马尾综合征早期手术减压是否能改善膀胱功能预后？
Does early surgical decompression in cauda equina syndrome improve bladder outcome?
作者信息
Srikandarajah Nisaharan, Boissaud-Cooke Matthew Alexander, Clark Simon, Wilby Martin John
机构信息
*The Walton Centre NHS Foundation Trust, Liverpool, United Kingdom; and †Warwick Medical School, The University of Warwick, Coventry, United Kingdom.
出版信息
Spine (Phila Pa 1976). 2015 Apr 15;40(8):580-3. doi: 10.1097/BRS.0000000000000813.
STUDY DESIGN
We analyzed retrospectively whether early surgery for cauda equina syndrome (CES) within 24, 48, or 72 hours of onset of autonomic symptoms made any difference to bladder function at initial outpatient follow-up.
OBJECTIVE
CES potentially causes loss of autonomic control including bladder dysfunction, resulting in significant disability. There is significant debate regarding appropriate timing of surgery.
SUMMARY OF BACKGROUND DATA AND METHODS
We conducted a retrospective cohort study of 200 patients between 2000 and 2011 who underwent decompressive surgery for CES at a regional neurosurgical center. Data collected were from clinical admission and at initial follow-up. Presentation was categorized into CES with retention (CESR) and incomplete CES (CESI) and duration of autonomic symptoms before surgical intervention.
RESULTS
A total of 200 patients had complete clinical records; 61 cases with CESR and 139 cases with CESI. Average initial follow-up time was 96 days. For the 36 cases with CESI less than 24 hours, normal bladder function was seen at follow-up in all patients except 4 (11.1%), but with 103 cases with CESI more than 24 hours, 48 (46.6%) had bladder dysfunction (Pearson χP = 0.000). For the 64 cases with CESI less than 48 hours, normal bladder function was seen at follow-up in all except 10 (15.6%), but with 75 cases with CESI more than 48 hours, 42 (56%) had bladder dysfunction (Pearson χP = 0.000). For the 35 patients with CESR, operating within 24, 48, or 72 hours made no obvious difference to bladder outcome. Data were also reanalyzed changing the dataset groups to CESI less than 24 hours, 24 to 48 hours, and more than 48 hours to calculate odds ratios regarding normal bladder outcome.
CONCLUSION
We identified that decompressive surgery within 24 hours of onset of autonomic symptoms in CESI reduces bladder dysfunction at initial follow-up, but no statistically significant difference in outcome was observed in CESR regarding timing of operation.
LEVEL OF EVIDENCE
研究设计
我们回顾性分析了马尾综合征（CES）在自主神经症状出现后24小时、48小时或72小时内进行早期手术，对首次门诊随访时膀胱功能是否有影响。
目的
CES可能导致自主神经控制丧失，包括膀胱功能障碍，从而造成严重残疾。关于手术的合适时机存在重大争议。
背景数据与方法总结
我们对2000年至2011年间在一家地区神经外科中心接受CES减压手术的200例患者进行了回顾性队列研究。收集的数据来自临床入院时和首次随访时。临床表现分为伴有尿潴留的CES（CESR）和不完全性CES（CESI）以及手术干预前自主神经症状的持续时间。
结果
共有200例患者有完整的临床记录；61例CESR和139例CESI。平均首次随访时间为96天。对于36例自主神经症状出现少于24小时的CESI患者，除4例（11.1%）外，所有患者在随访时膀胱功能正常，但对于103例自主神经症状出现超过24小时的CESI患者，48例（46.6%）有膀胱功能障碍（Pearson χP = 0.000）。对于64例自主神经症状出现少于48小时的CESI患者，除10例（15.6%）外，所有患者在随访时膀胱功能正常，但对于75例自主神经症状出现超过48小时的CESI患者，42例（56%）有膀胱功能障碍（Pearson χP = 0.000）。对于35例CESR患者，在24小时、48小时或72小时内进行手术对膀胱结局无明显差异。数据还重新进行了分析，将数据集分组改为自主神经症状出现少于24小时、24至48小时以及超过48小时的CESI，以计算膀胱结局正常的比值比。
结论
我们发现，CESI患者在自主神经症状出现后24小时内进行减压手术可减少首次随访时的膀胱功能障碍，但CESR患者在手术时机方面未观察到统计学上的显著差异。
证据级别
3级。
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