温针灸联合盆底肌训练、阴部神经电刺激治疗根治性前列腺切除术后尿失禁临床研究

目的：观察温针灸联合盆底肌训练（PFMT）、阴部神经电刺激对根治性前列腺切除术后尿失禁（PPI） 患者的治疗效果。方法：将93名行根治性前列腺切除术治疗的肾阳虚型PPI患者随机分为对照组46例和试验组47例。对照组采用PFMT联合阴部神经电刺激治疗，试验组在对照组基础上联合温针八髎、肾俞和命门穴治疗。治疗12周后，比较2组国际尿失禁咨询委员会尿失禁问卷表（ICI-Q-SF）、尿失禁生活质量问卷（I-QOL）、PPI康复趋势评分表、盆底肌力（Glazer方案）、1 h尿垫试验漏尿量和临床疗效。结果：治疗后，试验组愈显率为93.62%，对照组为78.26%，2 组比较，差异有统计学意义（P＜0.05）。治疗4、8、12 周，2组ICI-Q-SF评分均较治疗前下降（P＜0.05），并呈逐渐下降趋势（P＜0.05）；且试验组ICI-Q-SF评分在相同时间点均低于对照组（P＜0.05）。治疗4、8和12周，2组I-QOL评分均较治疗前升高（P＜0.05），并呈逐渐升高趋势（P＜0.05）；且试验组I-QOL评分在相同时间点均高于对照组（P＜0.05）。治疗4、8和12周，2组PPI康复趋势评分均较治疗前升高（P＜0.05），并呈逐渐升高趋势（P＜0.05）；且试验组PPI康复趋势评分在相同时间点均高于对照组（P＜0.05）。治疗4、8和12周，2组Glazer评分均较治疗前升高（P＜0.05），并呈逐渐升高趋势（P＜0.05）；且试验组Glazer评分在相同时间点均高于对照组（P＜0.05）。治疗4、8和12周，2组1 h尿垫试验漏尿量均较治疗前减少（P＜0.05），并呈逐渐减少趋势（P＜0.05）；且试验组1 h尿垫试验漏尿量在相同时间点均少于对照组（P＜0.05）。随访3个月，2组ICI-Q-SF 评分、1 h尿垫试验漏尿量均较治疗后升高（P＜0.05），I-QOL评分、PPI康复趋势评分、Glazer评分均较治疗后降低（P＜0.05）；且试验组ICI-Q-SF评分、1 h尿垫试验漏尿量低于对照组（P＜0.05），I-QOL评分、PPI康复趋势评分高于对照组（P＜0.05），而Glazer评分组间差异不大（P＞0.05）。结论：在PFMT联合阴部神经电刺激基础上加用温针灸治疗PPI疗效显著，可改善患者尿失禁症状及盆底肌功能，提高生活质量，促进疾病康复，且远期疗效相对较好。

Clinical Study on Warming-Needle Moxibustion Combined with Pelvic Floor MuscleTraining and Electrical Pudendal Nerve Stimulation for Urinary Incontinence AfterRadical Prostatectomy

Abstract： Objective： To observe the curative effect of warming-needle moxibustion combined withpelvic floor muscle training (PFMT) and electrical pudendal nerve stimulation (EPNS) on patients with postprostatectomyincontinence (PPI) after radical prostatectomy (RP). Methods： A total of 93 cases of PPIpatients of kidney yang deficiency type with RP treatment were randomly divided into the control group andthe trial group，with 46 and 47 cases in each group respectively. The control group was treated with PFMTcombined with EPNS of the pudendal nerve， and the trial group was additionally treated with warmingneedlemoxibustion at Baliao points， Shenshu point (BL 23)， and Mingmen point (Du 4) based on thetreatment of the control group. After 12 weeks of treatment，the scores of the International Consultation onIncontinence Questionnaire Incontinence short form (ICI-Q-SF) ， Incontinence Quality of Life Scale(I-QOL)， PPI Rehabilitation Trend Scoring Scale， and the pelvic floor muscle (Glazer Protocol)， urineleakage measured by 1-hour pad test， and clinical effects were compared between the two groups.Results：After treatment，the cure rate was 93.62% in the trial group and 78.26% in the control group，the difference being significant (P＜0.05). After treatment for 4， 8， and 12 weeks，ICI-Q-SF scores inthe two groups were decreased when compared with those before treatment (P＜0.05) and showed agradual downward trend (P＜0.05)；ICI-Q-SF scores in the trial group were lower than those in the controlgroup at the same time point (P＜0.05). After treatment for 4，8，and 12 weeks，I-QOL scores in the twogroups were increased when compared with those before treatment (P＜0.05) and showed a gradual risingtrend (P＜0.05)； I-QOL scores in the trial group were higher than those in the control group at the sametime point (P＜0.05). After treatment for 4，8，and 12 weeks，the scores of the PPI Rehabilitation TrendScoring Scale in the two groups were increased when compared with those before treatment (P＜0.05) andshowed a gradual rising trend (P＜0.05)；the scores of the PPI Rehabilitation Trend Scoring Scale in the trialgroup were higher than those in the control group at the same time point (P＜0.05). After treatment for 4，8， and 12 weeks， Glazer scores in the two groups were increased when compared with those beforetreatment (P＜0.05) and showed a gradual rising trend (P＜0.05)； Glazer scores in the trial group werehigher than those in the control group at the same time point (P＜0.05). After treatment for 4， 8， and12 weeks，urine leakage measured by 1-hour pad test in the two groups were decreased when comparedwith those before treatment (P＜0.05) and showed a gradual downward trend (P＜0.05)； urine leakagemeasured by 1-hour pad test in the trial group was less than that in the control group at the same time point(P＜0.05). During the 3-month follow-up， the ICI-Q-SF scores and urine leakage measured by 1-hourpad test in the two groups were increased when compared with those after treatment (P＜0.05)，and thescores of I-QOL ， the scores of the PPI Rehabilitation Trend Scoring Scale and Glazer were decreasedwhen compared with those after treatment (P＜0.05)； ICI-Q-SF scores and urine leakage measured by1-hour pad test in the trial group were lower than those in the control group (P＜0.05)， and the scoresof I-QOL，the scores of the PPI Rehabilitation Trend Scoring Scale in the trial group were higher than thosein the control group (P＜0.05)，but there was not much difference in Glazer scores between the two groups(P＞0.05). Conclusion：Warming-needle moxibustion has significant curative effects in the treatment of PPIbased on PFMT combined with EPNS of the pudendal nerve，which can improve the symptoms of urinaryincontinence and pelvic floor muscle function in patients， improve quality of life， promote diseaserecovery，and have relatively good long-term curative effects.