Franco I, Storrs B, Firlit C F, Zebold K, Richards I, Kaplan W E
Department of Pediatric Urology, Children's Memorial Hospital, Chicago, Illinois.
J Urol. 1992 Aug;148(2 Pt 2):648-50. doi: 10.1016/s0022-5347(17)36681-8.
Recent successful introduction of selective rhizotomy in the management of lower extremity spasticity in patients with myelodysplasia has prompted us to use it as a means of managing high pressure neurogenic bladders occasionally encountered in myelodysplastic patients. During the last 1 1/2 years 8 children have undergone selective sacral rhizotomy in an attempt to avert urinary diversion or bladder augmentation. Patient age ranged from 6.5 to 18.5 years. The level of the respective lesions was evenly distributed throughout the spine. At spinal surgery each patient had an electrode placed in the detrusor of the bladder via a suprapubic approach, electromyography electrodes were placed in the perineum and slow fill water cystometry was performed throughout the procedure. Standard electrophysiological stimulation of the nerve roots was performed to identify the rootlets that would only affect the detrusor and spare the external sphincter. Postoperative followup has been obtained on all patients. Of the patients 4 have exhibited significant improvement and they have not required augmentation, 2 have not shown any further deterioration in bladder function, 1 has demonstrated deterioration and 1 still lacks urodynamic followup. Postoperative cystometric studies have revealed a bladder capacity increase of 69% for the group. Uninhibited bladder contractions were abated in all but 1 patient. No patient has been rendered incontinent of urine from the procedure and no patient has had a problem with stool continence as a result of the rhizotomy. It appears that selective rhizotomy of the sacral roots has been able to increase bladder capacity as well as compliance in patients who normally would have been relegated to either bladder augmentation or urinary diversion. While these are encouraging results, some further followup is required to ascertain if the early improvements will be long-lasting.
最近，选择性脊神经根切断术成功应用于治疗脊髓发育不良患者的下肢痉挛，这促使我们将其作为治疗脊髓发育不良患者偶尔出现的高压神经源性膀胱的一种方法。在过去的1年半中，8名儿童接受了选择性骶神经根切断术，试图避免尿流改道或膀胱扩大术。患者年龄在6.5岁至18.5岁之间。各自病变的水平在整个脊柱中均匀分布。在脊柱手术中，每位患者通过耻骨上途径将电极置入膀胱逼尿肌，将肌电图电极置于会阴，并在整个手术过程中进行缓慢充盈膀胱测压。对神经根进行标准的电生理刺激，以识别仅影响逼尿肌而保留外括约肌的神经根丝。所有患者均获得了术后随访。其中4例患者有显著改善，无需进行膀胱扩大术；2例患者膀胱功能未进一步恶化；1例患者病情恶化；1例患者仍缺乏尿动力学随访。术后膀胱测压研究显示，该组患者的膀胱容量增加了69%。除1例患者外，所有患者的无抑制膀胱收缩均得到缓解。没有患者因该手术出现尿失禁，也没有患者因神经根切断术出现大便失禁问题。似乎骶神经根选择性切断术能够增加通常需要进行膀胱扩大术或尿流改道的患者的膀胱容量和顺应性。虽然这些结果令人鼓舞，但仍需要进一步随访以确定早期改善是否会持久。
