摘要
目的研究骶神经电刺激(SNM)治疗膀胱过度活动症(OAB)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月收治的行SNM治疗的43例OAB患者的临床资料。患者先进行SNM体外体验治疗,若主要症状改善程度≥50%或本人有强烈的手术意愿,再行Ⅱ期手术治疗(刺激器永久植入手术),否则取出刺激器,之后规律随访。本研究主要观察指标为平均尿急程度、日均排尿次数(24h)、日均夜尿次数以及生活质量评分(QoL);次要观察指标为最大次尿量、日均次尿量、日均排尿总量。对比患者基线数据与Ⅰ期(体验期)数据,记录数据行统计学分析。结果 43例接受了SNM治疗:34例行Ⅱ期手术,为治疗成功组;9例Ⅰ期治疗后症状改善不佳而拒绝行Ⅱ期手术,后于局麻下拔出电极,为治疗失败组。术后随访8~56个月,平均21.6个月。Ⅰ期至Ⅱ期的转化率为79.1%(34/43),其中治疗失败组术中反应位点数和最低起效电压与整体患者比较差异具有统计学意义(P均<0.05),手术前后主要观察指标和次要观察指标差异均无统计学意义(P均>0.05)。治疗成功组患者所有的主要观察指标均改善:①手术前后平均尿急程度(P<0.01)分别为(4.09±1.56)分和(1.76±1.10)分;②手术前后日均排尿次数(24h,P<0.01)分别为(26.57±14.54)次和(13.82±3.86)次;③手术前后日均夜尿次数(P<0.01)分别为(6.66±4.44)次和(3.32±2.48)次;④手术前后QoL评分(P<0.05)分别为(3.00±1.86)分和(4.03±1.25)分;以上观察指标差异均有显著性统计学意义。次要观察指标改善如下:手术前后最大次尿量分别为(119.14±60.62)mL和(210.32±78.63)mL;手术前后日均次尿量分别为(67.04±30.57)mL和(151.85±54.64)mL;手术前后日均排尿总量分别为(1 737.37±389.14)mL和(2 058.96±548.18)mL(P均<0.001);结论骶神经电刺激治疗膀胱过度活动症有效率高,体验期数据、植入后末次随访数据与基线对比均有显�
Objective To evaluate the safety and efficacy of sacral neuromodulation(SNM)in the treatment of overactive bladder(OAB).Methods The clinical data of 43 OAB patients from multiple medical institutions treated during Jan.2012 and Dec.2016 were retrospectively analyzed.If the patients’major symptoms improved≥50% or the patients had strong intention for operation,phaseⅡsurgery was performed,in which neurostimulation system(InterStim,Medtronic Inc.)was implanted.Otherwise,the neurostimulation system was removed and patients were followed up regularly.The primary indexes included urgency,24 h frequency,number of nocturia,and quality of life(QoL)score.The secondary indexes included maximum voided volume,mean voided volume and 24 h voided volume.The baseline data and phase I data were compared and recorded for statistical analysis.Results A total of 43 patients underwent SNM,34(79.1%,34/43)of whom received phaseⅡ operation were considered as the successful treatment group,and 9 who refused phaseⅡ operation due to lack of efficacy were considered as the treatment failure group.Postoperative follow-up ranged from 8 to 56 months,average 21.6 months.There were statistically significant differences in intraoperative response position points and the lowest starting voltage between the treatment failure group and the overall patients(all P<0.05),and no statistically significant differences in major and secondary indexes before and after the operation(all P>0.05).As compared to baseline,the major indexes were improved in patients who received phaseⅡimplantation:the urgency score decreased(P<0.01)from(4.09±1.56)to(1.76±1.10);24 h frequency decreased significantly(P<0.01)from(26.57±14.54)to(13.82±3.86);number of nocturia decreased(P<0.01)from(6.66±4.44)to(3.32±2.48);the QoL score increased(P<0.05)from(4.03±1.25)to(3.00±1.86).The secondary indexes also improved:maximum voided volume increased from(119.14±60.62)mL to(210.32±78.63)mL,mean voided volume increased from(67.04±30.57)mL to(151.85±54.64)mL,and 24 h
作者
刘晓东
孟令峰
张威
杜广辉
凌青
张小东
张鹏
卫中庆
沈百欣
廖利民
陈国庆
沈宏
罗德毅
徐智慧
吕坚伟
李佳怡
种铁
陈琦
文伟
张耀光
LIU Xiao-dong;M ENG Ling-feng;ZHANG Wei;DU Guang-hui;LING Qing;ZHANG Xiao-dong;ZHANG Peng;WEI Zhong-qing;SH EN Bai-xin;LIAO Li-ming;CHEN Guo-qing;SHEN Hong;LUO De-yi;XU Zhi-hui;LV Jian-w ei;LI Jia-yi;ZHONG Tie;CHEN Qi;WEN Wei;ZHANG Yao-guang(Department of Urology,Beijing Hospital,National Center for Gerontology,Beijing 100730;Department of Urology,Tongji Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology,Wuhan 430022;Department of Urology,Beijing Chaoyang Hospital,Beijing 100020;Department of Urology,The Second Affiliated Hospital of Nanjing Medical University,Nanjing 210010;Department of Urology,Beijing Bo'ai Hospital,Beijing 100020;Department of Urology,West China Hospital of Sichuan University,Chengdu 610044;Department of Urology,Zhejiang Provincial People’s Hospital,Hangzhou 310014;Department of Urology,Renji Hospital Affiliated to the Medical School of Shanghai Jiao Tong University,Shanghai 200127;Department of Urology,T he Second Affiliated Hospital of Xi’an Jiaotong University,Xi'an 710004;Department of Urology,Shanghai First Peoples Hospital Affiliated to the Medical School of Shanghai Jiao Tong University,Shanghai 200080,China)
出处
《现代泌尿外科杂志》
CAS
2019年第11期897-901,共5页
Journal of Modern Urology
基金
国家重点研发计划资助项目（No.2018YFC2002200）
