【摘要】：一、研究背景:腰椎間盤突出伴馬尾神經(jīng)綜合癥(Cauda equina symdrome caused by Lumbar disc protrusion,CES-LDP)是一種少見的,由各種原因引起馬尾神經(jīng)嚴(yán)重受壓致神經(jīng)功能受損的一種疾病。目前提倡早期甚至急診手術(shù)減壓,及時(shí)解除神經(jīng)壓迫,能防止持續(xù)性神經(jīng)功能受損,保留神經(jīng)功能恢復(fù)潛能,以期達(dá)到神經(jīng)功能恢復(fù)。但目前關(guān)于該類患者延遲手術(shù)減壓(延遲周以上)的神經(jīng)功能恢復(fù)狀況及長期隨訪結(jié)果,鮮有文獻(xiàn)報(bào)道。臨床實(shí)踐中,由于經(jīng)濟(jì)、就醫(yī)意識、社區(qū)醫(yī)療對該疾病意識缺乏,延遲手術(shù)情況時(shí)有發(fā)生。二、研究目的:探討腰椎間盤突出伴馬尾神經(jīng)綜合癥患者接受延遲手術(shù)減壓療效及其神經(jīng)功能恢復(fù)的長期隨訪結(jié)果。三、研究方法:回顧性分析35例有完整臨床病歷資料的腰椎間盤突出伴馬尾神經(jīng)綜合癥患者;如符合:1)充盈性尿失禁需尿管支持、2)大便失禁、3)勃起功能喪失、4)鞍區(qū)感覺消失中一項(xiàng)以上,為完全性馬尾神經(jīng)綜合癥組,部分喪失以上四項(xiàng)功能,則為不完全性馬尾神經(jīng)綜合癥組;隨訪著重關(guān)注患者術(shù)前及術(shù)后膀胱排空功能、排便功能、性功能及鞍區(qū)感覺改變并作術(shù)前術(shù)后對比。四、研究結(jié)果:35例患者中,完全性馬尾神經(jīng)綜合癥患者平均延遲手術(shù)減壓時(shí)間為4.1±3.9周,不完全性馬尾神經(jīng)綜合癥患者平均延遲減壓時(shí)間為5.5±7.6周;平均隨訪時(shí)間為43.0±28.9個(gè)月(3-110個(gè)月)。23例不完全性馬尾神經(jīng)綜合癥患者,19例完全恢復(fù),4例存在輕微的鞍區(qū)或下肢感覺功能改變。12例完全性馬尾神經(jīng)綜合癥患者,2例患者完全恢復(fù),4例患者存在輕微鞍區(qū)或下肢感覺障礙且其中2例存在偶發(fā)便秘,其余6例患者存在不同程度的鞍區(qū)感覺障礙、排尿及排便功能障礙。6例患者術(shù)前及術(shù)后有完整尿動(dòng)力學(xué)結(jié)果,隨訪尿動(dòng)力學(xué)提示排尿時(shí)腹壓明顯上升,殘余尿量較術(shù)前明顯減少,4例患者初次排尿感覺時(shí)膀胱容量恢復(fù)正常。五、研究結(jié)論:對接受延遲手術(shù)的腰椎間盤突出伴馬尾神經(jīng)綜合癥患者,長期隨訪結(jié)果顯示多數(shù)患者預(yù)后良好,神經(jīng)功能均有不同程度恢復(fù),不完全性組長期隨訪結(jié)局優(yōu)于完全性組;尿動(dòng)力學(xué)提示膀胱排空功能恢復(fù)可能來源于膀胱感覺恢復(fù)引發(fā)排尿時(shí)腹內(nèi)壓代償升高所致。
[Abstract]:Background: lumbar disc herniation with cauda equina syndrome (Cauda equina symdrome caused by Lumbar disc protrusion,CES-LDP) is a rare disease, which is caused by severe compression of cauda equina nerve. At present, early decompression or emergency operation should be advocated to relieve the nerve compression in time, which can prevent the damage of the sustained nerve function and preserve the recovery potential of the nerve function in order to achieve the recovery of the nerve function. However, there are few reports on the recovery of neurologic function and the results of long-term follow-up in patients with delayed surgical decompression (more than the delayed week). In clinical practice, due to economic, medical awareness, community medical awareness of the disease, delayed surgery occurred from time to time. Objective: to investigate the effect of delayed surgical decompression and neurological function recovery in patients with lumbar disc herniation and cauda equina syndrome. Methods: 35 cases of lumbar disc herniation with cauda equina syndrome were retrospectively analyzed. The results were as follows: 1) filling urinary incontinence required urethral support, 2) fecal incontinence, 3) erectile dysfunction, 4) more than one item of sensory disappearance in the Sellar region, belonging to the group of complete cauda equina syndrome, with partial loss of the above four functions. Incomplete cauda equina syndrome group; The follow-up focused on the changes of bladder emptying function, defecation function, sexual function and Sellar region sensation before and after operation. 4. The results showed that the average delayed decompression time was 4.1 鹵3.9 weeks in complete cauda equina syndrome patients and 5.5 鹵7.6 weeks in incomplete cauda equina syndrome patients. The mean follow-up time was 43.0 鹵28.9 months (3-110 months). Of the 23 patients with incomplete cauda equina syndrome, 19 recovered completely. 12 patients with complete cauda equina syndrome, 2 patients with complete cauda equina nerve syndrome, 4 patients with mild Sellar region or lower extremity sensory dysfunction, 2 patients with occasional constipation, 4 patients had slight Sellar region or lower extremity sensory function changes, 2 patients had complete cauda equina syndrome, 4 patients had mild Sellar area or lower limb sensory dysfunction, 2 patients had occasional constipation. The other 6 patients had different degree of Sellar area sensory disorder, urination and defecation dysfunction, 6 cases had complete urodynamic results before and after operation, and follow up showed that abdominal pressure increased obviously during urination. The residual urine volume was significantly lower than that before operation, and the bladder volume returned to normal at the first time of urination in 4 patients. Conclusion: for patients with prolapse of lumbar intervertebral disc and cauda equina syndrome, the long-term follow-up results showed that the prognosis of most patients was good, and the neurological function recovered in varying degrees. The long-term follow-up outcome of incomplete group was better than that of complete group. Urodynamics suggests that the recovery of bladder emptying function may be due to the increase of intra-abdominal pressure during urination induced by bladder sensory recovery.
【學(xué)位授予單位】：南方醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R687.3

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