経皮的内視鏡下腰部脊柱管拡大術（PEL）における工夫

Modification of Percutaneous Endoscopic Laminotomy

　背景：腰部脊柱管狭窄症に対する経皮的内視鏡下脊柱管拡大術は使用器具の能力と安全性，視野，出血のコントロールに課題がある．

　対象と方法：短尺で大径の経皮的内視鏡を用い，内視鏡用のドリルと超音波骨切除装置の内視鏡用先端チップや可屈曲鋭匙鉗子を使用して，片側進入両側除圧術を腰部脊柱管狭窄症3例に対して行った．出血が強い場合には無水止血を行った．

　結果とまとめ：視野や骨切除能力は十分で出血も少なくすることができ，また硬膜損傷のリスクを減らすことができた．

　Background：Percutaneous endoscopic laminotomy for lumbar spinal stenosis has had some drawbacks in relation to the performance of the inserted apparatus, the narrow field of view, control of bleeding, and safety.

　Methods：Percutaneous endoscopic bilateral decompression by a unilateral approach was performed by using a short, large-diameter (10 mm) endoscope and a drill and supersonic bone resection equipment for microendoscopic surgery.　Anhydrous hemostasis was performed whenever the view was blocked by bleeding.

　Results and conclusions：This modified method was used to treat three cases, and there were no dural tears.　The ability to perform bone resection and the range of view were adequate.　Bleeding was reduced, and the modified method decreased the risk of dural tears.