that of MIS-TLIF. ConclusionPercutaneous endoscopic lumbar interbody fusion has the advantages of less trauma and good effectiveness, but its learning curve is long, and indications should be strictly selected for this operation. In the future, with the continuous development and complementation of various endoscopic fusion technologies, this technology will gain better application prospects.
Objective To explore the clinical value of early enteral nutrition in severe acute pancreatitis （SAP） by percutaneous endoscopic gastrostomy/jejunostomy （PEG/J）.Methods Treatment condition of nighty patients with SAP were retrospectively analysed.The 90 patients were collected peripheral venous blood respectively on 1， 12， and 18 d after admission to hospital.Forty-five of them were in PEG/J group， the others were in control group. Serum IL-6，TNF-α and endotoxin were detected by enzyme-linked immunosorbent assay （ELISA），CD4 /CD8 was determinated by indirect immunofluorescence staining method （FITC-labeled）.Results On 12 d and 18 d，the levels of serum IL-6， TNF-α， and endotoxin in PEG/J group were lower than those in control group （P＜0.01）.The CD4 /CD8 was significantly higher than that in control group （P＜0.01）.In control group， 2 cases complicated upper gastrointestinal haemorrhage，4 cases complicated pancreatic pseudocysts， and 2 cases complicated double infection， the temperature became normal after about 13.5 d.In PEG/J group， there were not upper gastrointestinal haemorrhage and double infection，but 2 cases also complicated pancreatic pseudocysts， the temperature became normal after about 10.5 d.Conclusion The clinical effectiveness of early enteral nutrition in SAP by PEG/J is satisfactory.
Objective To evaluate the prel iminary cl inical outcomes of percutaneous endoscopic lumbar discectomy (PELD) for patient with discogenic chronic low back pain (CLBP) and fail ing to respond to conservative treatment. Methods From June 2007 to May 2008, 52 patients with CLBP and fail ing to respond to conservative treatment were treated, including 15 males and 37 females aged 29-46 years old (average 38.2 years old). Those patients were diagnosed ith discogenic pain by low pressure discography. Duration of CLBP was 6-110 months with an average of 32.1 months. MRI exam revealed 108 “black intervertebral discs” low in signal on T2 image, including 3 discs of L2,3, 17 of L3,4, 48 of L4,5 and 40 of L5-S1. Pressure-controlled discography showed positive response, fluoroscopy or intraoperative CT confirmed annulus fibrosus tears of posterior intervertebral disc in 79 discs. PELD was performed. Visual analogue scale (VAS) was evaluated before operation, 1 month after operation and at the final follow-up. The cl inical outcome was determined by modified Macnab criteria at the final follow-up. Results The average operation time of each disc was 30.7 minutes (range 21-36 minutes), and the mean length of postoperative hospital stay was 3.7 days (range 2-5 days). No compl ications such as infection and the injury of blood vessels and nerves occurred. Transient paralysis of nerve occurred in 5 cases on operation day, and those symptoms were disappeared at the final follow-up visit without special treatment. Fifty-two cases were followed up for 3-15 months (average 7.3 months). VAS score before operation, 1 month after operation and at the final follow-up was (7.34 ± 1.52), (3.62 ± 0.92) and (1.57 ± 0.48) points, respectively, indicating there were significant differences compared with preoperative score (P lt; 0.01). According to the modified Macnab criteria, 11 cases were graded as excellent, 23 as good, 13 as fair, 5 as bad, and the excellent and good rate was 65.38%. Conclusion Prel iminary study suggests that PELD is safe and effective in treating patient with discogenic CLBP and fail ing to respond to conservative treatment.
ObjectiveTo explore the clinical efficacy of percutaneous endoscopic interlaminar discectomy (PEID) and interlaminar fenestration discectomy in the treatment of lumbar (L) 5-Sacral (S) 1 lumbar disc herniation (LDH).MethodsLDH patients were retrospectively included from January 2016 to Januray 2018. And the patients were divided into the PEID group and the fenestration group according to their choice of different surgical methods. The operation time, intra-operative blood loss, and bed rest time in the two groups were recorded. The preoperative and postoperative [1 week, 1 month, 3 months, and last follow-up (>12 months)] Visual Analogue Score (VAS) of the lumbago and leg pain between the two groups were compared; the preoperative and postoperative [1 week, and last follow-up (>12 months)] Oswestry Disability Index (ODI) and also the postoperative [(>12 months)] therapeutic effect (modified MacNab) between the two groups were compared.ResultsA total of 66 patients were included, with 31 in the PEID group and 35 in the fenestration group. There was no significant difference in age, gender and course of disease between the two groups (P>0.05). There were leakage of cerebrospinal fluid and transient lumbago, leg pain and numbness, which were worse than those before operation in the PEID group (1 and 1 patient, respectively) and the fenestration group (2 and 3 patients, respectively). There were statistically significant differences between the PEID group and the fenestration group, in the operative time [(90.65±9.98) vs. (66.23±16.50) minutes], intra-operative blood loss [(51.77±18.64) vs. (184.29±78.38) mL], and bed time [(2.87±0.92) vs. (7.49±1.20) d] (t=−7.365, t’=−9.697, t=−17.374, P<0.001). There was no significant difference in the preoperative VAS score (lumbar-leg pain) and ODI index, and the ODI index at each postoperative time point, between the two groups (P>0.05). VAS score (lumbago) and VAS score (leg pain) in the PEID group at each postoperative time point were lower than those in the fenestration group (P<0.05); VAS scores (leg pain) at other time points were not statistically significant between the two groups (P > 0.05). VAS (lumbar-leg pain) score and ODI index at each postoperative time point were lower than those before the surgery. The was no statistically significant difference in the PEID group (90.32%) and fenestration group (85.71%) in the excellent rate (χ2=0.328, P=0.713).ConclusionsPEID has less surgical trauma, less bleeding, short bed rest, fast recovery, and better relief of postoperative lumbago symptoms. It is worthy of further promotion in clinical work.
Objectives To investigate the economic burden of percutaneous endoscopic gastrostomy (PEG) in hospitalized patients with amyotrophic lateral sclerosis (ALS) and analyze its influencing factors. Methods Clinical data of ALS patients who underwent PEG between 2014 and 2024 were collected through the inpatient electronic medical record system of West China Hospital of Sichuan University (including age, gender, comorbidities, disease course, daily living abilities, length of hospital stay, hospitalization costs, etc.), and their impact on the total hospitalization expenses were studied. Results A total of 102 patients were included. The median total hospitalization cost for ALS patients undergoing PEG was 12 701.00 (10 412.75, 16 720.00) yuan. The results of multiple linear regression analysis showed that the length of hospital stay and age of patients could affect the total hospitalization cost. Conclusions The total medical expenses for ALS patients undergoing PEG are approximately 10 000 yuan. Early assessment of the disease status in ALS patients, providing individualized management, and optimizing treatment plans to reduce hospital stay and medication costs can effectively control medical expenses.
Objective To investigate the effectiveness of unilateral biportal endoscopic discectomy (UBED), percutaneous endoscopic lumbar discectomy (PELD), and traditional fenestration discectomy (FD) in the treatment of lumbar disc herniation (LDH). Methods The clinical data of 347 LDH patients who met the selection criteria and underwent discectomy between January 2017 and December 2021 were retrospectively analyzed. They were divided into FD group (160 cases), PELD group (86 cases), and UBED group (101 cases) according to operation methods. There was no significant difference in gender, age, surgical level distribution, disease duration, and preoperative visual analogue scale (VAS) score and Oswestry disability index (ODI) between groups (P>0.05). The operation time, hospitalization stay, treatment cost, and incidence of surgery-related complications were recorded and compared between groups. The patients’ pain and functional recovery were evaluated by VAS score and ODI before and after operation. Results The operation time of FD group was significantly shorter than that of PELD group and UBED group, and the hospitalization stay was significantly longer than that of PELD group and UBED group (P<0.05); there was no significant difference between PELD group and UBED group (P>0.05). The treatment cost in UBED group was significantly higher than that in PELD group, and in PELD group than in FD group (P<0.05). All the patients were followed up 6-24 months, with an average of 14.6 months. VAS score of lower extremity and ODI in 3 groups significantly improved after operation when compared with that before operation (P<0.05). At 1 day after operation, VAS score of lower extremity of UBED group was significantly better than that in PELD group and FD group (P<0.05), but there was no significant difference between PELD group and FD group (P>0.05). There was no significant difference in VAS scores of lower extremity between the 3 groups at 1 and 3 months after operation (P>0.05). The difference of ODI before and after operation in FD group and UBED group was slightly better than that in PELD group (P<0.05), and there was no significant difference between FD group and UBED group (P>0.05). Incidence of surgery-related complications in FD group (20.0%) was significantly higher than that in PELD group (12.8%) and UBED group (6.9%), and PELD group was significantly higher than UBED group (P<0.05). All the incision infection occurred in FD group (12 cases), symptomatic disc cyst and myeloid hypertension-like occurred in 1 case each in PELD group.Conclusion UBED, PELD, and FD have similar effectiveness on lower extremity pain in early LDH. Compared with FD, UBED and PELD have the advantage of shorter hospitalization stay and fewer complications.
Objective To summarize the progress of percutaneous endoscopic lumbar interbody fusion in the treatment of lumbar degenerative diseases. Methods The relevant literature about percutaneous endoscopic lumbar interbody fusion at home and abroad in recent years was reviewed, the approaches, technical characteristics, short- and long-term effectiveness, and complications of different surgical procedures were summarized. Results Percutaneous endoscopic lumbar interbody fusion is a safe and reliable treatment. At present, the main surgical methods in clinical application can be roughly summarized as percutaneous endoscopic posterior transforaminal lumbar interbody fusion (Endo-PTLIF), percutaneous endoscopic transforaminal lumbar interbody fusion (Endo-TLIF), percutaneous endoscopic oblique lumbar interbody fusion (Endo-OLIF), percutaneous endoscopic lumbar interbody fusion/Z’s percutaneous endoscopic lumbar interbody fusion (Endo-LIF/ZELIF), and unilateral biportal endoscopic transforaminal lumbar interbody fusion (UBE-TLIF). Each surgical method has its own technical characteristics and development. Conclusion Percutaneous endoscopic lumbar interbody fusion is a kind of combined technology based on the individualization of the patient’s anatomical structure and the technical differentiation of the surgeon. Surgical experience, choosing adaptive indication and operative way reasonably are the key for the success.