骶神经刺激治疗难治性膀胱过度活动症9例报告

发布时间：2018-11-11 12:05

【摘要】：目的评估骶神经刺激(sacral nerve stimulation,SNS)治疗难治性膀胱过度活动症(overactive bladder,OAB)的有效性和安全性。方法回顾性分析2016年5~10月9例难治性OAB的临床资料。手术治疗包括体验性治疗与永久性植入两部分。术后使用三代喹诺酮类或二代头孢类抗生素预防感染。比较永久植入术后与体验治疗术前的排尿日记(包括5 d平均24 h排尿次数、5 d平均24 h每次排尿量)、膀胱过度活动症评分(overactive bladder symptom score,OABSS)、O’Leary-Sant评分(O’Leary-Sant problem and symptom index,OPSI)及其中的问题指数评分(interstitial cystitis problem index,ICPI)和症状指数评分(interstitial cystitis symptom index,ICSI)等。随访患者是否发生手术不良反应,刺激作用不良反应及装置不良反应。结果 9例体验治疗后疗效满意,均接受永久性调节器长期植入治疗,永久植入成功率为100%。体验治疗与永久植入术时间间隔为6~22 d,(9.6±5.0)d。术后随访3~8个月,(6.1±1.5)月。体验治疗术前平均24 h排尿次数(34.0±16.7)次,明显多于永久植入术后末次随访排尿次数(18.0±4.5)次(t=3.648,P=0.007);术前平均24 h每次排尿量(106.5±44.6)ml,明显少于永久植入术后末次随访排尿量(140.8±38.3)ml(t=-4.314,P=0.003)。体验治疗术前OABSS(10.8±1.7)分、OPSI(31.6±2.4)分、ICPI(14.4±1.1)分、ICSI(17.1±1.6)分,末次随访时上述各项指标均显著降低,分别为(6.3±3.3)分(t=5.946,P=0.000)、(16.0±3.5)分(t=9.061,P=0.000)、(6.8±2.5)分(t=7.667,P=0.000)、(9.2±2.6)分(t=6.475,P=0.000)。未发生感染、出血、神经或血管损伤等手术不良反应,植入位点疼痛、新发疼痛、肠道功能变化、短暂轻度的电击感等刺激作用不良反应,电极断裂、电极短路、功能异常、部件腐蚀、感染等装置不良反应。结论 SNS对于其他治疗效果不佳的难治性OAB安全、有效。
[Abstract]:Objective to evaluate the efficacy and safety of sacral nerve stimulation (sacral nerve stimulation,SNS) in the treatment of refractory bladder hyperactivity (overactive bladder,OAB). Methods the clinical data of 9 cases of refractory OAB from May to October 2016 were analyzed retrospectively. Surgical treatment consists of experiential treatment and permanent implantation. Third generation quinolones or second-generation cephalosporins were used to prevent infection after operation. The diaries of urination after permanent implantation were compared with those before experience therapy (including 5 days mean 24 h urination times, 5 d mean 24 h urine volume per time), and bladder hyperactivity score (overactive bladder symptom score,OABSS). O'Leary-Sant score (O'Leary-Sant problem and symptom index,OPSI), problem index score (interstitial cystitis problem index,ICPI) and symptom index score (interstitial cystitis symptom index,ICSI), etc. Follow-up patients with adverse reactions, irritation and device adverse reactions. Results 9 cases were treated with permanent adjuster for a long time and the success rate of permanent implantation was 100%. The interval between experience therapy and permanent implantation was 622 days and (9.6 卤5.0) days. Postoperative follow-up was 3 ~ 8 months, (6.1 卤1.5) months. The average number of urination before experience therapy was (34.0 卤16.7), which was significantly higher than that after permanent implantation (18.0 卤4.5) (t = 3.648). The mean urination volume (106.5 卤44.6) ml, at 24 hours before operation was significantly lower than that after permanent implantation (140.8 卤38.3) ml (/ t). Before experience therapy, OABSS (10.8 卤1.7), OPSI (31.6 卤2.4), ICPI (14.4 卤1.1), ICSI (17.1 卤1.6), were significantly decreased at the last follow-up. It was (6.3 卤3.3) minutes (t _ (5.946), (16.0 卤3.5) (t _ (9.061), (_ (0.000) 卤2.5) (t _ (7.667) P ~ (0.000), (_ (0.000) 卤2.6) (t ~ (6.475), (卤(0.000). There were no adverse reactions such as infection, hemorrhage, nerve or vascular injury, pain at implantation site, new pain, changes in intestinal function, transient and mild adverse effects of electrical stimulation, electrode breakage, short circuit of electrode, abnormal function, etc. Component corrosion, infection and other device adverse reactions. Conclusion SNS is safe and effective for other refractory OAB.
【作者单位】：北京大学第三医院泌尿外科;山东省潍坊市益都中心医院泌尿外科;
【分类号】：R694.5

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