腺性膀胱炎电切术后膀胱灌注无菌透明质酸钠液的疗效观察

Intravesicai instillation of sodium hyaluronate for the treatment of cystitis glandularis after transurethral resection

目的探讨经尿道腺性膀胱炎电切术后应用无菌透明质酸钠液膀胱内灌注的疗效。方法我院2008年6月至2010年1月初发性腺性膀胱炎患者85例，男9例，女76例。年龄37～70岁，平均51岁。行经尿道腺性膀胱炎电切术后随机分为3组：A组28例，男4例，女28例，年龄42～68岁，平均52岁，术后1周膀胱内灌注无菌透明质酸钠液（商品名：西施泰）40mg，每周1次，共4次，其后改为每月1次，共4次；B组27例，男2例，女25例，年龄41～70岁，平均55岁，术后灌注表柔比星50mg，方法同A组；C组30例，男4例，女26例，年龄37～68岁，平均48岁，术后未进行膀胱药物灌注。3组患者随访时间均为12个月，每3个月复查1次膀胱镜，并于第1、3、6、12个月时填写临床症状评分表，对腺性膀胱炎复发率、尿路刺激症状进行分析。结果3组患者12个月内复发情况分别为A组0例（0％），B组6例（22．2％），C组9例（33．0％），A组复发率显著低于B、C两组，差异有统计学意义（P〈0．05）；患者1、3、6、12月时临床症状评分A组为（3．18±1．44）、（1．29±0．65）、（1．25±0．64）、（1．21±0．63）分，B组为（3．37±1．62）、（3．33±1．59）、（1．37±0．74）、（1．30±0．60）分，C组为（3．47±1．81）、（3．40±1．52）、（3．27±1．41）、（3．23±1．19）分。将3组患者临床症状评分进行组内比较，A组于第3个月时评分明显下降（P〈0．05），B组第6个月时评分才明显下降（P〈0．05），C组12个月中评分无明显下降（P〉0．05）。结论无菌透明质酸钠液膀胱内灌注可以明显降低腺性膀胱炎电切术后复发率，改善尿路刺激症状效果明显。

Objective To discuss the efficacy of intravesical instillation of sodium hyaluronate for the treatment of cystitis glandularis after transurethral resection. Methods 85 patients （9 male and 76 female, age range 37 -70 years, mean age 51 ） who were diagnosed as CG in China-Japan Union Hospital of Jilin University underwent transurethral resection. After the operation they were divided into three groups randomly according to different intravescal instillation： sodium hyaluronate for group A, epirubicin for group B and no medicine for group C. The group A started to instill with sodium hyaluronate 40mg once a week for four weeks, and then once a month for four months. The group B did the same way of intravesical instillation of epirubicin. All the patients were followed-up for 12 months. The cystoscopy was done every three months to detect recurrence and the clinical symptom score was evaluated at 1, 3, 6 and 12 months. Results No patients in group A treated by sodium hyaluronate relapsed but 6 cases and 9 cases in group B and group C respectively. Recurrence rate of group A is significant low compared with group B and C （P 〈 0.05 ）. The scores of clinical symptom score appendix after 1, 3, 6 and 12 months for group A were （3.18 ± 1.44）, （1.29±0.66）, （1.25 ±0.65） and （1.21 ±0.63）, respectively. It was （3.37 ±1.62）, （3.33 ± 1.59）, （1.37 ±0.74） and （1.30 ±0.61） for group B, and （3.47±1.81）, （3.40±1.52）, （3.27 ±1.41 ） and {3.23 ± 1. 19） for group C. Compare the score of clinical symptom in the same group, there were significant differences for the score after 3 months compare with the score after 1 month in group A （ P 〈 0.05）. But in group B, the significant differences showed after 6 months （ P 〈 0. 05）. There was no significant difference in group C （P 〉 0. 05） in the whole year. Conclusions Intravesieal sodium hyaluronate therapy can effectively decline the recurrence rate of cystitis glandularis after transurethral resection. It could also significantly improve the urinary tract symptoms.