新型六触点电极与四触点电极骶神经调控系统治疗难治性膀胱过度活动症的效果比较

Evaluation of sacral neuromodulation system with new six-contact points electrode for the treatment of bladder dysfunction

目的比较新型六触点刺激电极和传统四触点刺激电极骶神经调控系统对难治性膀胱过度活动症患者的治疗效果。方法回顾性分析2018年1月至2020年1月于中国康复研究中心接受骶神经调控治疗的29例难治性膀胱过度活动症患者的资料。其中16例采用六触点刺激电极进行骶神经调控治疗,为六触点电极组;13例采用四触点刺激电极治疗,为四触点电极组。两组年龄[(51.63±14.67)岁与(51.85±17.18)岁]、性别[男/女:4/12与5/8],以及治疗前24h排尿次数[(22.10±9.05)次与(21.79±8.05)次]、次均排尿量[(135.68±56.98)ml与(131.00±53.05)ml]、尿急评分[(2.78±0.97)分与(3.02±0.91)分]差异均无统计学意义(P>0.05)。比较两组患者一期电极植入的手术时间、术中敏感触点(引起运动反应时的最小电压≤2V的触点)个数、术中反应触点(术中测试能够引起运动反应的电极触点)占比、同一种电极上各个触点的反应电压以及二期转化(骶神经脉冲发生器植入)率。结果六触点电极组与四触点电极组的敏感触点个数[(3.31±0.95)个与(1.85±0.38)个]差异有统计学意义(P<0.05)。六触点电极组与四触点电极组的反应触点占比[(96.87±6.71)%与(96.15±9.39)%]差异无统计学意义(P>0.05)。六触点电极组与四触点电极组一期手术时间[(71.25±18.21)min与(68.85±10.83)min]差异无统计学意义(P>0.05)。同一种电极各个触点反应电压比较,六触点电极的E4与E5触点反应电压差异无统计学意义[(1.07±0.41)V与(0.96±0.36)V,P>0.05];六触点电极其余触点反应电压[E0、E1、E2、E3分别为(3.37±0.79)、(2.90±0.61)、(2.09±0.61)、(1.65±0.63)V],以及四触点电极中所有触点的反应电压[E0、E1、E2、E3分别为(3.47±0.87)、(2.89±0.58)、(1.66±0.53)、(0.92±0.39)V]差异均有统计学意义(P<0.05)。六触点电极组二期转化率为87.5%(14/16),高于四触点电极组的76.9%(10/13),但差异无统计学意义(P>0.05)。结论本研究结果表明六触点电极与四触点电极相比,有更多的敏感触点。六触点电极骶神经调控治疗膀胱过度活动症有较高的二期转化率。

Objective To investigate the effects of sacral neuromodulation(SNM)using the new six-contact electrode vs.the four-contact electrode in patients with refractory overactive bladder.MethodsThe clinical data of 29 patients underwent SNM testing therapy from January 2018 to January 2020 in China Rehabilitation Research Center were reviewed.In six-contact points electrode group 16 patients accepted SNM with new six-contact points electrode,while 13 patients in four-contact points electrode group accepted SNM with four-contact points electrode.There were no significant differences between the two group in age[(51.63±4.67)vs.(51.85±7.18)years],gender(male/female,4/12 and 5/8),urination frequency[(22.10±9.05)vs.(21.79±8.05)times/24h],mean voided volume[(135.68±56.98)vs.(131.00±53.05)ml],and urgency score[(2.78±0.97)vs.(3.02±0.91)](all P>0.05).The number of sensitive contact points,the ratio of reaction contact points,operation time of stage I and the success rate of two groups were calculated.Results The mean number of sensitive points of six-contact points electrode group(3.31±0.95)was significantly higher than that of the four-contact points electrode group(1.85±0.38),(P<0.05).There was no significant difference in the ratio of reaction contact points[(96.87±6.71)%vs.(96.15±9.39)%]and operation time of stage 1[(71.25±18.21)min vs.(68.85±10.83)min] between six-contact points electrode group and four-contact points electrode group(P<0.05).The contact E4 and E5 of six-contact electrodes had similar reaction voltage(P>0.05).The implant rate of six-contact points electrode group was(14/16,87.5%),which was higher than that of four-contact points electrode group(10/13,76.9%),but there was no statistical difference(P>0.05).Conclusions This study showed that six-contact electrodes has more sensitive points compared with four-contact electrodes.Application of six contact electrodes,patients might get a higher implant rate.