膀胱疼痛和T12–L2输入作为间质性膀胱炎病因之一的综述

A. Dellon, Amin S. Herati
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引用次数: 4

摘要

摘要背景 间质性膀胱炎(IC)/膀胱疼痛综合征(BPS)的病因仍然是个谜。基于两名患者,其IC/BPS通过切除受伤的髂下腹部(IH)和髂腹股沟(II)神经而缓解,第一名患者通过内窥镜前列腺切除术而受伤,第二名患者拉伸/牵引损伤,假设一种参考的疼痛路径可应用于IC/BPS和既往腹壁手术/损伤的患者。方法 对已知的膀胱功能神经生理学以及公认的转诊疼痛综合征的途径进行了综述。后果 膀胱充盈的感知是由膀胱壁中的拉伸受体产生的脉冲产生的,这些脉冲沿着内脏传入纤维在T12、L1和L2进入胸腰椎,与内脏的交感神经流出位置相同,与膀胱的一些内脏传入位置相同。II和IH神经起源于T12、L1,有时来源于L2体细胞背根神经节。据推测,来自下腹壁的躯体传入疼痛冲动被误解为来自膀胱的内脏传入冲动,从而导致IC/BPS的尿频和紧迫性。切除受伤的皮肤传入(II和IH)可使第一名患者的IC/BPS长期缓解59个月,第二名患者可缓解30个月。来自骶骨内脏传入和骶骨躯体传入的神经输入似乎与这一提及的疼痛途径无关。结论 同时进行过腹壁手术/损伤的膀胱疼痛患者的T12-L2脊神经的神经阻滞可以识别IC/BPS患者,对他们来说,切除II和IH神经可能有利于获得持久的IC/BPS缓解。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Review of Bladder Pain and Referred T12–L2 Input as One Etiology for Interstitial Cystitis
Abstract Background The etiology of interstitial cystitis (IC)/bladder pain syndrome (BPS) remains a mystery. Based on two patients, whose IC/BPS was relieved by resection of injured iliohypogastric (IH) and ilioinguinal (II) nerves, injured by endoscopic prostatectomy in the first patient and a stretch/traction injury in the second patient, a referred pain pathway is hypothesized that can be applied to patients with IC/BPS and previous abdominal wall surgery/injury. Methods The known neurophysiology of bladder function was reviewed as were the pathways for accepted referred pain syndromes. Results Perception of bladder filling occurs by impulses generated from stretch receptors in the bladder wall, traveling along visceral afferent fibers that enter the thoracolumbar spinal cord at T12, L1, and L2, the same location as the sympathetic outflow to the viscera and the same location as some of the visceral afferents from the bladder. The II and IH nerves originate from T12, L1, and sometimes L2 somatic, dorsal root ganglia. It is hypothesized that somatic afferent pain impulses, from the lower abdominal wall, are misinterpreted as visceral afferent impulses from the bladder, giving rise to the urinary frequency and urgency of IC/BPS. Resecting injured cutaneous afferents (II and IH) permitted long-term IC/BPS relief in the first patient for 59 months and in the second patient for 30 months. Neural inputs from the sacral visceral afferents and sacral somatic afferents did not appear to be involved in this referred pain pathway. Conclusion Nerve blocks of the T12 -L2 spinal nerves in patients with bladder pain who also have had abdominal wall surgery/injury may identify IC/BPS patients for whom resection of the II and IH nerves may prove beneficial in obtaining lasting IC/BPS relief.
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