【摘要】：目的分析腰椎間盤突出伴馬尾神經(jīng)綜合征患者接受延遲手術(shù)減壓后神經(jīng)系統(tǒng)及排尿功能恢復(fù)的長期隨訪結(jié)果。方法將35例符合腰椎間盤突出伴馬尾神經(jīng)綜合征患者納入此次隨訪,著重關(guān)注患者術(shù)前及術(shù)后的膀胱排空功能、排便功能、性功能、鞍區(qū)感覺及下肢神經(jīng)功能恢復(fù)情況;6例患者術(shù)前術(shù)后均接受尿動力學檢查。結(jié)果 35例患者中,12例完全性馬尾神經(jīng)綜合征患者平均延遲手術(shù)減壓時間為4.1+3.9周,23例不完全性馬尾神經(jīng)綜合征患者平均延遲減壓時間為5.5+7.6周;所有患者隨訪3~110月(平均43.0+28.9月)。23例不完全性馬尾神經(jīng)綜合征患者中,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)綜合征患者中,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例有完整術(shù)前及術(shù)后尿動力學結(jié)果的患者中,隨訪尿動力學檢查提示排尿時腹壓明顯上升,殘余尿量較術(shù)前明顯減少,其中4例患者初次排尿感覺時膀胱容量恢復(fù)正常。結(jié)論對接受延遲手術(shù)的腰椎間盤突出伴馬尾神經(jīng)綜合征患者,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)。尿動力學檢查提示膀胱排空功能恢復(fù)可能為膀胱感覺恢復(fù)引發(fā)的排尿時腹內(nèi)壓代償升高所致。膀胱功能恢復(fù)的關(guān)鍵策略為促進膀胱逼尿肌收縮功能的恢復(fù)。
[Abstract]:Objective to analyze the long-term follow-up results of patients with lumbar disc herniation and cauda equina syndrome after delayed decompression of nervous system and urination. Methods 35 patients with cauda equina syndrome and lumbar intervertebral disc herniation were included in the follow-up, focusing on the recovery of bladder emptying, defecation, sexual function, sensory and lower extremity nerve function before and after operation. All 6 patients underwent urodynamic examination before and after operation. Results the average delayed decompression time was 4.1 3.9 weeks in 12 patients with complete cauda equina syndrome and 5.5 7.6 weeks in 23 patients with incomplete cauda equina syndrome. All patients were followed up from 3 to 11 months (mean 43.028.9 months). Of the 23 patients with incomplete cauda equina syndrome, 19 were completely recovered, and 4 had slight changes in the sensory function of the Sellar region or lower extremity. In 12 patients with complete cauda equina syndrome, 2 patients recovered completely, 4 patients had mild Sellar area or lower extremity sensory disturbance and 2 patients had occasional constipation, the remaining 6 patients had different degree of Sellar region sensory disorder. In 6 patients with complete preoperative and postoperative urodynamic results, the results of follow-up urodynamic examination showed that abdominal pressure was significantly increased, and residual urine volume was significantly decreased in 6 patients with dysuria and defecation dysfunction. The bladder volume returned to normal in 4 patients at the first time of urination. Conclusion for the 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. Urodynamic examination suggested that the recovery of bladder emptying function might be due to the increase of intra-abdominal pressure during urination induced by bladder sensory recovery. The key strategy of bladder function recovery is to promote the recovery of bladder detrusor contraction function.
【作者單位】： 南方醫(yī)科大學南方醫(yī)院脊柱外科;南方醫(yī)科大學南方醫(yī)院泌尿外科;
【分類號】：R687.3

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