选择性骶神经前后根组合切断恢复脊髓损伤后膀胱功能的实验研究

目的：探讨脊髓损伤后膀胱完全性去神经传入手术的替代方法。方法：健康杂种犬16只经T10平面截瘫后,按L7－S3神经根切断程度的不同,从完全保留到完全切断分成六组,比较术中神经根（总根和后根）电刺激时的膀胱尿道压力变化和术后膀胱压力容积曲线（CMG）变化。结果 （1）电刺激研究：犬磅胱的神经支配以S2为主,S1次之,尿道的神经支配以S1为主,S2次之,在保留S1或S2前后根完整的情况下,刺激同平面S1或S2的总根或后根,膀胱尿道的压力反应相同,切断S1或S2前根,刺激同平面的S1或S2后根,膀胱尿道的压力反应显著降低。（2）CMG研究：保留同一平面S1或S2前后根的完整,其CMG曲线与完全不切断的对照组相似,形成痉挛性膀胱,不保留同一平面前后根的完整,即切断S1或S2前根,其CMG曲线与切断全部后根的对照组相似,形成驰缓性膀胱,结论 不同平面的骶神经前后根组合切断,能获得与完全性后根切断相同的膀胱去神经效果。     

选择性骶神经根切断治疗脊髓损伤后痉挛性膀胱的实验研究

目的：观察选择性骶神经根切断治疗脊髓损伤痉挛性膀胱的实际疗效,探讨骶神经根高选择性切断的治疗机制及最佳手术方式。方法：雄性家犬１２ 只,制备成脊髓损伤后痉挛性膀胱模型,根据骶神经切断方式分为Ａ、Ｂ、Ｃ、Ｄ４ 组,通过尿流动力学检测及电生理观察,记录并计算骶神经切断前（ 对照组）及术后各组各项功能性指标的变化,并进行比较分析。结果：Ａ、Ｂ、Ｃ、Ｄ４ 组术后膀胱容量均明显高于术前对照组,尿道压力均低于术前对照组,其中Ｂ 组的膀胱贮尿功能、排空能力、尿道压力均接近正常,且对犬阴茎勃起功能无明显影响。结论：高选择性骶神经根切断治疗脊髓损伤后痉挛性膀胱有确实明显的疗效,是一种值得研究的新方法。     

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.     

选择性髓神经根切断治疗脊髓损伤后痉挛性膀胱的实验研究

目的：观察选择性骶神经根切断治疗脊髓损伤痉挛性膀胱的实际疗效,搪塞骶神经根高选择性切断的治疗机制及最佳手术方式。方法：雄性家犬１２只,制备成脊髓２后痉挛民生膀胱模型,根据骶神经切断方式分为Ａ、Ｂ、Ｃ、Ｄ４组,通过尿流动力学检测及电生理观察,记录并计算骶神经切断前（对照组）及术后各组各项功能性指标的变化,并进行比较分析。结果：Ａ、Ｂ、Ｃ、Ｄ４组术后膀胱容量均明显高于术前对照组,尿道压力均低于术前对照     

膀胱神经支配重建研究的历史与现状

脊髓损伤后膀胱功能障碍一直是未能很好解决的医学难题之一，它常引起严重的尿潴留和尿路感染，甚至发生肾功能衰竭，导致死亡。有资料表明，在美国有超过５０万的截瘫患者需要进行膀胱功能重建，并且这一数字还在以每年５万的速度不断增加〔１〕。近一个世纪以来，许多相...     

截瘫后经马尾骶神经根重建自控性膀胱功能

目的 通过对截瘫患马尾骶神经根的桥接来改善膀胱功能,建立起自控性膀胱。方法 将2例截瘫后患行切断15前根,两例行L5-S2前根的桥接。结果 2例患近期表现为膀胱容量增大,顺应性提高,远期有敲击跟腱后引发排尿．最大尿流率11．0mL/s。结论 建立“腱反射—脊髓中枢—膀胱”的人工反射弧途径来达到重建自控性膀胱功能是可行的。     

利用正常腰骶神经根重建膀胱反射弧对下肢功能影响的临床观察

目的 观察利用正常腰骶神经根重建膀胱反射弧对切断神经根所支配区域运动功能的影响.方法 对9例脊髓损伤后膀胱功能障碍而下肢运动功能仍存在的患者,利用其功能健存的脊髓节段的单根神经根前根中枢端,吻接支配膀胱的S2(或S3)神经根前根周围端,建立新的膀胱人工反射弧以重建膀胱功能,术后观察下肢相应区域运动功能变化.结果 9例中4例S1神经前根切断,术后主观感觉小腿肌力稍有下降,查体踝跖屈肌力约下降半级,3个月后随访肌力恢复;2例L3神经前根切断,2例L4神经前根切断,1例L5神经前根切断,术后肌力均无明显影响.结论 切断单一腰骶神经根前根对下肢运动功能无明显影响.     

骶神经根电刺激排尿中完全性后根去传入的替代方法

目的 探讨脊髓损伤病人进行骶神经根电刺激排尿时膀胱完全性去传入手术的替代方法。方法 １０条犬经Ｔ１０平面截瘫后,按Ｌ７～Ｓ３前后根切断程度和组合方式的不同分成４组,观察术中神经根电刺激时膀胱尿道的压力变化和术后膀胱压力容积曲线（ＣＭＧ）变化。结果 保留２侧Ｓ１前后根完整,电刺激同平面Ｓ１的总根或后根,膀胱尿道的压力反应相同;切断两侧Ｓ１前根,刺激同平面的Ｓ１后根,膀胱尿道的压力反应显著降低,仅为前     

骶神经根功能性磁刺激对脊髓损伤相关神经源性膀胱过度活动症的疗效分析

目的 探讨骶神经根功能性磁刺激(functional magnetic stimulation,FMS)治疗脊髓损伤(spinal cord injury,SCI)相关神经源性膀胱过度活动症(overactive bladder,OAB)的临床疗效.方法 纳入2018年8月～2019年8月于本院收治的94例SCI相关神...     

人工膀胱反射弧的实验与临床研究

目的 建立人工膀胱反射弧,以恢复脊髓损伤后的膀胱功能,它将体反射运动是化的运动同支传入膀胱,引起膀胱的自主性收缩。方法 将犬右Ｌ５前根近端与右Ｓ２前根远端在硬膜内吻合,经轴突再生后,建立膝腱－脊髓中枢－膀胱人工反射通路。进行神经电生理、膀胱测压、膀胱逼尿肌 图等早期和无期功能观察。临床１例Ｔ２、３完全性截竣患者,硬膜内行双侧Ｌ５与Ｓ２前根的吻合。结果 单相方波（１１５ｍＶ,１．０ｍｓ）刺激右Ｌ５后     

大鼠骶髂关节传入神经通路的实验研究

目的:通过逆行神经追踪法研究大鼠骶髂关节的传入神经通路。方法:30只雄性Sprague-Dawley大鼠随机分成非交感神经切除组(A组)和交感神经切除组(B组),每组15只,交感神经切除组切除左侧L1以下椎旁交感干。两组左侧骶髂关节注入30%的辣根过氧化物酶(HRP)20μl,72h后取出双侧的L1-S1背根神经节(DRG),TMB法染色后在光学显微镜下观察HRP阳性神经元细胞并计数。结果:两组左侧L1、L2背根神经节内HRP阳性神经元差异有显著性意义(P<0·05),B组HRP阳性神经元明显减少;左侧L3-S1背根神经节内HRP阳性神经元差异无显著性意义(P>0·05)。结论:L1-S1神经节含有支配同侧骶髂关节的传入神经元,同侧椎旁交感干可能是骶髂关节到L1-L2神经节重要的传入神经旁路,而不是到L3-L5神经节的传入旁路或重要的传入旁路。     

Experimental rat bladder urothelial cell carcinoma models

Bladder cancer is a major public health problem. Currently available therapeutic options seem to be unable to prevent bladder cancer recurrence and progression. To enable preclinical testing of new intravesical therapeutic agents, a suitable bladder tumor model that resembles human disease is highly desirable. The aim of this topic paper was to discuss the problems associated with current in vivo animal bladder tumor models, focusing on the orthotopic syngeneic rat bladder tumor model. In the second part of the paper the development of a potential new orthotopic rat bladder tumor model is described.     

Metastatic involvement of sacral nerve roots from uterine carcinoma: a case report

BACKGROUND CONTEXT: Metastatic involvement of peripheral nerves is considered common in carcinoma of the head and neck with perineural invasion. It is also possible that perineural and endoneural invasion occur in presacral local recurrence. Little is reported about metastasis in pelvic lesions including sacral nerve roots. PURPOSE: We describe the clinical presentation and diagnosis of metastatic involvement of sacral nerve roots retrogradely from uterine carcinoma, and its implication for spine surgeons, along with a brief review of literature. STUDY DESIGN/SETTING: A case report of a patient with metastatic lesions in S1 and S2 nerve roots originating from uterine adenocarcinoma is presented. METHODS: A 39-year-old woman with history of uterine cancer presented with persistent severe low back pain, intractable radicular pain, and neurological deficit in the right lower extremity. She had undergone radical hysterectomy for uterine adenocarcinoma 4 years ago followed by chemotherapy and radiotherapy. Magnetic resonance imaging (MRI) revealed abnormal swelling of the S1 and S2 nerve roots along with a soft-tissue mass in the retroperitoneal space. RESULTS: The patient underwent surgical rhizotomy and histology of the roots revealed metastatic tumor in the dorsal root ganglion. The patient had good pain relief, she died of metastatic disease 3 years later. CONCLUSIONS: Despite being uncommon, sacral nerve root metastasis should be considered in some patients with history of cancer of pelvic organs including the uterus. MR images were of little value in differentiating a carcinomatous lesion from a benign lesion.     

全程管理在神经源性膀胱患者骶神经调节治疗的疗效评价

目的评价基于多学科团队协作的骶神经调节治疗神经源性膀胱患者全程管理方案的实践效果。 方法收集2018年1月至2019年12月中山大学孙逸仙纪念医院收治的36例神经源性膀胱行骶神经调节治疗患者的病例资料。将36例患者按入院时间分为对照组15例（2018年1~ 12月）和干预组21例（2019年1~12月）。对照组给予常规管理,干预组实施全程护理模式。比较两组骶神经调节二期手术转化率,两组患者一期术后3个月时膀胱功能管理效果、尿路感染发生率、患者满意度和生活质量的差异。 结果两组患者在骶神经调节二期手术转化率、平衡膀胱达标率、膀胱容量、患者满意度和生活质量的差异有统计学意义（P<0.05）,干预组均高于对照组。 结论多学科团队协作的全程管理实现了骶神经调节治疗神经源性膀胱患者连续的全程化、个性化管理,协调多学科团队协作,改善了患者的临床疗效,提高了患者满意度,是一种有效的患者管理照护模式。     

Spastic bladder and spinal cord injury: seventeen years of experience with sacral deafferentation and implantation of an anterior root stimulator

INTRODUCTION: Spinal cord injured patients with a suprasacral lesion usually develop a spastic bladder. The hyperreflexia of the detrusor and the external sphincter causes incontinence and threatens those patients with recurrent urinary tract infections (UTI), renal failure, and autonomic dysreflexia. All of these severe disturbances may be well managed by sacral deafferentation (SDAF) and implantation of an anterior root stimulator. MATERIAL AND METHOD: Between September 1986 to December 2002, 464 paraplegic patients (220 female, 244 male) received a SDAF-SARS. Almost exclusively the SDAF was done intradurally, which means with one operation field there can be done two steps (SDAF and SARS). RESULTS: 440 patients have a follow-up with 6.6 years (at least > 6 months-17 years). The complete deafferentation was successful in 94.1%. A total of 420 paraplegics may use the SARS for voiding (frequency 4.7 per day) and 401 use it for defecation (frequency 4.9 per week). Continence was achieved in 364 patients (83%). UTI declined from 6.3 per year preoperatively to 1.2 per year postoperatively. Kidney function presented stable. Early complications were 6 CSF leaks, 5 implant infections. Late complications with receiver or cable failures made us do surgical repairs in 34 paraplegics. A step-by-step program for trouble-shooting differentiates implant failure and myogenic or neurogenic failure. CONCLUSION: SDAF is able to restore the reservoir function of the urinary bladder and to achieve continence. Autonomic dysreflexia disappeared in most of the cases. By means of an accurate adjustment of stimulation parameters it is possible to accomplish low resistance micturition. The microsurgical technique requires an intensive education. One has to be able to manage late implant complications.     

骶正中动脉造影及栓塞在骶骨肿瘤切除术中的价值

目的探讨骶正中动脉在骶骨肿瘤术前栓塞及治疗中的作用。方法对63例骶骨肿瘤患者常规行X线平片,CT和（或）MR检查,术前均行双侧髂内动脉和（或）腰动脉、骶正中动脉造影,并超选择插管栓塞肿瘤供血动脉。结果63例骶骨肿瘤中,肿瘤表现为富血供者37例,乏血供者26例。富血供者37例中,骶正中动脉参与供血者22例,表现为血管增粗、增多、纡曲、肿瘤染色。术前栓塞后,61例手术效果满意,不满意2例。结论骶正中动脉在骶骨肿瘤术前栓塞治疗中具有重要意义。对骶骨肿瘤,术前栓塞除常规髂内动脉栓塞外,应考虑到有骶正中动脉等多支供血的特点,尽量栓塞彻底以减少术中出血。     

Sprouting of bladder nerves into cystoplastic cecal segment in the rat

Incorporation of bowel into the bladder (enterocystoplasty) has been widely used to increase bladder capacity. It has been reported by others that the response of smooth muscle from the cystoplastic segment of the intestine shifts from that of the intestine (relaxation to α-agonists and ATP) to that of the bladder (contraction to α-agonists and ATP). This suggests a functional integration of the intestinal muscle into the bladder; the mechanisms are unknown. The aims of the present study were (1) to elucidate if there are signs of bladder nerves sprouting across the anastomosis into the intestinal segment, and (2) to study what happens with the intrinsic innervation of the intestinal segment. As a model, we used cecocystoplasty in rats. The bladder was opened and a patch of cecum with intact vascular supply was anastomosed to the bladder. After two to 11 months the rats were sacrificed and the bladders mounted as wholemounts and stained for acetylcholinesterase-containing nerves, or embedded in paraffin for histology. A pronounced degeneration of the myenteric plexus was found in the cecal segments. In some areas, this had proceeded to the extent that the ganglia were isolated ovoid lumps of cells with no apparent connection to other ganglia. Areas lacking ganglia and nerve trunks but still with muscle could be found in all specimens. Abundant axon bundles were demonstrated sprouting from the cut bladder nerves close to the anastomosis. The bundles spread out in a fan-like pattern or were organized as fewer thicker nerves. There were many nerve bundles entering the cecal segment where they branched and the diameter decreased till they no longer became visible. Some nerves reached surviving lumps of myenteric ganglion cells. The results show that the bladder nerves sprout into the anastomosed cecal segment. It is reasonable to assume that these nerves are responsible for the changes in receptor pharmacological properties of the cecal smooth muscle towards that of bladder muscle. Received: 30 October 1998 / Accepted: 18 May 1999