A型肉毒毒素治疗失调性排尿的临床观察

Clinical observation of Botlinum A toxin in the treatment of dysfunctional voiding

目的观察A型肉毒毒素（BTX—A）尿道内注射治疗失调性排尿患者的临床效果。方法收集长征医院泌尿外科2011年9月～2013年12月30例经尿流动力学检查证实存在失调性排尿经口服巴氯芬无效的患者。随机分为治疗组和对照组，每组各15例。治疗组采用200UBTX—A溶解于8mL生理盐水中，尿道镜下向膜部尿道壁插入尿道注射导管针分8个注射点，2个平面（相隔0．3—0．5cm），每点1mL向尿道外括约肌内注射BTX—A溶液。对照组采用等量生理盐水用同样方法尿道外括约肌注射．两组注射后口服抗生索预防感染，比较两组患者治疗前后尿频症状、最大尿流率（Qmax）、最大尿道闭合压（MUCP）及排尿开始和最大尿流率时括约肌肌电图电势比值的常用对数值[TL值，log（T／L）]的变化。对照组在实验结束后予BTX—A尿道内注射治疗。结果治疗后1个月进行随访，治疗组前，尿频症状[（15．00±3．50）次／24h]、Qmax[（7．00±4．00）mL／s]、MUCP[（60．84±17．33）cmH2O]、TL（-0．15±0．10）与治疗后[（8．00±4．50）次／24h、（18．00±5．00）mL/s、（43．70±11．50）cmH2O、（0．10±0．01）]比较，差异有统计学意义（P〈0．05），对照组治疗前后比较各指标差异无统计学意义（P〉0．05）。治疗后两组各指标比较，差异均有统计学意义（P〈0．05）。结论BTX—A注射可以有效改善失调性排尿经巴氯芬治疗无效患者的排尿障碍，但长期疗效及起效时间节点尚需进一步的随访观察。

Objective To evaluate the clinical efficacy of botulinum A toxin （BTX-A）injection into external sphincter in treatment of dysfunctional voiding （DV）. Methods From September 2011 to December 2013, in Changzheng Hospital of Second Military Medical University, 30 patients with DV by urodynamic examination confirmed were selected and randomly divided into two groups （treatment group and control group）, with 15 cases in each group. The treatment group were given 200 U of BTX-A toxin, the control group were given 8 mL of normal saline, and the solution was injected at 8 different sites （1 mL per site） of the external sphincter via a 5F flexible cystoscopic needle. The urinate frequence, Qmax, MUCP, and TL value were assessed. When this experiment was over, all patients in the control group were given BTX- A treatment for the ethical consideration. Results I month after the treatment, compared with before the treatment, the urinate frequence [（8.00±4.50） times/24 h], Qmax [（18.00±5.00） mL/s], MUCP [（43.70±11.50） cm H20], TL value （0.10± 0.01） of patients in treatment group were improved than those before the treatment [（15.00±3.50）times/24 h, （7.00± 4.00） mL/s, （60.84±17.33） cm H2O, （-0.15±0.10）], the differences were statistically significant （P 〈 0.05）; whereas the control group had no significant change, the differences were not statistically significant （P 〉 0.05）. After the treatment, the indexs of the treatment group were better than those of the control group, the differences were statistically significant （P 〈 0.05）. Conclusion BTX-A injection into urethral external sphincter can effectively treat DV patients who take Baelofen invalid, but the long-term efficacy and working time still need to be further observed.