改良反射弧重建术治疗脊髓损伤后痉挛性膀胱功能障碍的疗效

Preliminary efficacy analysis of modified reflex arc reconstruction in the treatment of spastic bladder dysfunction after spinal cord injury

目的:探讨改良反射弧重建术治疗脊髓损伤后痉挛性膀胱功能障碍的初步疗效。方法:对2例脊髓损伤后痉挛性膀胱功能障碍的患者行改良反射弧重建,在硬膜外切断并吻合一侧S1和S2及S3前根,对侧行S1和S2前根转位吻合,保留S3前根完整。观察术前及术后大小便情况、尿动力情况及自主神经过反射情况并进行分析。结果:2例患者术后1个月尿动力检测均有明显好转,最大膀胱容量较术前均值增加了1.22倍,膀胱内压下降了66.3%,顺应性更是提高了3.56倍。检测期间血压没有明显变化,未出现自主神经过反射现象。术后均为间断导尿且大便性状较前变软,通畅程度改善,未出现大便失禁。结论:硬膜外椎管内双侧S1前根与一侧S2和S3前根双根、对侧S2前根精确转位吻合重建反射弧可能为脊髓损伤后痉挛性膀胱功能障碍的治疗提供一种新的简单安全、经济实用且易于推广的手术方式和研究思路。

Objective To investigate the preliminary efficacy of modified reflex arc reconstruction in the treatment of spastic bladder dysfunction after spinal cord injury.Methods Two patients with spastic bladder dysfunction after spinal cord injury underwent modified reflex arc reconstruction.Epidurally,the anterior roots S1 and S2 and S3 on one side are cut off and anastomosed on one side,and the anterior roots of S1 and S2 are transposed on the opposite side,and the anterior root of S3 is intact.Preoperative and postoperative stool and urine,urodynamic conditions and autonomic hyperreflexia were observed and analyzed.Results One month after operation,the urodynamic test of the two patients improved significantly.The maximum bladder volume increased by 1.22 times compared with the preoperative mean value,the bladder internal pressure decreased by 66.3%,and the compliance increased by 3.56 times.There was no significant change in blood pressure and no autonomic hyperreflexia during the test.After surgery,all urinary catheterization is intermittent,and the stool characteristics are softer than before,and the patency is improved.Conclusion The precise transposition anastomosis reconstruction reflex arc of bilateral S1 anterior root and one side S2 and S3 anterior root and contralateral S2 anterior root of epidural spinal canal may provide a new simple,safe,economical and easy-to-promote surgical method and research idea for the treatment of spastic bladder dysfunction after spinal cord injury.