骶神经调节治疗顽固性下尿路功能障碍经验初探

Initial experience of sacral neuromodulation in refractory lower urinary tract dysfunction

目的：初步探讨骶神经调节（SNM）治疗顽固性下尿路功能障碍的相关经验。方法：2013年1月-2015年1月应用SNM疗法治疗顽固性下尿路功能障碍患者20例,对比术前患者状况、Ⅰ期自固定电极植入后及Ⅱ期永久刺激器植入后的短期随访中相关症状的改善程度,观察该疗法的有效性及安全性,并总结相关经验。结果：20例患者Ⅰ期手术时间平均1.6h,电极植入体验时间平均3.1周。8例因Ⅰ期测试效果不佳,于术后4-5周在局麻下实施电极拔除;12例患者接受Ⅱ期永久刺激器植入。Ⅰ-Ⅱ期转换率为60%,Ⅱ期永久刺激器植入术后平均随访时间为9.9个月。接受Ⅱ期永久植入患者治疗前和截止随访时的相关数据分别为：24小时平均排尿次数分别为17.5次和13.3次（P〈0.05）,夜尿平均为4.2次和2.7次（P〈0.05）,平均尿量为110 ml和165.8ml（P〈0.05）。12例患者随访过程中,9例症状持续缓解;2例出现暂时性原有症状反复,通过参数调整能够缓解;1例患者（原发病为膀胱疼痛综合征）原有症状反复较严重,需间断参数调整。2例患者出现轻微电极植入位置及永久刺激器植入位置囊袋不适,可自行缓解。所有12例患者均无便秘、腹泻、刺激感消失、非预期性刺激、局部感染、突发电击感、刺激器自发关机等情况出现。结论：SNM是治疗顽固性下尿路功能障碍安全、有效的微创治疗方式;患者在术后需要接受定期随访,根据症状改善情况及时进行参数调整。

Objective：To introduce the initial experience of sacral neuromodulation（SNM）in refractory lower urinary tract dysfunction.Method：From January 2013 to January 2015,20 patients with refractory lower urinary tract dysfunction were recruited in our study.They were all recruited in SNM treatment.We tried to compare the data before stageⅠtined lead implanted and the data of short-term follow-up after stageⅡimplanted pulse generator（IPG）embedded in order to summarize the initial experience of SNM.Result：Twenty patients received stageⅠ operation with percutaneous approach,implanted a tined lead.The average stageⅠ operation time was 1.6h,and the stageⅠtest duration was 3.1weeks.Eight of them removed the tined lead under local anesthesia because of poor effects 4-5weeks later after stageⅠtrial.Other 12 patients underwent embedding IPG at the end of stageⅠ.The conversion rate of stageⅠto stageⅡ was 60%.The follow-up period after stageⅡ was 9.9months.The data of voiding frequency in 24 hours,nocturia and average voiding amount between baseline（before stageⅠ）and after stageⅡ were 17.5vs 13.3（P〈0.05）,4.2vs 2.7（P〈0.05）and 110 ml vs 165.8ml（P〈0.05）,respectively.During the follow-up period,nine patients were satisfied with relieving symptoms without recurrence,two patients had temporary symptoms recurrence but problems were solved with parameter adjustment.However,one BPS/IC patient experienced her most severe symptom recurrence which could not be successfully solved by parameter adjustment.Besides,two patients felt mild uncomfortable at the implantation site of tined lead and IPG,and their feeling spontaneously improved.All 12 patients had no complications such as constipation,diarrhea,loss of stimulation,local infection,sudden shock feeling or spontaneous shutdown of stimulator.Conclusion：SNM is an effective,safe and minimally invasive procedure for refractary lowery urinary tract dysfunction.Patients ought to be arranged regular follow-up visit and parameter adjustment is needed according to patients＇ condition.