骶神经植入术治疗老年人下尿路功能障碍的多中心研究  

Safety and efficacy of sacral neuromodulation therapy for lower urinary tract dysfunction in elderly people:A multicenter study

作　　者：刘晓东 王佳文 孟令峰[1] 张威[1] 杜广辉[2] 凌青 张小东[3] 张鹏[3] 卫中庆[4] 沈百欣[4] 廖利民[5] 陈国庆 沈宏[6] 罗德毅[6] 徐智慧[7] 吕坚伟[8] 李佳怡[8] 种铁[9] 陈琦[9] 文伟 张耀光[1] Liu Xiaodong;Wang Jiawen;Meng Lingfeng;Zhang Wei;Du Guanghui;Ling Qing;Zhang Xiaodong;Zhang Peng;Wei Zhongqing;Shen Baixin;Liao Limin;Chen Guoqing;Shen Hong;Luo Deyi;Xu Zhihui;Lyu Jianwei;Li Jiayi;Zhong Tie;Chen Qi;Wen Wei;Zhang Yaoguang(Department of Urology,Beijing Hospital,National Center of Gerontology,Beijing,100730,China;Department of Urology,Tongji Hospital,Huazhong University of Science and Technology,Wuhan 430022,China;Department of Urology,Beijing Chaoyang Hospital,Capital Medical University,Beijing 100020,China;Department of Urology,the Second Affiliated Hospital of Nanjing Medical University,Nanjing 210010,China;Department of Urology,China Rehabilitation Research Centre,Rehabilitation School of Capital Medical University,Beijing 100020,China;Department of Urology,West China Hospital,Sichuan University,Chengdu 610044,China;Department of Urology,Zhejiang Provincial People’s Hospital,Hangzhou 310014,China;Department of Urology,Renji Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200127,China;Department of Urology,the Second Affiliated Hospital of Xi’an Jiaotong University,Xi’an 710004,China;Department of Urology,Shanghai General Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200080,China)

机构地区：[1]北京医院泌尿外科,国家老年医学中心,100730 [2]华中科技大学同济医学院附属同济医院泌尿外科,武汉430022 [3]北京朝阳医院泌尿外科,100020 [4]南京医科大学附属第二医院泌尿外科,210010 [5]北京博爱医院泌尿外科,100020 [6]四川大学华西医院泌尿外科,成都610044 [7]浙江省人民医院泌尿外科,杭州310014 [8]上海交通大学医学院附属仁济医院泌尿外科,200127 [9]西安交通大学附属第二医院泌尿外科,710004 [10]上海交通大学医学院附属上海市第一人民医院泌尿外科,200080

出　　处：《中华老年医学杂志》2020年第4期418-423,共6页Chinese Journal of Geriatrics

基　　金：国家重点研发计划资助(2018YFC2002200)。

摘　　要：目的:研究老年患者接受骶神经植入术(SNM)治疗下尿路功能障碍(LUTD)的有效性及安全性。方法:回顾性分析全国多个医学中心2012年1月至2016年12月接受SNM治疗的91例LUTD老年患者的临床资料,并将患者分为四组:间质性膀胱炎组(IC)28例,神经源性膀胱组(NB)36例,膀胱过度活动症组(OAB)13例以及特发性排尿困难组(ID)14例。研究根据不同疾病设置不同观察指标对比患者基线数据、Ⅰ期(体验期)、Ⅱ期(永久植入期)数据,记录数据并行统计学分析。结果:接受SNM治疗的总人数为91例,共53例患者接受Ⅱ期永久植入手术,接受Ⅱ期永久植入手术的患者术前病程3个月~30年,转化率为58.2%(53/91),术后随访2~58个月,平均19.6个月。Ⅰ期术后改善情况:尿急程度评分:35.4%;日均排尿次数:31.6%;日均夜尿次数:33.7%;最大次尿量(ml):32.6%;日均次尿量(ml):49.2%;日均漏尿次数:43.2%;生活质量评分:54.1%。Ⅱ期术后改善情况:尿急程度评分:43.2%;日均排尿次数:40.0%;日均夜尿次数:37.8%;最大次尿量(ml):50.5%;日均次尿量(ml):70.5%;日均漏尿次数:70.4%;生活质量评分:43.2%。不良事件3例:NB组1例患者症状反复,1例患者中度感染,IC/BPS组中1例患者出现电极移位。结论:SNM治疗老年患者LUTD疗效确切、稳定;下一步应该延长随访时间对安全性展开进一步研究。Objective To investigate the safety and efficacy of sacral neuromodulation(SNM)therapy for the treatment of lower urinary tract dysfunction(LUTD)in elderly patients.Methods Clinical data of 91 elderly patients with LUTD from multiple medical institutions who received SNM during the period from January 2012 to December 2016 were retrospectively analyzed.Patients were divided into four groups:the interstitial cystitis(IC)group(n=28),the neurogenic bladder(NB)group(n=36),the overactive bladder syndrome(OAB)group(n=13)and the idiopathic dysuria(ID)group(n=14).Different sets of evaluation parameters were used for different diseases.Patients’baseline data and data in stage I(test phase)and stageⅡ(permanent SNM)were recorded,statistically analyzed and compared.Results Ninety-one people underwent SNM treatment.Of them,53 patients received permanent implants(stageⅡ),and the total conversion rate of stage I to stageⅡwas 58.2%(53/91).Patients receiving permanent implants(stageⅡ)had a preoperative period ranging from 3 months to 30 years,and were followed up for 2 to 58 months after treatment,with an average follow-up of 19.6 months.The improvement rates in stage I for urinary urgency,daily urination frequency,daily nocturnal urination frequency,maximum urine volume,daily average urine volume,daily urine leakage frequency,and quality of life score were 35.4%,31.6%,33.7%,32.6%,49.2%,43.2%and 13.2%,respectively.The improvement rates in stageⅡfor urinary urgency,daily urination frequency,daily nocturnal urination frequency,maximum urine volume,daily average urine volume,daily urine leakage frequency,and quality of life score were 43.2%,40.0%,37.8%,50.5%,70.5%,70.4%and 43.2%,respectively.Three adverse events occurred,including 1 case of recurrent symptoms,1 case of moderate infection,and 1 case of electrical lead dislocation.Conclusions Sacral nerve stimulation has definitive and consistent curative effects on LUTD in elderly people.The follow-up time should be extended to further study the safety of sacral nerve sti

关 键 词：骶神经调控 下尿路功能障碍 

分 类 号：R695[医药卫生—泌尿科学]