骶神经调控治疗顽固性间质性膀胱炎/膀胱疼痛综合征的有效性及安全性

Efficacy and safety of sacral neuromodulation in the treatment of refractory interstitial cystitis/bladder pain syndrome

摘要

目的 分析骶神经调控（SNM）治疗顽固性间质性膀胱炎/膀胱疼痛综合征（IC/BPS）的长期疗效及安全性，为该疾病的诊治提供更多临床证据。方法 回顾性分析2015年1月-2021年12月首都医科大学附属北京朝阳医院收治的27例顽固性IC/BPS患者的临床资料，患者均接受SNM Ⅱ期手术。用总体反应评估（GRA）SNM Ⅱ期患者的疗效，比较患者SNM术前及术后的日均排尿次数、日均夜尿次数、功能膀胱容量、O'Leary-Sant评分、盆腔疼痛与尿频尿急症状（PUF）评分、生活质量（QoL）评分、疼痛视觉模拟量表（VAS）评分。结果 术后随访（55.55±16.33）个月，27例患者中12例症状无缓解（GRA≤4分），15例症状得到缓解（GRA＞4分），总体有效率55.56%（15/27）。相比于术前，SNM Ⅱ期术后患者的日均排尿次数[（28.74±13.84）次 vs.（24.74±16.33）次]、O'Leary-Sant评分[（30.19±5.35）分 vs.（25.63±9.34）分]、PUF评分[（25.63±5.34）分 vs.（22.04±8.29）分]、QoL评分[（5.67±0.55）分 vs.（4.33±1.57）分]以及VAS评分[（8.04±1.91）分 vs.（5.33±3.09）分]均明显改善，差异有统计学意义（P＜0.05）。未发生切口感染、刺激器植入部位疼痛等并发症。结论 SNM治疗顽固性IC/BPS安全有效，但也存在长期疗效减退或消失的风险，故应慎重选择合适的患者。

Abstract

Objective To summarize the long-term efficacy and safety of sacral neuromodulation (SNM) in treating refractory interstitial cystitis/bladder pain syndrome (IC/BPS), so as to provide clinical evidence for this therapeutic approach. Methods This study retrospectively analyzed the data of 27 patients with refractory IC/BPS treated at our hospital during Jan. 2015 and Dec. 2021. All patients underwent SNM Ⅱ. The therapeutic effects were evaluated with Global Response Assessment (GRA). The preoperative and postoperative daily urinary frequency, nocturia frequency, functional bladder capacity, O'Leary-Sant score, pelvic pain, urgency and frequency (PUF) score, quality of life (QoL) score, and visual analogue scale (VAS) score were compared. Results During the follow-up of (55.55±16.33) months, 12 patients showed no symptom relief (GRA≤4), while 15 experienced symptom relief (GRA>4), resulting in an efficacy rate of 55.56% (15/27). The average daily urination frequency decreased from (28.74±13.84) to (24.74±16.33) times, the O'Leary-Sant score decreased from (30.19±5.35) to (25.63±9.34), PUF score decreased from (25.63±5.34) to (22.04±8.29), QoL score decreased from (5.67±0.55) to (4.33±1.57), and VAS score decreased from (8.04±1.91) to (5.33±3.09), the differences were statistically significant (P<0.05). No complications such as incision infections or pain at the implant site were observed. Conclusion SNM is safe and effective for refractory IC/BPS, but there is a risk of long-term failure. Therefore, patients should be discreetly selected.

关键词

骶神经调控 / 间质性膀胱炎 / 膀胱疼痛综合征

Key words

sacral neuromodulation / interstitial cystitis / bladder pain syndrome

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