骶神经调节术治疗间质性膀胱炎/膀胱疼痛综合征的临床疗效  

Clinical application of sacral nerve modulation in the treatment of interstitial cystitis/bladdel pain syndrome

作　　者：张翼飞[1] 詹长生 尹水平[1] 梁朝朝[1] Zhang Yifei;Zhan Changsheng;Yin Shuiping;Liang Chaozhao(Department of Lrology,The First Affiliated Hospital of Anhui Medical University,Hefei 230022,China)

机构地区：[1]安徽医科大学第一附属医院泌尿外科,合肥230022

出　　处：《中华泌尿外科杂志》2024年第2期118-121,共4页Chinese Journal of Urology

摘　　要：目的探讨骶神经调节术治疗间质性膀胱炎/膀胱疼痛综合征的临床疗效。方法本文回顾性分析2019年6月至2021年3月安徽医科大学第一附属医院收治的8例间质性膀胱炎/膀胱疼痛综合征患者的病例资料, 男1例, 女7例。中位年龄58(42, 72)岁。病程(39.6±41.3)个月。8例均采用抗生素和M受体阻滞剂等治疗2个月以上无效, 其中4例有膀胱水扩张手术史, 2例有膀胱水扩张+透明质酸钠灌注治疗史, 1例有膀胱水扩张+透明质酸钠灌注+A型肉毒毒素膀胱逼尿肌注射治疗史。O’Leary-Sant量表评分(34.00±1.93)分。疼痛模拟视觉量表(VAS)评分(9.38±0.92)分。生活质量(QOL)评分(5.50±0.53)分。术前24 h排尿次数(39.12±6.75)次, 夜尿次数(15.87±5.14)次, 每次尿量(51.62±16.51)ml。8例均局麻下行SNM一期手术, 将电极置入S3孔。术后测试治疗2~4周, 记录其症状改善情况, 尿频、尿急、疼痛等临床症状较术前改善>50%, 认为治疗有效, 可行二期永久刺激器植入手术。结果本组7例女性患者临床判定有效, 转二期永久刺激器植入手术, 转化时间(41.71±22.48)d。1例男性患者临床判定无效, 拆除临时刺激器。7例转二期患者术前、术后1周、术后1个月24h排尿次数分别为(39.12±6.75)次、(17.71±3.40)次、(14.71±4.27)次, VAS评分分别为(9.38±0.92)分、(2.71±1.38)分、(2.29±1.11)分, 差异均有统计学意义(P<0.01)。2例女性患者分别于二期术后3、6个月尿频症状复发, 予调整频率后症状缓解, 此2例均于术后12个月更换为变频模式, 更换模式后随访3个月症状未再反复。7例转二期患者症状控制后3、6个月的24 h排尿次数分别为(12.57±4.40)次、(12.86±5.30)次, VAS评分分别为(2.14±1.21)分、(2.28±1.11)分, 与术前比较差异均有统计学意义(P<0.01)。结论骶神经调节治疗间质性膀胱炎/膀胱疼痛综合征的短期疗效和长期疗效均较好, 是一种可靠的治疗手段。Objective To discuss the clinical effect of sacral nerve modulation in the treatment of interstitial cystitis/bladder pain syndrome.Methods A total of 8 patients with interstitial cystitis were retrospectively analyzed.These patients were treated in the First Affiliated Hospital of Anhui Medical University from June 2019 to March 2021,including 7 females and 1 male,aged from 42 to 72 years,with a median age of 58 years.The course of disease ranged from 6 months to 11 years,with an average of 39.6 months.All 8 patients were treated with antibiotics and M receptor blockers for more than 2 months without clinical effect.Four patients had a history of bladder hydrodistension,and two patients had received sodium hyaluronate perfusion treatment plus bladder hydrodistension.One patient had a history of botulinum toxin injection into bladder detrusor,sodium hyaluronate perfusion treatment and bladder hydrodistension.The aveary-Sant scale assessed an average score of 34.00±1.93.The average pain visual analogue scale(VAS)score was 9.38±0.92.The average QOL score was(5.50±0.53)points.The average number of urinations within 24 hours before operation was(39.12±6.75)times,and the average nocturia was(15.87±5.14)times with the average urine volume of(51.62±16.51)ml.SNM electrode was placed into S3 under local anesthesia(SNM stage 1),and treated for 2-4 weeks after operation.The improvement of symptoms after sacral neuromodulation stage 1 was observed and recorded.Compared with pre-operation,if the symptoms of frequency,urgency and pain improved>50%,the second-stage permanent stimulator implantation can be performed.Results Seven female patients were converted to secondary permanent stimulator implantation with an average conversion time of(41.71±22.48)days.One male patient was clinically ineffective and the stimulator was removed.The average number of urinations in 24 hours before operation,1 week after operation and 1 month after operation were(39.12±6.75)times,(17.71±3.40)times and(14.71±4.27)times respectively;whil

关 键 词：膀胱炎 间质性 骶神经调节 膀胱疼痛综合征 

分 类 号：R699.5[医药卫生—泌尿科学]