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目的:初步探讨骶神经调节(SNM)治疗顽固性下尿路功能障碍的相关经验。方法:2013年1月~2015年1月应用SNM疗法治疗顽固性下尿路功能障碍患者20例,对比术前患者状况、Ⅰ期自固定电极植入后及Ⅱ期永久刺激器植入后的短期随访中相关症状的改善程度,观察该疗法的有效性及安全性,并总结相关经验。结果:20例患者Ⅰ期手术时间平均1.6h,电极植入体验时间平均3.1周。8例因Ⅰ期测试效果不佳,于术后4~5周在局麻下实施电极拔除;12例患者接受Ⅱ期永久刺激器植入。Ⅰ~Ⅱ期转换率为60%,Ⅱ期永久刺激器植入术后平均随访时间为9.9个月。接受Ⅱ期永久植入患者治疗前和截止随访时的相关数据分别为:24小时平均排尿次数分别为17.5次和13.3次(P<0.05),夜尿平均为4.2次和2.7次(P<0.05),平均尿量为110 ml和165.8ml(P<0.05)。12例患者随访过程中,9例症状持续缓解;2例出现暂时性原有症状反复,通过参数调整能够缓解;1例患者(原发病为膀胱疼痛综合征)原有症状反复较严重,需间断参数调整。2例患者出现轻微电极植入位置及永久刺激器植入位置囊袋不适,可自行缓解。所有12例患者均无便秘、腹泻、刺激感消失、非预期性刺激、局部感染、突发电击感、刺激器自发关机等情况出现。结论:SNM是治疗顽固性下尿路功能障碍安全、有效的微创治疗方式;患者在术后需要接受定期随访,根据症状改善情况及时进行参数调整。
Objective: To explore the related experience of sacral neuromodulation (SNM) in treating refractory lower urinary tract dysfunction. Methods: From January 2013 to January 2015, 20 patients with intractable lower urinary tract dysfunction were treated with SNM therapy. Compared with the preoperative condition, the implantation of stage Ⅰ self-fixating electrode and the permanent implantation of stage Ⅱ permanent stimulator Short-term follow-up of the relevant symptoms of improvement, observe the effectiveness and safety of the therapy, and summarize the relevant experience. Results: In the 20 cases, the average time of operation Ⅰ was 1.6 hours and the average time of electrode implantation was 3.1 weeks. In 8 cases, the results of first-phase test were poor, and the electrode was removed under local anesthesia 4 to 5 weeks after operation. Twelve patients underwent second-stage permanent stimulator implantation. The conversion rate of stage Ⅰ ~ Ⅱ was 60%. The average follow-up time of stage Ⅱ permanent stimulator was 9.9 months. The data before and at the end of follow-up for patients undergoing permanent implantation in stage II were 17.5 and 13.3 times (P <0.05) for 24 hours and 4.2 and 2.7 times for nocturia (P <0.05, respectively) ), With an average urine volume of 110 ml and 165.8 ml (P <0.05). During the follow-up of 12 patients, the symptoms of 9 patients continued to be relieved. Two of the patients had transient original symptoms and could be relieved by adjustment of parameters. One patient (the primary disease was bladder pain syndrome) repeatedly suffered from severe symptoms, Intermittent parameter adjustment. 2 patients with mild electrode placement and permanent sphincter implantation position of the bladder, can relieve itself. All 12 patients had no constipation, diarrhea, irritation disappeared, unexpected stimulation, local infection, sudden electric shock, stimulator spontaneous shutdown and so on. Conclusion: SNM is a safe and effective minimally invasive treatment of intractable lower urinary tract dysfunction. Patients should undergo regular follow-up after operation, and adjust the parameters timely according to the improvement of symptoms.