骶神经调控手术安全共识

Safety consensus of sacral neuromodulation surgery

摘要

本共识由中国医师协会神经调控专业委员会尿控盆底疾病学组与中国老年保健协会盆底疾病专业委员会神经调控学组组织多学科专家团队共同制订，旨在应对骶神经调控技术在国内广泛应用背景下，临床操作不规范、并发症风险增加等问题，为骶神经调控手术规范、安全开展提供指导。共识的制订基于对国内外相关文献的系统回顾，并结合丰富的临床实践经验。为确保推荐意见的科学性与临床指导价值，专家组采用分级评价体系，并对共识意见进行投票，形成了涵盖六大核心领域的推荐。本共识与既往共识不同之处在于系统阐述了开展骶神经调控手术的医院与科室条件保障、患者筛选与术前管理、一期电极置入与二期刺激器植入的规范化手术流程、术后程控与长期随访体系、临床风险事件（如出血、感染、疼痛、电极移位等）的管控策略，还特别针对骶骨畸形、儿童及青少年等特殊人群的处理策略提出了具体建议，并提炼出涵盖上述六大领域的核心推荐意见。本共识强调了多学科团队（MDT）建设、严格的患者选择、规范化的手术操作、个体化的程控随访以及并发症的积极防控，对于保障骶神经调控手术疗效与患者安全起关键性作用。

Abstract

Developed by a multidisciplinary expert team organized by the Neuro-urology & Pelvic Floor Disorder Group of Chinese Association of Neurological Regulation and the Neuro-modulation Group of Reproductive Health and Pelvic Floor Disease Branch of China Association of Geriatric Health, this consensus aims to address the challenges of non-standardized clinical procedures and increased complication risks arising from the widespread application of sacral neuromodulation (SNM) in China, providing guidance for the standardized and safe practice of SNM. Based on a systematic review of relevant domestic and international literature, combined with extensive clinical experience, the expert panel adopted a graded evidence evaluation system and formed expert consensus to ensure the scientific validity and clinical value of the recommendations, ultimately formulating recommendations covering six core domains. Unlike previous consensuss, this document systematically elaborates on institutional and departmental requirements for performing SNM, patient selection and preoperative management, standardized surgical procedures for stage-1 lead placement and stage-2 implantable pulse generator(IPG) implantation, postoperative programming and long-term follow-up, and strategies for managing clinical adverse events(e.g., bleeding, infection, pain, lead migration). Moreover, it provides specific recommendations for managing special populations, including patients with sacral anomalies and children/adolescents, and distills core recommendations across the six aforementioned domains. This consensus emphasizes the critical roles of multidisciplinary team(MDT) approach, rigorous patient selection, standardized surgical techniques, individualized programming and follow-up, and proactive prevention and management of complications in ensuring the efficacy and safety of SNM.

关键词

骶神经调控 / 手术治疗 / 安全共识

Key words

sacral neuromodulation / surgical treatment / safety consensus

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基金资助

国家临床重点专科建设项目(10000015Z55080000004)