The purpose of this study is to come up with new methods to quantitate the blood loss under endoscope and explore the influence of blood loss on percutaneous endoscopic lumbar discectomy (PELD). Clinical research and in vitro experiment are combined. In the in vitro experiment, 2.0-ml blood was diluted in different ratio to simulate the rinse solution of PELD, the hematocrit method (HCT-M) and red blood cell count method (RBC-M) were came up to estimate blood loss and the new methods were calibrated with the direct measurement method (Direct-M). In clinical research, 74 patients with L5/S1 disk herniation were treated with PELD, and HCT-M and the empirical method (EMP-M) were used to estimate the blood loss under endoscope. According to blood loss, all patients were divided into group A (≤ 10 ml) and group B (> 10 ml). The blood loss, operation time, fluoroscopy frequency, visual analog scale (VAS), and Oswestry Disability Index (ODI) scores were compared between the two groups. In the in vitro experiment, the hematocrit of the rinse solution was always stable over time. The estimated blood loss by HCT-M was stable and quite approximate to actual blood volume (2.0 ml) whatever the blood dilution ratio, while according to RBC-M, the estimated blood loss was close to the actual blood volume only when the dilution ratio was greater than 300 times. In clinical research, the blood loss estimated by HCT-M was higher than that by EMP-M in both groups (P < 0.05). There was a significant difference between group A and group B in blood loss (7.40 ± 1.61 vs 19.91 ± 10.94 ml), operation time (80.51 ± 34.70 vs 136.51 ± 41.88 min), and fluoroscopy frequency (6.92 ± 1.52 vs 11.11 ± 2.32 times) (P < 0.05). The VAS and ODI scores in group B were higher than that in group A 1 week after operation (P < 0.05); however, the scores were not different between the two groups at pre-operation (P > 0.05). HCT-M is a reliable method to estimate endoscopic blood loss in PELD. The amount of endoscopic blood loss affects the operative procedure in operation time and fluoroscopy frequency, as well as clinical effects in VAS and ODI scores after operation in short term.

中文翻译：

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经皮内镜下腰椎间盘切除术（PELD）内​​镜下失血量的估计及其影响：临床观察研究结合体外实验。

本研究的目的是提出内镜下定量失血量的新方法，并探讨失血量对经皮内镜腰椎间盘切除术（PELD）的影响。临床研究与体外实验相结合。体外实验中，将2.0ml血液按不同比例稀释，模拟PELD冲洗液，采用血细胞比容法（HCT-M）和红细胞计数法（RBC-M）来估算失血量和新方法采用直接测量法（Direct-M）进行校准。临床研究中，74例L5/S1椎间盘突出症患者接受PELD治疗，并采用HCT-M和经验法（EMP-M）在内镜下估计失血量。根据失血量将所有患者分为A组（≤10ml）和B组（>10ml）。比较两组的失血量、手术时间、透视频率、视觉模拟量表（VAS）和Oswestry残疾指数（ODI）评分。在体外实验中，冲洗液的血细胞比容随时间始终保持稳定。无论血液稀释比如何，HCT-M 的估计失血量都很稳定，并且非常接近实际血容量（2.0 ml），而根据 RBC-M，只有当稀释倍数相同时，估计失血量才接近实际血容量大于300倍。临床研究中，两组HCT-M估算的失血量均高于EMP-M（P < 0.05）。A组与B组在失血量（7.40±1.61 vs 19.91±10.94 ml）、手术时间（80.51±34.70 vs 136.51±41.88 min）、透视次数（6.92±1.52 vs 11.11±2.32次）方面存在显着差异。 ）（P < 0.05）。术后1周B组VAS、ODI评分高于A组（P < 0.05）；但术前两组评分无差异（P>0.05）。HCT-M 是估计 PELD 内镜下失血量的可靠方法。内镜失血量影响手术方式、手术时间、透视频率以及术后短期内VAS、ODI评分的临床效果。