骶神经调控治疗不完全性脊髓损伤患者下尿路症状的疗效分析

Effect analysis of sacral neuromodulation in the treatment of incomplete spinal cord injured patients suffering from neurogenic lower urinary tract symptoms

目的评估骶神经调控治疗不完全性脊髓损伤患者下尿路症状的有效性和安全性。方法回顾性分析2015年2月至2019年5月南部战区总医院收治的36例接受骶神经调控治疗的不完全性脊髓损伤患者(ASIA分级为C或D级)下尿路症状的临床资料。36例患者分为NUR组(神经源性尿潴留组)16例,NOAB组(神经源性膀胱过度活动组)20例。骶神经调控电极植入术(Ⅰ期)后患者临床症状改善≥50%时,可植入骶神经永久刺激器(Ⅱ期)。术前、Ⅰ期术后及Ⅱ期术后采用排尿日记、残余尿量、清洁导尿次数、OABss评分、1 h尿垫试验参数等对患者临床症状进行评估。结果共21例(58.3%)患者测试有效并接受了Ⅱ期手术,其中NUR组7例(19.4%),NOAB组14例(38.9%)。NUR组患者术后膀胱残余尿量、日均导尿次数、日均排尿次数、每次排尿量均有不同程度的改善(P<0.05),NOAB组患者手术后尿频、尿急、尿失禁症状均有不同程度缓解(P<0.05)。随访中,2例尿潴留患者电刺激失效,予对侧S3行Ⅰ期测试治疗后,疗效恢复。1例患者术后感染,予感染灶清除术后伤口愈合。结论骶神经调控治疗不完全性脊髓损伤患者的下尿路症状安全有效,有助于脊髓损伤患者肾功能的保护。虽不能改善全部症状,但对于不能耐受传统治疗或治疗无效的患者,骶神经调控是一种可选择的治疗方式。

Objective To determine the efficacy and safety of sacral neuromodulation(SNM)in incomplete spinal cord injured(SCI)subjects affected by neurogenic lower urinary tract symptoms.Methods Clinical data of 36 patients with incomplete spinal cord injury who underwent SNM from February 2015 to April 2019 were retrospectively analyzed and were divided into group NUR(16 cases neurogenic urinary retention group)and group NOAB(20 cases of neurogenic bladder overactive group).If at least 50%clinical improvement occurred,the patient would undergo a permanent SNM procedure.The patients were evaluated by using bladder diary,postvoid residual volume measurement,frequency of clean catheterization and urodynamic parameters before and during the test,and after the permanent SNM.Results Among the 36 patients,21 cases(58.3%)were tested effectively and received permanent stimulator implantation,7(19.4%)in NUR group and 14(38.9%)in NOAB group.The residual urine volume of bladder,the average number of catheterization and the average number of urination in NUR group were improved in different degrees.After operation,the symptoms of frequent urination,urgency of urination and incontinence in NOAB group were relieved to varying degrees.During the follow-up,2 patients with urinary retention failed the treatment.After theⅠphase of the contralateral S3,the curative effect was recovered.A patient were infected after operation,and the wound healed after removal of the infection.Conclusions The SNM is safe and effective in the treatment of neurogenic lower urinary tract symptoms in some incomplete spinal cord injury patients,and is helpful to protect renal function in patients with spinal cord injury.SNM can not improve all symptoms at times,but the SNM can be considered in patients with ineffective or intolerant traditional treatment.