骶神经调控术治疗膀胱——直肠功能障碍性疾病的短期有效性及安全性的初步探索:基于16例患者的临床资料  

Short-term effectiveness and safety of sacral nerve modulation in the treatment of bladder-and-bowel dysfunction:a preliminary exploration of 16 cases

作　　者：钱瑞君 黄谨 甘营国 黄丹丹[1,2,3] 刘智敏 谢尚奎[1,2,3] 任东林 吴培锐[1,2,3] 陆立 Qian Ruijun;Huang Jin;Gan Yingguo;Huang Dandan;Liu Zhimin;Xie Shangkui;Ren Donglin;Wu Peirui;Lu Li(Department of General Surgery(Anorectal Surgery),The Sixth Affiliated Hospital,Sun Yat-sen University,Guangzhou 510655,Guangdong,China;Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases,The Sixth Affiliated Hospital,Sun Yat-sen University,Guangzhou 510655,Guangdong,China;Biomedical Innovation Center,The Sixth Affiliated Hospital,Sun Yat-sen University,Guangzhou 510799,Guangdong,China;Department of Emergency,The Sixth Affiliated Hospital,Sun Yat-sen University,Guangzhou 510655,Guangdong,China)

机构地区：[1]中山大学附属第六医院普通外科(肛肠外科),广东广州510655 [2]广东省结直肠盆底疾病研究重点实验室,广东广州510655 [3]广州市黄埔区中六生物医学创新研究院,广东广州510799 [4]中山大学附属第六医院急诊科,广东广州510799

出　　处：《结直肠肛门外科》2023年第6期557-562,570,共7页Journal of Colorectal & Anal Surgery

基　　金：国家临床重点专科;广东省消化系统疾病临床医学研究中心项目(2020B1111170004);中山大学附属第六医院1010临床研究项目【1010PY(2022)-41】。

摘　　要：目的探索骶神经调控术治疗膀胱—直肠功能障碍性疾病的短期有效性及安全性。方法回顾性分析2021年4月至2023年8月于中山大学附属第六医院肛肠外科接受骶神经调控术的16例膀胱—直肠功能障碍性疾病患者的临床资料。其中,7例便秘+膀胱出口梗阻,4例大便失禁+膀胱出口梗阻,2例便秘+尿失禁,2例大便失禁+尿失禁,1例便秘+膀胱过度活动症。骶神经调控术分两期进行,Ⅱ期手术为永久刺激器植入术。以Ⅰ期手术前为临床观察的基线期,Ⅰ期手术与Ⅱ期手术的时间间隔为体验治疗期。记录并分析患者治疗后短期内的症状改善情况及不良事件的发生情况,症状改善情况基于Wexner大便失禁量表、Wexner便秘量表、国际尿失禁咨询委员会制定的男性/女性下尿路症状量表长表进行评估。结果16例患者的平均体验治疗期为(30.6±7.0)d,所有患者均完成基线期和体验治疗期结束时的随访。体验治疗期结束后,15例患者症状改善在50%以上。14例患者选择接受Ⅱ期手术,有12例患者在Ⅱ期手术术后6个月完成随访;2例患者选择拔除电极、终止本疗法并完成术后6个月内的随访。各量表在基线期、体验治疗期结束时和Ⅱ期手术术后6个月这三个时间点进行总体比较的评分差异有统计学意义(P<0.05);Ⅱ期手术术后6个月的评分较基线期降低,差异有统计学意义(P<0.05)。随访期间,不良事件包括切口感染2例,切口延迟愈合1例,电极拉伸致治疗失效再植入1例。结论骶神经调控术治疗经谨慎筛选后的膀胱—直肠功能障碍性疾病患者的短期效果满意,安全性尚可。Objectives To explore the short-term effectiveness and safety of sacral nerve modulation(SNM)in the treatment of bladder-and-bowel dysfunction(BBD).Methods A retrospective analysis was conducted on the clinical data of 16 patients with BBD who underwent SNM between April 2021 and August 2023.The study included various presentations of BBD,such as constipation+bladder outlet obstruction(7 cases),fecal incontinence+bladder outlet obstruction(4 cases),constipation+urinary incontinence(2 cases),fecal incontinence+urinary incontinence(2 cases),constipation+overactive bladder(1 case).SNM was performed in two stages,with the second stage involving permanent stimulator implantation.The clinical baseline data was collected before the first stage surgery.The trial treatment period spanned the interval between the first and second stage surgeries.Shortterm improvement and adverse events were recorded and analyzed.The improvement of symptoms was evaluated using the Wexner fecal incontinence scale,Wexner constipation scale,and International Consultation on Incontinence Modular Questionnaire on Male/Female Lower Urinary Tract Symptoms long form.Results The average trial treatment period for 16 patients was(30.6±7.0)days,with all completing follow-up at baseline and the end of the trial treatment period.After the trial treatment period,15 patients experienced more than 50%symptoms improvement.Fourteen patients proceeded to the second stage surgery,and 12 completed follow-up 6 months post-surgery.Two patients chose to remove the electrode,terminate this therapy,and completed followup within 6 months after surgery.Significant differences in the scores of each scale were observed at baseline,the end of the trial treatment period,and 6 months after the second stage surgery(P<0.05);the scores at 6 months after the second stage surgery was significantly lower than that at baseline(P<0.05).During follow-up,adverse events included 2 cases of wound infection,1 case of delayed wound healing,and 1 case of electrode stretching leading to

关 键 词：膀胱—直肠功能障碍性疾病 骶神经调控术 大便失禁 便秘 膀胱出口梗阻 膀胱过度活动症 尿失禁 

分 类 号：R659[医药卫生—外科学]