骶神经调节治疗膀胱疼痛综合征/间质性膀胱炎患者的初步临床结果  

Sacral neuromodulation for the treatment of painful bladder syndrome/interstitial cystitis： preliminary results

作　　者：张耀光[1] 王建业[1] 张大磊[1] 田子健[1] 张志鹏[1] 王萱[1] 万奔[1] 魏东[1] 刘明[1] 张力青[1] 朱生才[1] 朱刚[1] 王建龙[1] 陈鑫[1] 王鑫[1] 马宏[1] 赵爽怿 伍建业[1] 

机构地区：[1]北京医院泌尿外科,100730

出　　处：《中华泌尿外科杂志》2015年第2期91-94,共4页Chinese Journal of Urology

摘　　要：目的 评估骶神经调节术（sacral neuromodulation,SNM）治疗膀胱疼痛综合征/间质性膀胱炎（painful bladder syndrome/interstitial cystitis,PBS/IC）患者的有效性和安全性. 方法 2012年4月至2014年10月21例PBS/IC患者接受SNM体验治疗.患者均曾接受行为治疗、口服药物治疗、膀胱灌注无菌透明质酸钠液、膀胱水扩张或膀胱黏膜下注射A型肉毒毒素等治疗,但疗效不佳.收集患者体验治疗术前及永久性调节器植入术后的排尿日记、视觉模拟疼痛评分、间质性膀胱炎指数和生命质量评分.术后2周、3个月、6个月各随访1次,之后每6个月随访1次.临床成功被定义为以体验治疗术前的排尿日记、视觉模拟疼痛评分、间质性膀胱炎指数和生命质量评分为基准线,体验治疗术后上述评价标准改善率达到50％及以上,且患者要求植入永久性调节器. 结果 体验治疗后3例患者因体验治疗后疗效不满意拒绝植入调节器,18例接受InterStim长期植入治疗.本组永久植入成功率为86％.术后随访2～ 30个月,平均18个月.术前平均24 h排尿次数为（23.2±7.1）次、夜尿次数为（13.0±4.7）次、平均每次排尿量（73.3±12.9） ml、视觉模拟疼痛评分7.2±1.1、间质性膀胱炎问题指数15.6±1.3、间质性膀胱炎症状指数14.1±1.8、生命质量评分5.6±0.5.术后疗效保持稳定,末次随访时上述各项指标分别为（11.1±3.2）次、（5.9±2.1）次、（164.4±28.5） ml、3.4±0.8、7.0±0.7、6.6±1.0、1.9±1.0,永久植入术后较体验治疗术前症状及评分均有明显改善,差异有统计学意义（P＜0.05）.未发生感染、电极移位断裂或其他不可逆的不良反应. 结论 初期临床结果显示,SNM对于其他治疗效果不佳的PBS/IC患者安全、有效.Objective To evaluate the effectiveness and safety of sacral neuromodulation for the treatment of painful bladder syndrome/interstitial cystitis.Methods There were 21 painful bladder syndrome/interstitial cystitis patients treated during April 2012 to October 2014.Behavior therapy,oral therapy,intravesical instillation of sterile sodium hyaluronate,water expansion of bladder,bladder submucosal injection of botulinum toxin type A and so on did not have a good effect on the patients.The data of voiding diary,visual pain scale,interstitial cystitis symptom index and quality of life score were collected.The time of follow-up was 2 week,3 month and 6 month after the surgery.Then the patient was followed up every 6 months.Those individuals demonstrating a 50% reduction in voiding diary,visual pain scale,interstitial cystitis index and the quality of life score were eligible for surgical placement of a permanent device.Results Three of them refused to accept InterStim therapy because of failure of experimental therapy.Eighteen of them received InterStim long term implantation therapy.The rate of long term implantation was 86%.The average follow-up time was 18 months.Before the surgery,the average voiding times of 24 hours,the times of nocturia,the voiding volume,the visual pain score,the interstitial cystitis problem index,interstitial cystitis symptom index and the quality of life score were 23.2±7.1,13.0±4.7,73.3±12.9 ml,7.2±1.1,15.6±1.3,14.1±1.8,5.6±0.5.After surgery,the data were 11.1±3.2,5.9±2.1,164.4±28.5 ml,3.4±0.8,7.0±0.7,6.6± 1.0,1.9± 1.0,respectively.And there were significant differences （P〈0.05）.There was no complication such as infection,electrode displacement,electrode fracture and so on.Conclusion Results of this initial clinical study demonstrate that sacral neuromodulation is safe and effective for refractory painful bladder syndrome

关 键 词：骶神经调节 排尿障碍 尿控 膀胱炎 间质性 膀胱疼痛综合征 

分 类 号：R699.5[医药卫生—泌尿科学]