骶神经调节术治疗女性膀胱过度活动症及间质性膀胱炎/膀胱疼痛综合征的疗效分析  

A retrospective analysis of sacral neuromodulation for female overactive bladder and interstitial cystitis/painful blader syndrome

作　　者：王磊[1] 宋奇翔 程欣[1] 高雅[1] 朴曙光[1] 刘智勇[1] 

机构地区：[1]第二军医大学附属长海医院泌尿外科,上海200433

出　　处：《中华泌尿外科杂志》2017年第10期751-754,共4页Chinese Journal of Urology

基　　金：国家自然科学基金青年基金（81500579）

摘　　要：目的 分析骶神经调节术（SNM）治疗女性膀胱过度活动症（OAB）及间质性膀胱炎/膀胱疼痛综合征（IC/PBS）的疗效并总结经验.方法 回顾性分析2016年5月至2017年4月收治的13例采用SNM治疗的女性OAB及IC/PBS患者的临床资料.年龄42～67岁,平均52.3岁.其中OAB患者6例,IC/PBS患者7例.OAB患者术前24h平均排尿次数为22.5次（18～33次）,夜尿次数平均为5.2次（3～8次）,平均每次尿量为120.3ml（53～160 ml）.IC/PBS患者术前疼痛评分平均7.3分（6～8分）,24h平均排尿次数为21.6次（14 ～ 25次）.比较手术前后患者24 h的排尿次数、夜尿次数、平均每次尿量以及疼痛评分的变化情况.结果 13例患者均接受Ⅰ期SNM治疗,Ⅰ期手术时间平均92 min（52 ～ 125 min）,Ⅰ期电极植入后测试时间平均为3.6周（2.5～4周）.6例OAB患者中,4例转为Ⅱ期手术,转换率为66.7％（4/6）.Ⅰ期植入后,6例OAB患者的24 h平均排尿次数为14.3次（9～21次）,夜尿次数平均为2.3次（1～4次）,平均每次尿量为166.4 ml（110 ～225ml）,与Ⅰ期植入前比较差异有统计学意义（均P＜0.05）.7例IC/PBS患者中,4例接受Ⅱ期手术治疗,转换率为57.1％（4/7）.Ⅰ期植入后7例IC/PBS患者的VAS评分平均3.8分（2～5分）,24h平均排尿次数为16.8次（11～ 20次）,与术前比较差异均有统计学意义（均P＜0.05）.Ⅰ期、Ⅱ期手术总转化率为61.5％ （8/13）.Ⅱ期术后随访3～15个月,平均8.3个月,未出现切口感染、血肿、电极排异反应、电极移位等严重不良反应.结论 SNM Ⅰ期手术是影响术后疗效的关键,SNM可显著改善部分患者的尿急、尿频及疼痛症状,创伤小、出血少,是治疗女性OAB及IC/PBS安全、有效的微创治疗手段.Objective To evaluate the effects of sacral neuromodulation （SNM） on female overactive bladder （OAB） and interstitial cystitis/ painful bladder syndrome （IC/PBS）.Methods From May 2016 to April 2017,13 patients with OAB or IC/PBS who had been treated with SNM were assessed retrospectively.Among them,6 cases were OAB patients,and 7 cases were IC/PBS patients.The average age was 52.3 （42-67）years old,and the preoperative and postoperative 24 h urine frequency,night urination frequency and average voided volume were compared.Results Totally 13 patients underwent stage Ⅰprocedure.The operation time for stage Ⅰ was 52-125min（average 92 min）.After an average follow-up of 3.6 weeks,stage 11 procedures were performed on responders.Four OAB patients accepted stage Ⅱ1 surgery （conversion rate：66.7%）,and the 24h frequency and night urination frequency reduced from preoperative 22.5 and 5.2 times to postoperative 14.3 and 2.3 times （P 〈 0.05） respectively,and average voided volume increased from 120.3ml to 166.4ml （P 〈 0.05）.Among 4 patients presenting IC/PBS who had underwent stage Ⅱ surgery （conversion rate：57.1%）,VAS score and 24 h voiding frequency reduced from 7.3 and 21.6 to 3.8 and 16.8 （P 〈 0.05）,respectively.No adverse event,such as wound infection or electrode translocation was detected during an average follow-up of 8.3 months.Conclusions Stage Ⅰ procedure is crucial for the long term efficacy of SNM.Postsurgical wound management and parameter adjustment are equal essential in order to achieve a maximum benefits.SNM has advantages in minimal invasiveness and less bleeding,which provides a minimal invasive approach for the managemem of OAB and IC/PBS.

关 键 词：骶神经调节术 膀胱过度活动症 间质性膀胱炎/膀胱疼痛综合征 

分 类 号：R699.5[医药卫生—泌尿科学]