摘要
目的探讨可能影响骶神经渊节术（SNM）一期体验治疗效果的因素。方法回顾性分析2012年4月至2016年1月收治的39例排尿障碍相关疾病患者的病例资料，男14例，女25例。年龄15-86岁，平均54岁。其中膀胱疼痛综合征／问质性膀胱炎18例，特发性尿潴留5例，膀胱过度活动症8例，神经源性膀胱6例，急迫性尿失禁2例。所有患者经过行为治疗、药物治疗以及至少1种推荐疗法治疗无效。39例均行SNM，根据一期治疗效果将患者分为二期植入组和未二期植入组，比较两组的病例资料、视觉模拟疼痛评分、生活质量评分、焦虑评分，以及排尿日记等数据。结果本研究39例中，27例（69％）一期疗效满意，行二期手术；12例（31％）一期疗效不满意，未行二期手术。二期植入率为69％。平均体验时间为（21．6±3．0）d。未二期植入组12例，男6例，女6例；平均年龄（44．5±19．1）岁；其中膀胱疼痛综合征／间质性膀胱炎3例，膀胱过度活动症3例，神经源性膀胱4例，特发性尿潴留1例，急迫性尿失禁1例；有腹盆腔及泌尿系手术史者2例，无手术史者10例；病程平均（100．6±125．5）个月；体重指数（BMI）（21．8±3．7）kg／m。；术前焦虑评分（33．7±5．3）分，术前疼痛评分（8．0±1．0）分，生活质量评分（4．6±0．8）分；平均日尿次数（23．1±12．8）次，次均尿量（89．4±33．0）ml，平均夜尿次数（10．3±5．5）次。二期植入组27例，男8例，女19例；平均年龄（57．9±16．7）岁；其中膀胱疼痛综合征／问质性膀胱炎15例，膀胱过度活动症5例，神经源性膀胱2例，特发性尿潴留4例，急迫性尿失禁1例；有腹盆腔及泌尿系手术史者10例，无手术史者17例；病程平均（83．0±56．0）个月；BMI（24．1±2．6）kg／m^2；术前焦虑评分（27．7±5．9）分，术前疼痛评分（7．9±1．6）分，生活质量评分（5．3±0．9）分；平均日尿次数（30．6±14．2）次，平均次均尿量（64．8±37．4）ml，平均夜尿次数（13．3±9．2）次。两组比较，二期植入组的年龄偏大（P=0．034），BMI值高（P=0．043），焦虑程度低（P=0．008）。两组的性别（P=0．287）、病种（P=0．116）、日尿次数（P=0．140）、次均尿量（P=0．470）、夜尿次数（P=0．068）、疼痛评分（P=0．880）、手术史（P：0．276）及病程（P=0．116）等比较差异均无统计学意义。结论年龄、BMI及术前焦虑程度可能是影响SNM一期体验治疗效果的因素。
Objective To explore the factors affecting the effect of first stage treatment of sacral neuromodulation. Methods A retrospective analysis of 39 patients with dysuria related diseases from April 2012 to January 2016 was performed. There were 14 male patients and 25 female patients. Their age ranged from 15 to 86 years old, mean 54 years old. The types of disease were bladder pain syndrome/interstitial cystitis in 18 eases,idiopathic urinary retention in 5 cases,overactive bladder in 8 cases,neurogenic bladder in 6 cases, and urgent incontinence in 2 cases. All patients were treated by behavioral therapy, drug therapy, and at least one recommended treatment method. All previous treatments were ineffective. All patients were collected baseline medical records. The voiding diary,visual analogue pain score, quality of life score, anxiety score and other information before and after the first stage surgery and the last follow-up after the second stage surgery were also collected. Results A total of 39 patients were enrolled in this study. 27 patients （69%）who were satisfied with the effect of the first stage of surgery were treated with the second stage surgery, and 12 patients （31%）who were not satisfied with the results of the first phase operation did not undergo the second phase operation. The second stage implantation rate was 69%. The average experience time was （21.6 ± 3.0） days. In the single first stage implantation group, there were 6 males and 6 females, including interstitial cystitis in 3 cases, overactive bladder in 5 cases, neurogenic bladder in 4 cases, idiopathic urinary retention in 1 cases and urgent incontinence in 1 cases. 2 cases have a history of pelvic and urinary surgery and 10 cases dont. The average BMI was 21.8±3.7 kg/m^2 ,and mean age was（44.5 ± 19.1 ） years old. The average preoperative anxiety score was 33.7 ± 5.3 and the average pain score of preoperative was 8.0 ± 1.0. The average quality of life score was 4.6 ± 0.8 and the average daily number of urine was 23.1 ± 12.8. The average mean urine volume was （89.4 ± 33.0） ml,the average frequency of nocturia was 10.3 ±5.5 ,the average medical history time was （ 100.6 ± 125.5） months. In the second stage implantation group,there were 8 males and 19 females, including interstitial cystitis in 15 cases, overactive bladder in 5 cases, neurogenic bladder in 2 cases, idiopathic urinary retention in 4 cases, and urgent incontinence in 1 cases. 10 cases have a history of pelvic and urinary surgery while 17 cases don＇t. Average BMI was（24.1±2.6）kg/m^2, and mean age was（57.9 ± 16.8 ） years old. The average preoperative anxiety score was 27.7 ± 5.9, the average pain score of preoperative was 7.9 ± 1.6. The average quality of life score was 5.3 ± 0.9 the average daily urinary number was 30.6 ± 14.2. The average mean urine volume was （64. 8 ±37.4） ml and the average frequency of nocturia was 13.3 ±9.2. The average history of time was （ 83.0 ± 56.0） months. Patients who were implanted with permanent sacral neuromodulation system were mostly older （P = 0. 034 ）, with higher BMI （ P = 0. 043 ） and lower anxiety （ P = 0. 008 ）. There were no statistically significant differences in gender（ P = 0. 287 ）, disease （ P = 0.116 ）, the daily urinary frequency （ P =0. 140 ）, the average urine volume （ P = 0. 470）, nocturia frequency （ P = 0. 068 ）, pain scores （ P = 0. 880）, surgical history （P = 0. 276 ）and the medical history time （P = 0. 116 ） between patients who underwent first stage surgery only and second stage surgery. Conclusion BMI, age and anxiety may be the factors that affect the outcome of the first stage treatment of sacral neuromodulation.
作者
张威
王建业
万奔
魏东
刘明
王建龙
陈鑫
王鑫
张大磊
张亚群
张耀光
Zhang Wei;Wang Jianye;Wan Ben;Wei Dong;Liu Ming;Wang Jianlong;Chen Xin;Wang Xin;Zhang Dalei;Zhang Yaqun;Zhang Yaoguang(Department of Urology,Beijing Hospital,National Center of Gerontology,Beijing 100730,China)
出处
《中华泌尿外科杂志》
CAS
CSCD
北大核心
2018年第9期694-697,共4页
Chinese Journal of Urology
