骶神经根选择性切断治疗截瘫后痉挛性膀胱的实验及临床研究

目的观察高选择性骶神经根前根切断术治疗脊髓损伤后痉挛性膀胱的疗效,探讨其治疗机制、最佳手术方法及临床实际疗效. 方法雄性家犬12只,制成脊髓损伤后痉挛性膀胱模型,根据骶神经根切断方式:切断S2前根,切断S2前根 S3 1/2前根,切断S2、S3前根,完全切断S2～4神经根,依序分为A、B、C、D 4个组,通过尿动力学检测及电生理观察,分析比较骶神经根切断前、后各组功能性指标的变化,确定其最佳手术方案.临床治疗则根据实验结果,选择性切断脊髓损伤后痉挛性膀胱患者S2前根或 S3 1/2前根共32例.术前膀胱容量平均(120±30) ml,术前排尿量平均(100±30) ml,尿道压力平均为(120±20) cm H2O. 结果 4个组术后膀胱容量分别为:(150±50)、(180±50)、(230±50)、(400±50) ml;排尿量分别为:(130±30)、(180±50)、(100±50)、(50±30) ml.临床治疗32例,术后膀胱容量平均增加至410 ml左右,排尿量平均增加至350 ml左右,所有患者尿失禁消失.有13例获22个月远期随访,无复发. 结论高选择性骶神经根切断治疗脊髓损伤后痉挛性膀胱疗效显著,是一种值得研究、推广的新方法.

EXPERIMENTAL AND CLINICAL STUDIES ON SELECTIVE SACRAL RHIZOTOMY IN TREATMENT OF SPASTIC BLADDER AFTER SPINAL CORD INJURY

OBJECTIVE: To observe the effect of selective sacral rhizotomy in treating spastic bladder after spinal cord injury and to explore the mechanism and the best surgical method of different sacral rhizotomies. METHODS: The spastic bladder models were established in 12 male dogs and were divided into 4 groups according to the different rhizotomies of the sacral nerve as the following: rhizotomy of the anterior root of S2 (group A), rhizotomy of the anterior root of S2 and half of the anterior root of S3 (group B), rhizotomy of the anterior roots of S2 and S3 (group C), and total rhizotomy of the nerve roots of S2-4 (group D). By urodynamic examination and electrophysiological observation, the changes of all functional data were recorded and compared between pre-rhizotomy and post-rhizotomy to testify the best surgical method. In clinical trial, according to the results of the above experiments, rhizotomy of the anterior root of S2 or one of the half-anterior root of S3 were conducted on 32 patients with spastic bladder after spinal cord injury. The mean bladder capacity, the mean urine evacuation and the mean urethra pressure were (120 +/- 30), (100 +/- 30)ml and (120 +/- 20) cm H2O, respectively before rhizotomy. RESULTS: After rhizotomy, the bladder capacity in 4 groups amounted to (150 +/- 50), (180 +/- 50), (230 +/- 50), and (400 +/- 50) ml, respectively; and the urine evacuation volume were (130 +/- 30), (180 +/- 50), (100 +/- 50) and (50 +/- 30)ml, respectively. In the treated 32 patients, the mean bladder capacity were raised to 410 ml, and the mean urine evacuation volume were also increased to 350 ml. Incontinence of urine disappeared in all patients. After 22-month follow-up on 13 patients, no recurrence was observed. CONCLUSION: The effect of selective sacral rhizotomy in treating spastic cord injury is significant and worthy of further studies.