【摘要】 目的评估骶神经刺激(sacral nerve stimulation,SNS)治疗难治性膀胱过度活动症(overactive bladder,OAB)的有效性和安全性。方法回顾性分析2016年5~10月9例难治性OAB的临床资料。手术治疗包括体验性治疗与永久性植入两部分。术后使用三代喹诺酮类或二代头孢类抗生素预防感染。比较永久植入术后与体验治疗术前的排尿日记(包括5 d平均24 h排尿次数、5 d平均24 h每次排尿量)、膀胱过度活动症评分(overactive bladder symptom score,OABSS)、O’Leary-Sant评分(O’Leary-Sant problem and symptom index,OPSI)及其中的问题指数评分(interstitial cystitis problem index,ICPI)和症状指数评分(interstitial cystitis symptom index,ICSI)等。随访患者是否发生手术不良反应,刺激作用不良反应及装置不良反应。结果 9例体验治疗后疗效满意,均接受永久性调节器长期植入治疗,永久植入成功率为100%。体验治疗与永久植入术时间间隔为6~22 d,(9.6±5.0)d。术后随访3~8个月,(6.1±1.5)月。体验治疗术前平均24 h排尿次数(34.0±16.7)次,明显多于永久植入术后末次随访排尿次数(18.0±4.5)次(t=3.648,P=0.007);术前平均24 h每次排尿量(106.5±44.6)ml,明显少于永久植入术后末次随访排尿量(140.8±38.3)ml(t=-4.314,P=0.003)。体验治疗术前OABSS(10.8±1.7)分、OPSI(31.6±2.4)分、ICPI(14.4±1.1)分、ICSI(17.1±1.6)分,末次随访时上述各项指标均显著降低,分别为(6.3±3.3)分(t=5.946,P=0.000)、(16.0±3.5)分(t=9.061,P=0.000)、(6.8±2.5)分(t=7.667,P=0.000)、(9.2±2.6)分(t=6.475,P=0.000)。未发生感染、出血、神经或血管损伤等手术不良反应,植入位点疼痛、新发疼痛、肠道功能变化、短暂轻度的电击感等刺激作用不良反应,电极断裂、电极短路、功能异常、部件腐蚀、感染等装置不良反应。结论 SNS对于其他治疗效果不佳的难治性OAB安全、有效。更多还原

【Abstract】 Objective To evaluate the effectiveness and safety of sacral nerve stimulation(SNS) for the treatment of refractory overactive bladder(OAB). Methods We analyzed clinical data of 9 patients with refractory OAB from May 2016 to October 2016 retrospectively. The 9 patients were treated with SNS,which consisted of experimental therapy and permanent implantation therapy. Antibiotics of third generation quinolones and second generation cephalosporins were used to prevent infection after surgery. The data of voiding diary(including average urinary frequency of 24 h in 5 d and average micturition volume of 24 h in5 d),overactive bladder symptom score(OABSS),O’Leary-Sant problem and symptom index(OPSI),interstitial cystitis problem index(ICPI) and interstitial cystitis symptom index(ICSI) were collected. All the patients were followed up for adverse reactions related to operation,related to stimulation and related to the device. Results All the 9 cases accepted permanent implantation therapy after a period of experimental therapy with satisfactory curative effects. The success rate of permanent implantation in this group was 100%. The interval time between experimental therapy and permanent implantation therapy was 6-22 days,with an average of(9. 6 ± 5. 0) days. Postoperative follow-up time ranged from 3-8 months,with an average of(6. 1 ± 1. 5) months. Before the surgery,the average urinary frequency of 24 h was(34. 0 ± 16. 7) times. After surgery,the data was(18. 0 ± 4. 5) times. There was significant difference before and after surgery(t = 3. 648,P = 0. 007). The difference was also statistically significant(t =-4. 314,P = 0. 003) between preoperative average micturition volume of 24 h(106. 5 ± 44. 6 ml) and postoperative micturition volume(140. 8 ± 38. 3 ml). Before the surgery,the OABSS,OPSI,ICPI and ICSI were(10. 8 ± 1. 7),(31. 6 ± 2. 4),(14. 4 ± 1. 1),and(17. 1 ± 1. 6) points. After surgery,the data were(6. 3 ± 3. 3),(16. 0 ± 3. 5),(6. 8 ± 2. 5),and(9. 2 ± 2. 6) points. The scoreswere significantly improved or the differences were statistically significant in the OABSS(t = 5. 946,P = 0. 000),OPSI(t = 9. 061,P = 0. 000),ICPI(t = 7. 667,P = 0. 000) and ICSI(t = 6. 475,P = 0. 000). Surgery related adverse reactions such as infection,bleeding,neurological or vascular injury did not occur. There were no stimulation related adverse reactions such as implantation site pain,new pain and bowel function changes,transient mild electric shock feeling and device related adverse reactions(electrode breakage,short electrode,dysfunction,part corrosion and infection). Conclusion Initial clinical results show that SNS is safe and effective for patients with refractory OAB who are not well treated by conservative treatment.更多还原