摘要
目的分析腰椎间盘突出伴马尾神经综合征患者接受延迟手术减压后神经系统及排尿功能恢复的长期随访结果。方法将35例符合腰椎间盘突出伴马尾神经综合征患者纳入此次随访,着重关注患者术前及术后的膀胱排空功能、排便功能、性功能、鞍区感觉及下肢神经功能恢复情况;6例患者术前术后均接受尿动力学检查。结果 35例患者中,12例完全性马尾神经综合征患者平均延迟手术减压时间为4.1+3.9周,23例不完全性马尾神经综合征患者平均延迟减压时间为5.5+7.6周;所有患者随访3~110月(平均43.0+28.9月)。23例不完全性马尾神经综合征患者中,19例完全恢复,4例存在轻微的鞍区或下肢感觉功能改变;12例完全性马尾神经综合征患者中,2例患者完全恢复,4例患者存在轻微鞍区或下肢感觉障碍且其中2例存在偶发便秘,其余6例患者存在不同程度的鞍区感觉障碍、排尿及排便功能障碍。6例有完整术前及术后尿动力学结果的患者中,随访尿动力学检查提示排尿时腹压明显上升,残余尿量较术前明显减少,其中4例患者初次排尿感觉时膀胱容量恢复正常。结论对接受延迟手术的腰椎间盘突出伴马尾神经综合征患者,长期随访结果显示多数患者预后良好,神经功能均有不同程度恢复。尿动力学检查提示膀胱排空功能恢复可能为膀胱感觉恢复引发的排尿时腹内压代偿升高所致。膀胱功能恢复的关键策略为促进膀胱逼尿肌收缩功能的恢复。
Objective To assess the impact of delayed decompression on long-term neurological and bladder function recovery in patients with cauda equina syndrome （CES） secondary to lumbar disc herniation （LDH）.Methods The clinical data of 35 patients receiving delayed decompression surgery for CES secondary to LDH were reviewed.The bladder empty function,bowel control,sexual ability and neurological functions of the lower limbs were evaluated after the operation,and the urodynamic changes were assessed in 6 patients with urodynamic data before and after the operation.Results Surgical decompression was performed at 4.1 ± 3.9 weeks in 12 patients with complete CES and at 5.5 ± 7.6 weeks in 23 patients with incomplete CES after the onset of symptoms.The patients were followed up for a mean of 43.0 ± 28.9 months （3-110 months）.In the 23 patients with incomplete CES,19 obtained full recovery,4 had slight sensory alterations in the saddle area or the lower limbs.In the 12 patients with complete CES,2 had full recovery,4 reported slight sensory alterations in the saddle area or the lower limbs（including 2 with occasional constipation）; 6 still had sense deficit in the saddle area and difficulties in bladder or bowl emptying,but they all reported significant improvements compared to the condition before operation.Urodynamic analysis in the 6 patients with preand postoperative urodynamic data showed increased abdominal pressure when voiding with significantly reduced residual urine in all the 6 patients; 4 patients with abnormal first desire volume before operation reported recovery after the operation.Conclusion Patients with LDH-induced CES who missed the chance of early decompression can still expect favorable functional recovery in the long term.The improvement of bladder function following decompression is probably a result of recovery of bladder sensation and the compensation by increased intra-abdominal pressure.The key strategy to promote bladder function recovery in these patients is to promote the detrusor recovery.
作者
赖勋维
李威
王吉兴
张辉见
彭红梅
杨德鸿
LAI Xunwei LI Wei WANG Jixing ZHANG Huijian PENG Hongmei YANG Dehong(Department of Spinal Surgery Department of Urinary Surgery, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China)
出处
《南方医科大学学报》
CAS
CSCD
北大核心
2017年第9期1143-1148,共6页
Journal of Southern Medical University
