摘要
目的初步探索双侧骶神经调节对于保守治疗无效的特发性尿潴留的临床疗效。方法本研究为一项探索性的小样本、长期疗效回顾性研究,对于4例保守治疗无效的特发性尿潴留患者(女性1例,男性3例,平均年龄34.7岁,术前平均病程为27.5月),采用一次性植入双侧骶神经刺激电极和骶神经调节永久刺激器(北京品驰,BetterStim)的手术方式,术后应用品驰远程程控技术,按照两侧分别单侧开机调试(每侧调试6~8周),单侧均无效后再双侧开机调试的方法,对4例患者进行术后不间断调试和随访,总结患者术后长期随访结果。结果4例顽固性特发性尿潴留患者接受了探索性的双侧骶神经系统植入手术,术后第1、2、4号患者完成了平均5年的随访,3号患者随访数据截止到术后14个月。1、2、4号患者在末次随访时有明显改善效果,第1、2号患者自述刺激器均已关闭且无药物治疗,均可维持正常生活,考虑临床痊愈,第4号患者截止末次随访各项排尿指标参数均较术前明显改善,随访时仍间断口服药物治疗。第3号患者双侧同时开启刺激器,术后1年随访中自述治疗无效,于术后14个月自愿取出双侧骶神经刺激系统植入物。术后随访过程中,所有患者均无SNM相关并发症发生(如切口感染、植入部位疼痛、电极移位等)。结论对于特发性尿潴留的患者,双侧骶神经调节有长期疗效,且较单纯骶神经刺激有更好的疗效,值得后续进一步研究。
Objective To investigate the clinical efficacy of bilateral sacral neuromodulation(SNM)for urinary retention patients with failed conservative treatment.Methods The study was an exploratory,small sample,long-term retrospective study,including 4 patients(1 female and 3 male,average age 34.7 years,average duration of course 27.5 months)with urinary retention whose conservative treatment was ineffective.Bilateral SNM electrodes and stimulator(Beijing Pins,BetterStim)were implanted.After operation,the stimulator was adjusted by Pins remote program control technology according to the method of unilateral adjustment(6-8 weeks for each side)and bilateral adjustment after both sides were invalid.The results of long-term postoperative follow-up were summarized.Results Patients 1,2 and 4 completed the 5-year follow-up,while patient 3 had follow-up data up to 14 months postoperatively.Patients 1,2 and 4 showed significant improvement at the last follow-up:both patients 1 and 2 reported that SNM were closed and they were able to maintain a normal life without medication,while patient 4 had all urinary symptoms significantly improved,and took oral medication intermittently.Patient 3 turned on the bilateral stimulator after surgery,received repeated parameter adjustment for 1 year and voluntarily removed bilateral SNM system at 14 months after surgery for it was ineffective.No SNM-related complications(e.g.,incisional infection,pain,electrode displacement,etc.)occurred after operation.Conclusion In patients with urinary retention and failed conservative treatment,bilateral SNM has long-term efficacy and better efficacy than unilateral SNM;however,more research is still needed.
作者
常冉
张建忠
吴栗洋
周飞
王菲
张朝华
张鹏
CHANG Ran;ZHANG Jianzhong;WU Liyang;ZHOU Fei;WANG Fei;ZHANG Chaohua;ZHANG Peng(Department of Urology,Capital Medical University,Beijing Chaoyang Hospital,Beijing100020,China)
出处
《现代泌尿外科杂志》
CAS
2022年第9期745-750,共6页
Journal of Modern Urology
基金
北京市科技计划(No.Z161100001816034)。
