经皮穿刺腹下交感神经阻滞治疗难治性间质性膀胱炎/膀胱疼痛综合征

Treatment of refractory interstitial cystitis / painful bladder syndrome by percutaneous hypogastric nerve block

目的探讨经皮穿刺腹下交感神经阻滞（HNB）治疗难治性间质性膀胱炎/膀胱疼痛综合征（IC/PBS）的有效性和安全性。方法回顾性分析78例难治性IC/PBS女性患者的临床资料,所有患者均行CT和电刺激检测仪定位穿刺针,准确定位双侧腹下交感神经,注射2%利多卡因20 m L、甲基维生素B120.25 mg、曲安奈德20 mg。该治疗每2周1次,一个疗程3次。比较患者治疗前1周、治疗后1周,及1、3、6、9、12个月的疼痛视觉模拟评分（VAS）、O’Leary-Sant间质性膀胱炎症状指数评分（ICSI）及问题指数评分（ICPI）、24 h排尿次数及平均每次排尿量,并观察治疗期间患者的不良事件。结果 78例患者均完成3次HNB,治疗后1周及1、3、6、9、12个月患者的显效率分别为79.5%、79.5%、67.9%、55.1%、30.8%、16.7%,患者疗效随时间延长而逐渐降低;患者症状缓解维持时间为3~17（8.5±2.8）个月。治疗后患者膀胱区疼痛/酸胀缓解率高于尿频/尿急缓解率。患者治疗后1周及1、3、6、9、12个月的VAS评分、ICSI评分、ICPI评分、24 h排尿次数和平均每次排尿量与治疗前比较差异均有统计学意义（P=0.000 0）。所有患者在治疗期间未发生明显的不良事件。结论经皮穿刺HNB能缓解部分难治性IC/PBS患者的临床症状,且损伤小、不良反应少。

Objective To assess the efficacy and safety of percutaneous hypogastric nerve block（HNB） in treating refractory interstitial cystitis/painful bladder syndrome（IC /PBS）.Methods Clinical data of 78 female patients with refractory IC /PBS were retrospectively analyzed.Puncture needles were guided to both hypogastric sympathetic nerves by CT and electrical stimulation detector.Patients were injected with 20 mL 2%lidocaine,0.25 mg methycobal and 20 mg triamcinolone acetonide.This treatment was performed once per 2 weeks with 3times per course.Mean visual analogue scale（VAS） scores,O’ Leary-Sant interstitial cystitis patient symptom index（ICSI） scores and patient problem index（ICPI） scores,urination frequency in 24 hours and mean urinary output per time 1 week before treatment and 1 week,1,3,6,9 and 12 months after treatment were compared.Adverse events during the treatment were observed.Results All 78 patients completed 3 rounds of HNB.Effective rates 1 week,1,3,6,9 and 12 months after treatment were 79.5%,79.5%,67.9%,55.1%,30.8%and 16.7%,respectively.Efficacy was gradually decreased with time.Maintain time for symptom relief was 3-17（8.5 ±2.8） months.Remission rate of bladder pain or discomfort was higher than that of frequent or urgent urination.The differences in VAS scores,ICSI scores,ICPI scores,urination frequency in 24 hours and mean urinary output per time between before treatment and 1 week,1,3,6,9 and 12 months after treatment were statistically significant（P = 0.000 0）.No significant adverse event was observed during the treatment.Conclusion Percutaneous HNB can alleviate clinical symptoms in some patients with refractory IC /PBS with less injury and adverse reactions.