钬激光外括约肌切开术在神经源性膀胱男性患者中的应用及长期随访  

Transurethral Sphincterotomy with Holmium Laser in Male Patients with Neurogenic Bladder and Long- Term Follow- up

作　　者：李鹏国[1,2] 廖利民[1,2] 鞠彦合[1,2] 付光[1,2] 李东[1,2] 熊宗胜[1,2] 史文博[1,2] 

机构地区：[1]首都医科大学康复医学院,北京市100068 [2]中国康复研究中心北京博爱医院泌尿外科,北京市100068

出　　处：《中国康复理论与实践》2013年第12期1108-1110,共3页Chinese Journal of Rehabilitation Theory and Practice

基　　金：国家"十二五"科技支撑计划项目(No.2012BAI34B02)

摘　　要：目的研究钬激光外括约肌切开术在神经源性膀胱男性患者中的治疗效果及长期随访。方法对20例接受钬激光外括约肌切开术的神经源性膀胱男性患者进行回顾性分析。其中颈髓损伤7例,胸髓损伤6例,圆锥马尾神经损伤3例;脊膜膨出1例,骶裂1例,室管膜瘤术后1例,脊髓炎后遗症1例。年龄20~64岁,平均45.1岁。随访时间3~95个月,平均43.6个月。结果 20例患者术后在症状学、实验室检查、影像学和尿动力学指标等方面均获得明显改善。随访过程中3例患者再次行钬激光外括约肌切断。17例患者长期随访效果稳定。结论钬激光外括约肌切开术具有出血少、安全、疗效确切的优点,长期随访效果相对稳定。对于不能实行或不愿实行间歇导尿的男性神经源性膀胱患者,尤其是伴有自主神经过反射、逼尿肌外括约肌协同失调的患者可作为一种有效的治疗方法。Objective To explore the technique, efficacy and complications of transurethral sphincterotomy with Holmium laser for the treatment of male patients with neurogenic bladder and examine its long-term outcome. Methods 20 male cases who received transurethral sphincterotomy with Holmium laser were included in this retrospective analysis, in which 7 cases injuried at cervical spinal cord, 6 at thorac- ic spinal cord, 3 at cauda equine; 1 was spinal meningocele, 1 was sacral crack, 1 was ependymoma, and 1 was myelitis sequel. The age was 20~64 years, averaged 45.1 years. They were followed up for 3~95 months （averaged 43.6 months） since the last sphincterotomy. Results The 20 patients significantly improved in symptoms, laboratory examination, imaging demonstration and urodynamic index after the opera- tion. There were 3 patients who required repeated laser surgery during the follow-up. 17 patients were stable. Conclusion Transurethral sphincterotomy with Holmium laser is effective on neurogenic bladder with less bleeding for the appropriately selected patients.

关 键 词：脊髓损伤 神经源性膀胱 钬激光 括约肌切开 

分 类 号：R694[医药卫生—泌尿科学]