膀胱水扩张联合灌注透明质酸钠治疗间质性膀胱炎的临床研究

Clinical research of bladder hydrodistention combined with sodium hyaluronate irrigation for treatment of interstitial cystitis

目的:探讨间质性膀胱炎(IC)的临床诊断与治疗方法,评估膀胱水扩张加透明质酸钠灌注治疗IC的临床有效性及安全性。方法:2009年5月~2014年3月采用美国国立糖尿病、消化及肾病协会(NIDDK)制定的标准诊断IC患者60例,均在麻醉下行膀胱镜检查加水扩张术,术后第2~3天用无菌透明质酸钠液40mg/50ml行膀胱灌注,每周灌注1次,疗程12~36周,并且于治疗前和随访6个月时行钾离子敏感实验及膀胱镜检查,观察治疗前后患者盆腔疼痛及尿频评分(PUF)、O'Leary-Sant IC问卷表评分(ICSI/ICPI)、膀胱容量测定和生活质量评分(QOL)的变化。结果:60例患者均完成治疗,随访6~32个月,平均16个月,51例患者症状缓解或消失,PUF评分、ICSI/ICPI评分、膀胱容量、QOL评分明显改善,9例患者效果较差。PUF评分治疗前为(21.18±3.26)分,治疗3个月后降为(10.03±3.60)分,治疗6个月后为(12.17±3.46)分;ICSI治疗前为(12.15±2.08)分,治疗3个月后降为(8.58±2.27)分,治疗6个月后为(8.82±2.52)分。ICPI治疗前为(10.59±2.12)分,治疗3个月后为(7.87±2.56)分,治疗6个月后为(7.95±2.28)分。膀胱容量由(128.32±15.35)ml增加为(296.59±81.20)ml,QOL评分治疗前为(22.71±6.35)分,治疗3个月后升为(43.68±7.62)分,治疗6个月后为(58.25±5.26)分,治疗前后比较差异均有统计学意义(P<0.05)。结论:膀胱水扩张联合灌注透明质酸钠能显著改善IC患者的临床症状,提高生活质量,是一种安全有效的治疗方法。

Objective.. To discuss the clinical diagnosis and treatment of interstitial cystitis （IC） and evaluate the efficacy of bladder hydrodistention combined with sodium hyaluronate irrigation. Method： The data of 60 IC pa- tients （diagnosed by standards of National Institute of Diabetes and Digestive and Kidney Diseases, NIDDK） from May 2009 to March 2014 were retrospectively analyzed. All patients were received cystoscopic hydrodistention un- der anesthesia. Bladder irrigation with sodium hyaluronate 40 mg diluted with 50 ml 2-3 days postoperatively once a week for 12-36 weeks and cystoscopy and potassium sensitivity test were performed before and six months after the treatment. The Pelvic Pain, Urgency and Frequency （PUF）, O＇Leary-Sant IC symptom index and problem, in- dex （ICSI/ICPI）, the maximum bladder capacity and quality of life （QOL） were observed before and after treat- ment. Resuit^No patients withdrawed. All patients were followed up for 6-a2 months （mean, 16 months）, and 51 patients＇ symptom relieved. All evaluating indicators including PUF, ICSI/ICPI, the maximum bladder capacity and QOL improved, but nine patients had poor response to this treatment. The results of evaluating indicators were as follows., the PUF reduced from （21.18±3.26） to （10.03±3.60） after three months of treatment and de- creased to （12.17±3. 46） after six months of therapy O＇Le/ry-Sant ICSI reduced from （12.15±2.08） to （8.58±2.27） after three months of treatment and decreased to （8.82±2.52） aiter six months of therapy ICPI reducedfrom （10. 59±2.12） to （7.87±2.56） after three months of treatment and decreased to （7.95±2.28） after six months of therapy the maximum bladder capacity increased from （128.32 4±15.35） ml to （296.59± 81.20） ml QOL increased from （22. 714±8. 35） to （43.68±7.62） after three months of treatment and increased to （58. 254± 5.26） after six months of therapy. There were significant improvements in all the above parameters comparing be- tween the baseline and three months or six months after the treatment （P〈0.05）. ConelusionzThe treatment of IC with bladder hydrodistention and sodium hyaluronate irrigation is effective and can significantly relieve clinical symptoms and improve quality of life of patients.