脊髓损伤后的排尿功能重建

目的 :介绍2种恢复脊髓损伤 (SCI)后控制性排尿的新方法及其临床经验。方法 :(1)总结国内第1例Brindley 骶神经前根电刺激器埋置术的手术方法和经验。(2)在成功建立犬膝腱 -脊髓 -膀胱人工反射弧的基础上 ,对3例圆锥上SCI痉挛性膀胱的病人 ,进行肌腱 -脊髓 -膀胱人工反射弧建立术。结果 :安装Brindley电刺激器的病人 ,术后随访6个月 ,控制性排尿良好 ,尿失禁被完全根除。建立人工膀胱反射弧的3例病人 ,1例随访13个月 ,已能通过人工反射弧激发排尿 ,效果良好。结论 :骶神经前根电刺激和建立人工膀胱反射弧是恢复SCI病人控制性排尿功能的可靠方法。

Functional reconstruction of controlled micturition in spinal cord injury

objective: To introduce two new procedures for reconstruction of controlled urinary micturition in supraconal spinal cord injury.Methods: (1) We implanted the first case of Brindley's sacral anterior root stimulator (SARS) in China in a woman for controlled micturition. (2) Based on successful experimental study in 6 dogs, an artificial tendon-cord-bladder reflex was established in 3 patients. Results:SARS controlled micturition: after 6 months follow-up, the stimulator works very well and the woman is completely continent day and night.Artificial bladder reflex: One out of the 3 patients was followed 13 months after operation, the results are very encouraging, because the patient can use the artificial reflex to trigger micturition. Conclusion: Both implantation of SARS and establishment of artificial reflex are effective and reliable methods to restore controlled micturition in supraconal spinal cord injury. However, further studies are still needed to elucidate the mechanisms.