第2代骶神经调节治疗难治性下尿路症状(附45例报告)

Second Generation Sacral Neuromodulation for Refractory Lower Urinary Tract Symptoms:Report of 45 Cases

目的探讨第2代骶神经调节(sacral neuromodulation,SNM)治疗难治性下尿路症状的疗效及安全性。方法2015年6月～2017年11月我科应用第2代SNM治疗难治性下尿路症状45例,治疗包括Ⅰ、Ⅱ期手术两部分。Ⅰ期手术测试并选择应答良好的骶神经,连接临时刺激器,采用24 h排尿量、24 h排尿次数、夜尿次数、24 h漏尿次数、膀胱过度活动症评分(Overactive Bladder Symptom Score,OABSS)、1 h尿垫试验、残余尿量、最大尿流率等进行评估,患者的主要症状改善程度达到或超过50%且疗效达到患者预期,判定为治疗有效,行Ⅱ期手术,植入永久性刺激器,Ⅱ期术后采用上述指标定期进行疗效评估。结果 22例因Ⅰ期测试效果不佳或疗效未达到患者预期,术后4～5周在局麻下实施电极拔除。23例接受Ⅱ期永久刺激器植入,Ⅰ、Ⅱ期转换率为51.1%。尿频尿急17例,10例有效;尿失禁14例,7例有效;尿潴留14例,6例有效。Ⅱ期术后随访6～9个月,平均7个月,23例均无局部感染及刺激感消失、非预期性刺激、突发电击感、刺激器自发关机或其他不可逆不良反应出现。结论第2代SNM治疗部分难治性下尿路症状安全有效,能够改善患者的生活质量,近期随访未见明显不良反应。

Objective To explore the effectiveness and safety of second generation of sacral neuromodulation （SNM） in the treatment of refractory lower urinary tract symptoms （ LUTs）. Methods From June 2015 to November 2017, 45 cases of refractory LUTs were treated with the second generation SNM in our hospital. Operative treatment included two parts： stage Ⅰ and stage Ⅱ operations. The stage Ⅰ operation tested and selected good response of the sacral nerve, and connected temporary stimulator. By using urine volume in 24 h, urination times in 24 h, number of nocturnal times, leakage of urine in 24 h, Overactive Bladder Symptom Score （OABSS） , 1 h urine cushion test, residual urine volume, and maximum urine flow rate, the assessment was made tor main symptoms of the patients. When improvement of more than 50% , and the effect reaching the patient＇ s expectation, the treatment was regarded as effective and the stage Ⅱ operation was performed, in which a permanent stimulator was implanted. Results Of the 45 cases, 22 patients had poor outcome in stage I test or failed to achieve the expected outcome, and the electrodes were removed under local anesthesia at 4 - 5 weeks after operation. Twenty-three patients underwent second-stage permanent stimulator implantation. The eonversion rate of stage Ⅰ to Ⅱ was 51.1%. The effective rates tbr stage Ⅲ were. as follows： in 17 cases of urinary urgeney-frequeney, 10 cases were effective; in 14 cases of urinary incontinence, 7 cases were effective; in 14 cases of urinary retention, 6 cases were effective. After stage Ⅱ operations, follow-ups for 6 - 9 months （mean, 7 months） in 23 patients showed no irritation disappearance, local infection, unintended stimulation, sudden electric shock, spontaneous shutdown of stimulator or other irreversible adverse reactions. Conclusions The second generation of SNM is an effective and safe treatment for refractory LUTs. It can improve the quality of life of patients, and no obvious adverse reactions are observed after short-term follow-ups.