Reconstruction of reflex pathways to the atonic bladder after conus medullaris injury: Preliminary clinical results
Reconstruction of reflex pathways to the atonic bladder after conus medullaris injury: Preliminary clinical results
复制标题
DOI：
10.1002/micr.20504
复制
发表时间：
2008-01-01
期刊：
影响因子：
2.1
通讯作者：
Wang, Shibo
中科院分区：
文献类型：
--
作者：
Lin, Haodong;Hou, Chun-Lin;Wang, Shibo
脊髓损伤后神经源性膀胱功能障碍是一个重大的医学和社会问题，目前尚无理想的治疗策略。在这项研究中，脊髓神经根切断术在10例脊髓圆锥外伤性损伤的截瘫患者中进行，试图重新支配麻痹的膀胱。在手术中，切断病变上方的功能性T11前根（VR），并通过神经移植物单侧缝合至S2前根。T11背根作为轴突再生后排尿的触发器保持完整。所有患者在术前和随访时均接受尿动力学评价。平均随访时间为2年。10例患者中，7例（70%）在VR显微吻合术后18-24个月内恢复了满意的膀胱控制。在这7名患者中，平均膀胱容量从508 +/- 83（平均值+/- SD）降至370 +/- 59 ml，残余尿从477 +/- 98降至35 +/- 11 ml，未观察到泌尿系感染。肾功能受损的患者完全恢复。3例患者术后无明显改善。这些结果表明，一个恢复过程发生在膀胱神经再支配后，从新的T11 VR连接到膀胱神经。可能受益于这种神经交叉手术的脊髓病变是位于圆锥处的那些病变，由此功能性骶上神经可以连接到骶根以绕过损伤，从而试图恢复与膀胱的中枢连接。(C)2008 Wiley-Liss，Inc.
Neurogenic bladder dysfunction following spinal cord injury is a major medical and social problem for which there is no ideal treatment strategy. In this study, spinal root anastomoses were performed in 10 paraplegic patients with traumatic lesions of the conus medullaris, in an attempt to reinnervate the paralyzed bladder. For the operation, the functional T11 ventral root (VR) above the lesion was transected and anastomosed to the S2 ventral roots unilaterally through a nerve graft. The T11 dorsal root was left intact as the trigger for micturition after axonal regeneration. All patients underwent urodynamic evaluation before surgery and at follow-up. The mean follow-up duration was 2 years. Of the 10 patients, 7 (70%) regained satisfactory bladder control within 18-24 months after VR microanastomosis. In these seven patients, the average bladder capacity decreased from 508 +/- 83 (mean +/- SD) to 370 +/- 59 ml, residual urine decreased from 477 +/- 98 to 35 +/- 11 ml, and urinary infections were not observed. Patients with impaired renal function experienced a full recovery. Three patients failed to show any improvement after the operation. These results suggest that a restitutive process occurs in the bladder following reinnervation from new T11 VR connections to the bladder nerves. Spinal cord lesions that may benefit from such a nerve crossover surgery are those located at the conus, whereby a functional suprasacral nerve can be connected to the sacral roots to bypass the injury in an attempt to restore central connections to the bladder. (C) 2008 Wiley-Liss, Inc.