骶神经调节在女性糖尿病性膀胱功能障碍治疗中的应用

Applications of SNM therapy in treating female diabetic bladder dysfunction

目的:总结骶神经调节(SNM)治疗女性糖尿病性膀胱功能障碍(DBD)患者的初步经验。方法:回顾性分析2017年5月～2018年8月我院采用SNM治疗的10例女性DBD患者的临床资料,年龄43～72岁,平均51岁,糖尿病病程2～23年,膀胱功能障碍病程0.5～8年,比较治疗前、Ⅰ期测试阶段及Ⅱ期永久刺激器植入后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,并初步总结相关经验。结果:10例患者均在局麻下接受了SNMⅠ期电极植入,4例因测试效果不佳,于局麻下取出测试电极。6例经测试后行Ⅱ期永久刺激器植入,Ⅰ期至Ⅱ期转换率为60%(6/10)。接受Ⅱ期刺激器永久植入患者在随访截止时与治疗前相比,日排尿次数[(11.2±9.6)次vs.(18.3±9.4)次,P=0.02]、每次排尿量[(181.3±61.5)ml vs.(104.5±55.3)ml,P<0.01]、生活质量评分[(3.5±1.5)分vs.(6.2±1.3)分,P<0.01]、残余尿量[(66.7±57.9)ml vs.(188.6±63.4)ml,P<0.01]、排尿困难评分[(3.9±1.4)分vs.(8.2±1.7)分,P<0.01]均显著改善。围手术期未见明显并发症发生,1例患者随访中出现手术侧臀部及下肢疼痛不适,通过程控改变电刺激模式后好转。5例在Ⅱ期植入术后症状持续缓解,1例出现症状反复,症状缓解不明显,予以保留刺激器并结合间断清洁自我导尿。结论:对于女性DBD患者,SNM是一种安全、有效的微创治疗方式。选择合适的患者、更精细的手术操作及适当延长测试的时间,可以提高转换率,改善患者疗效。

Objective:To investigate the infect of Sacral neuromodulation therapy upon the patient of diabetic bladder dysfunction.Method:Between May 2017 to August 2018,10 female patients with diabetic bladder dysfunction were treated with SNM therapy in the First Affiliated Hospital of Nanjing Medical University.The symptom improvement of pretherapy,phase I(testing phase),phase II(post permanent stimulator implantation)were compared and the safety of SNM in such patients was observed.Result:10 patients received phase I electrode stimulator implantation under local anaesthesia,and electrode stiumlators were removed in 4 cases due to unsatisfactory effect.The other 6 cases undergo a permanent SNM procedure,the conversion rate was 60%(6/10).Number of urinations per day[(11.2±9.6)times vs.(18.3±9.4)times,P=0.02],urinary volume per time[(181.3±61.5)ml vs.(104.5±55.3)ml,P<0.01],quality of life[(3.5±1.5)vs.(6.2±1.3),P<0.01],residual volume[(66.7±57.9)ml vs.(188.6±63.4)ml,P<0.01],dysuria score[(3.9±1.4)vs(8.2±1.7),P<0.01]were significant improved after permanent SNM procedure compared with pretherapy.No obvious complications occurred during perioperative period.pain and discomfort in surgical location was observed in one case and was relieved by modified electrical stimulus pattern.5 cases received long period of relief after permanent SNM procedure.Recurrence of symptoms was observed in one patient,and intermittent self-catheterization was introduced to this patient with the stimulator reserved.Conclusion:SNM is a safety,effective and minimally invasive manner for femal diabetic bladder dysfunction patients.Appropriate patient selection,expertly surgical operation and appropriately prolonged testing can significantly improve the conversion rate and efficacy.