多节段微创经椎间孔腰椎椎间融合术 (MIS-TLIF)术后引流管安置时机的研究进展

Research Progress on the Timing of Drainage Tube Placement after Multi-Level Minimally Invasive Transforaminal Lumbar Interbody Fusion (MIS-TLIF)

摘要: 背景：多节段MIS-TLIF术后引流管安置时机仍存争议。目的：综述该术式引流策略及出血量对决策的影响。方法：通过检索CNKI、PubMed等数据库的国内外文献，评价不同策略对术后恢复的影响。结果：术中出血量是决策核心指标。失血量大(单节段 > 300 mL或多节段 > 400 mL)者，即刻置管可显著降低血肿风险；出血较少(<100~150 mL)且无硬膜损伤者，选择性不留置策略可缩短住院时间并降低感染率。此外，术后高引流量(>200 mL/24h)无临床获益，反而增加感染风险。结论：引流决策应基于出血量及硬膜损伤、抗凝状态、基础病等多维变量进行动态评估，实施风险分层决策树模型下的个体化管理有利于促进患者围术期康复。

Abstract: Background: The timing of drainage tube placement following multi-level MIS-TLIF remains controversial. Objective: To review drainage strategies and the impact of blood loss on decision-making. Methods: Domestic and international literature from databases such as CNKI and PubMed was evaluated for the impact of different strategies on postoperative recovery. Results: Intraoperative blood loss is the core indicator in decision-making. For high blood loss (single-level > 300 mL or multi-level > 400 mL), immediate placement significantly reduces hematoma risk. For low blood loss (<100~150 mL) without dural injury, a selective non-retention strategy shortens hospital stay and lowers infection rates. Postoperative drainage > 200 mL/24h offers no clinical benefit and increases infection risks. Conclusion: Drainage decisions should be dynamically evaluated based on blood loss and multidimensional variables (e.g., dural injury, anticoagulation status, and comorbidities); implementing individualized management under a risk-stratified decision-tree model facilitates perioperative recovery.