骶神经调节术治疗下尿路功能障碍:单中心14年经验总结

摘要

Objective: To summarize 14-year experience with sacral neuromodulation (SNM) for lower urinary tract dysfunction at our center.Methods: We retrospectively reviewed the patient database at our center to assess the long-term outcome and incidence of adverse events after sacral neuromodulation implantation for lower urinary tract dysfunction between 2002 and 2016.Results: Between May 2002 and Apr.2016,69 patients were given a preliminary test SNM.In the test phase,the rate of improvement was 100% (7/7) in overactivity bladder,66.7% (6/9) in non-obstructive urinary retention and 50.0% (4/8) in interstitial cystitis.In neurogenic bladder patients,the rate of improvement in dysuria (23.1%,9/39) was significantly lower than in urgency-frequency (54.2%,13/24),urinary incontinence (64.2%,12/19),constipation (63.9%,23/36) and bladder pain (50%,2/4).At last,an implant was performed on 35 (50.7%) patients.The conversion rate from testing phase to implantation phase was 58.3% (14/24) in non-neurogenic bladder patients and 46.7% (21/45) in neurogenic bladder patients.During the follow-up period (35.8±7.7 months),the long-term success rate was 88.6%.Conclusions: SNM is a minimally invasive procedure with a good long-term outcome to treat lower urinary tract dysfunction.%目的:总结单中心关于骶神经调节治疗下尿路功能障碍的14年经验.方法:回顾分析单中心的患者数据库,对2002年5月~2016年4月在中国康复研究中心北京博爱医院进行骶神经调节治疗的患者数据进行统计分析,评价其长期疗效以及不良事件的发生.结果:共69例患者接受骶神经调节治疗.在测试阶段,膀胱过度活动症患者的症状改善有效率为100% (7/7),非梗阻性尿潴留患者的症状改善有效率为66.7% (6/9),间质性膀胱炎患者的症状改善有效率为50.0% (4/8).在神经源性膀胱患者中,排尿困难患者的症状改善有效率为23.1%(9/39),明显低于尿频-尿急(54.2%,13/24)、尿失禁(64.2%,12/19)、便秘(63.9%,23/36)以及膀胱疼痛(50%,2/4).最终,35(50.7%)例患者接受了永久植入.其中,非神经源性膀胱患者由测试向永久植入的转换率为58.3% (14/24),神经源性膀胱患者的转换率为46.7% (21/45).平均随访(35.8±7.7)个月,长期有效率为88.6%.结论:骶神经调节治疗下尿路功能障碍微创且长期效果满意.