经皮胫神经刺激治疗肛肠良性疾病术后短期排尿功能障碍的临床疗效观察

关键词：经皮胫神经刺激  排尿功能障碍  肛肠手术  并发症

Keywords:percutaneous tibial nerve stimulation  voiding dysfunction  anorectal surgery  complications

摘要：

      摘要 目的：评估经皮胫神经刺激（PTNS）在促进肛肠良性疾病术后短期排尿功能障碍康复作用的疗效。 方法：选取80例因肛肠良性疾病术后出现不同程度排尿功能障碍的患者，按随机分组法分为对照组和PTNS组，各40例。对照组接受常规治疗，PTNS组在常规治疗基础上加用PTNS治疗。治疗结束后，评估两组患者的排尿感觉及功能恢复情况，包括排尿感觉分级、首次排尿时间和尿量。同时，利用VAS评分、生存质量评分（HEMO-FISS-QoL量表）、术后首次排便时间及布里斯托尔粪便分类量表（Bristol stool scale）观察PTNS治疗对术后疼痛、排便情况及康复效果的影响。 结果：PTNS组患者达到排尿感觉分级Ⅲ级及以上的比例为67.5%，显著高于对照组的37.5%（P=0.037）。此外，PTNS组的首次排尿时间（P=0.030）和首次排尿量（P=0.041）均优于对照组，差异具有显著性意义。对照组中有20%的患者需要留置导尿，而PTNS组仅为12.5%。在疼痛评分方面，PTNS组患者显著低于对照组（P=0.024）。两组患者治疗后的生存质量评分均较术前有所提高，但组间比较显示无显著性差异（P=0.106）。与对照组相比，PTNS组患者的住院时间显著更短（P＜0.001）。在术后排便方面，两组的首次排便时间（P=0.214）及布里斯托尔粪便分类法评估的便质（P=0.363）均无显著差异。研究期间及随访1个月内，两组均未报告不良事件。 结论：手术作为混合痔患者的临床治疗方案，术后辅以PTNS治疗，可有效恢复患者术后膀胱功能，减轻术后疼痛，缩短住院时间，且不增加不良事件风险，因此成为传统治疗策略的可行替代方案。

Abstract:

      Abstract Objective： To evaluate the efficacy of percutaneous tibial nerve stimulation （PTNS） in promoting recovery from short-term urinary dysfunction following surgery for benign anorectal diseases. Method： Eighty patients experiencing urinary dysfunction following surgery for benign anorectal diseases were randomly assigned to either a control group or a PTNS group， with 40 patients in each. The control group received standard treatment， whereas the PTNS group received standard treatment plus additional PTNS therapy. The outcomes of interest included urinary sensation grading， time to first urination， and urine volume. Additionally， postoperative pain， bowel function， and overall recovery were evaluated using the visual analogue scale （VAS）， the HEMO-FISS-QoL （a quality of life questionnaire specific to hemorrhoidal disease）， time to first bowel movement， and the Bristol stool scale. Result： The proportion of patients in the PTNS group who achieved an urinary sensation grade of III or higher was 67.5%， significantly higher than the 37.5% observed in the control group （P=0.037）. Furthermore， the PTNS group exhibited statistically significant improvements in the time to first urination （P=0.030） and the volume of first urination （P=0.041） compared to the control group. In the control group， 20% of patients required indwelling catheterization， whereas only 12.5% of patients in the PTNS group required it. Regarding pain scores， patients in the PTNS group reported significantly lower levels of pain compared to those in the control group （P=0.024）. Although both groups experienced improvements in quality of life scores post-treatment compared to pre-surgery， the between-group difference was not statistically significant （P=0.106）. Patients in the PTNS group had significantly shorter hospital stays compared to those in the control group （P<0.001）. In terms of postoperative bowel movements， no significant differences were observed between the two groups in the time to first bowel movement （P=0.214） or stool consistency as assessed by the Bristol stool scale （P=0.363）. No adverse events were reported in either group during the study period or follow-up. Conclusion： Surgery is a standard treatment for patients with mixed hemorrhoids， and when supplemented with postoperative PTNS therapy， it effectively restores bladder function， reduces postoperative pain， shortens hospital stays， and does not increase the risk of adverse events. Thus， it represents a viable alternative to traditional treatment strategies.