膀胱不同部位注射A型肉毒素治疗女性难治性膀胱过度活动症的临床研究

Clinical study of botulinum toxin type A injection on different positions of the bladder in female overactive bladder

目的观察膀胱不同部位注射A型肉毒素治疗女性难治性膀胱过度活动症的疗效。方法 40例入选病例,随机分为逼尿肌注射组(A组)、逼尿肌联合三角区注射组(B组),评估患者治疗前及治疗后4周的临床症状(平均每日日间排尿次数、平均每次排尿量、夜尿次数、尿急次数)及尿动力学指标(初始尿意膀胱容量、最大膀胱容量)和OABSS评分、QOL评分情况。结果经过A型肉毒素注射治疗4周后,A组平均每日日间排尿次数、平均每次排尿量、夜尿次数、尿急次数以及OABSS评分,QOL评分、最大膀胱容量均较B组有明显改善(P<0.05)。结论 A型肉毒素膀胱内注射治疗难治性膀胱过度活动症疗效好,无明显毒副作用,是治疗难治性膀胱过度活动的经济、有效的新方法;采用逼尿肌联合三角区部位的注射,症状缓解更为明显,值得进一步的研究及推广。

Objective To observe the different effects caused by different injection sites in bladder,in cases of female overactive bladder cured by botulinum toxin type A injection. Methods Forty cases were divided into 2 groups randomly. Cases of group A accepted botulinum toxin type A injection only on detrusor. Cases of group B accepted botulinum toxin type A injection on detrusor and trigone of urinary bladder. The following parameters were recorded to evaluate the effects 4 weeks later：average daytime u- rination frequency, urination frequency at night, average quantity of each urination, frequency of urgency, gladder capacity at first desire,maxima bladder capacity, OABSS scores and QOL scores. Results After 4-week treatment with botulinum toxin type A,all pa- rameters,average daytime urination frequency, urination frequency at night, average quantity of each urination, frequency of urgen- cy,bladder capacity at first desire,maxima bladder capacity, OABSS scores and QOL scores in cases of group A had a better improvment than those of cases of group B. Conclusion Botulinum toxin type A injection on bladder is a new effective method for female refractory overactive bladder. Injection on detrusor and trigone of urinary bladder is better than injection only on detrusor.