骶神经根病变致神经源性膀胱的诊断和治疗  

Diagnosis and treatment of patients with neurogenic bladder caused by sacral nerve root lesions

作　　者：杜广辉[1] 徐磊[1] 李小辉[1] 许盛飞[1] 陈忠[1] 杨为民[1] 叶章群[1] 

机构地区：[1]华中科技大学同济医学院附属同济医院泌尿外科湖北省泌尿外科研究所,武汉430030

出　　处：《中华泌尿外科杂志》2015年第2期100-103,共4页Chinese Journal of Urology

摘　　要：目的 探讨骶神经根病变引起的神经源性膀胱患者的临床病理特点、诊断和治疗.方法 回顾性分析2002年5月至2013年11月手术治疗的27例骶神经根病变引起尿潴留和难治性下尿路症状（lower urinary tract symptom,LUTS）患者的临床资料.27例患者中急性尿潴留4例,慢性尿潴留6例,难治性LUTS 17例;均有尿动力学异常,腰骶丛MRI检查均显示存在骶神经根单发或多发占位性病变.患者均行骶神经根病变切除术. 结果 术后病理检查显示多样化病理改变：单纯囊肿3例、节细胞神经瘤5例、囊壁炎症细胞浸润15例、囊壁玻璃样变15例、囊壁含退变神经纤维15例.27例围手术期无严重并发症.术后至少随访1年,10例尿潴留患者中9例恢复自主排尿,l例继续膀胱造瘘;17例LUTS患者的国际前列腺症状评分、疼痛评分、生命质量评分、最大尿流率、残余尿量均较术前显著改善,手术前后比较差异有统计学意义（P＜0.01）. 结论 骶神经根病变可能是引起尿潴留和难治性LUTS的原因之一,手术治疗可改善患者的排尿功能、LUTS症状和生命质量.Objective To investigate the clinical and pathological features of sacral nerve root lesions and the diagnosis and treatment for these clinical entities.Methods The clinical data of the patients with urine retention or refractory lower urinary tract symptoms （LUTS） caused by sacral nerve root lesions were retrospectively analyzed.Totally 27 patients were included in this study,including 4 cases of acute retention,6 chronic retention and 17 refractory LUTS.All patients had urodynamic disorders and sacral nerve root space-occupying lesions demonstrated by magnetic resonance imaging.All the patients received surgical treatment and were followed up one year or more.Results The pathological findings included simple cyst in 3 cases,ganglioneuroma in 5,cyst wall inflammation in 15,cyst wall hyaline degeneration in 15,and neurodegeneration in 15.Postoperatively,9 of the 10 patients with retention could voluntarily void and 1 remained suprapubic catheter drainage.All 17 patients with refractory LUTS improved significantly in terms of international prostate symptom score,visual analogue scale pain score,quality of life,maximal urinary flow rate and post void residual （P〈0.01）.Conclusions Sacral nerve root lesions can be the causes of urinary retention or refractory LUTS.Surgical treatment can improve patient＇s voiding function and quality of life.

关 键 词：骶神经根病变 尿潴留 下尿路症状 盆腔疼痛 神经源性膀胱 

分 类 号：R694.5[医药卫生—泌尿科学]