摘要
目的 评估逼尿肌A型肉毒毒素注射治疗脊髓损伤患者逼尿肌反射亢进和神经原性尿失禁的临床效果。 方法 损伤平面在骶髓以上的完全性脊髓损伤患者 31例 ,男 2 0例、女 11例 ,平均年龄 30岁。均表现为肾积水、输尿管返流及严重尿失禁。将 30 0UA型肉毒毒素溶解于 15ml生理盐水 ,使用膀胱镜注射针分 30个点注射于三角区以外的膀胱壁 ,0 .5ml/点。治疗前后记录排尿日记、行尿动力学检查 ,并观察毒副作用。 结果 治疗后第 3周 ,31例平均尿失禁次数由 14 .2次 /d降至 2 .5次 /d ,平均导尿量由 12 4ml/次增至 4 95ml/次 ,尿动力学结果表明平均最大膀胱测压容积由 133ml增至 4 75ml、平均充盈末逼尿肌压力由 6 2 .7cmH2 O(1cmH2 O =0 .0 98kPa)降至 17.1cmH2 O。起效平均时间为 6 .8d(3～ 14d) ,6 .5 % (2 /31)患者因治疗后症状无改善改用其它方法 ,12 .9% (4 /31)患者因症状再次加重而接受第 2次肉毒素治疗 ,12 .9% (4 /31)患者因症状改善有限而同时服用托特罗定治疗。随访 1～ 15个月 ,平均 8.5个月。随访期未观察到任何毒副作用。 结论 逼尿肌A型肉毒毒素注射是一种治疗脊髓损伤患者逼尿肌反射亢进和神经原性尿失禁的有效、安全、可行、可重复的微创方法。
Objective To evaluate the effects of Botulinum-A toxin (BTX-A) injection into detrusor to treat detrusor hyperreflexia and neurogenic incontinence in the patients with spinal cord injury (SCI). Methods A total of 31 patients with SCI(mean age,30 years;male 20,female 11) were included into the study.All the patients underwent urodynamic examination and voiding diary was recorded.300 U of BTX-A was dissolved in 15 ml of saline,and the solution of BTX-A was injected into 30 different points in detrusor using a flexible cystoscopic needle.The evaluation for the effects and follow-up included voiding diary,urodynamic testing and observation of adverse and toxic effects. Results After the first injection,29 of the 31 patients had symptom relief within 3 to 14 days;4 cases received the second injection;4 cases were treated in combination with anticholinergic medication;and 2 cases had no improvement and,therefore,received other treatments.The mean follow-up was 8.5 months. After 3-week treatment of BTX-A,the mean frequency of incontinence decreased from 14.2 to 2.5 times per day.The mean volume of intermittent catheterization (IC) increased from 124 to 495 ml each time.Urodynamic data showed that mean cystometric bladder storage volume increased from 133 to 475 ml,mean maximum storage detrusor pressure decreased from 62.7 to 17.1 cmH 2O(1 cmH 2O=0.098 kPa).No adverse and toxic effect was observed. Conclusions Our initial experience suggests that Botulinum-A toxin injection into detrusor to treat detrusor hyperreflexia and neurogenic incontinence in patients with SCI may be an effective,safe,feasible and micro-invasive treatment choice.However,it is necessary to observe its long term outcome.
出处
《中华泌尿外科杂志》
CAS
CSCD
北大核心
2004年第9期596-598,共3页
Chinese Journal of Urology
