肉毒毒素注射尿道外括约肌对逼尿肌-尿道外括约肌失协调患者逼尿肌厚度的影响

The effect of botulinum toxin injection to the external urethral sphincter on detrusor wall thickness in pa- tients with detrusor-sphincter dyssynergia

目的观察肉毒毒素A（BTX-A）注射尿道外括约肌对脊髓损伤后逼尿肌-尿道外括约肌收缩失协调（DSD）患者逼尿肌厚度及膀胱功能的影响。方法选取脊髓损伤后DSD成年患者21例，所有患者均在会阴超声引导下向尿道外括约肌注射BTX-A（100U）。于治疗前、治疗后4周、8周时进行尿动力学检查和下尿道超声评估，测定患者逼尿肌厚度、逼尿肌漏尿点压、残余尿量及最大膀胱容量。结果治疗后4周时人选患者残余尿量显著下降（P〈0．05），而逼尿肌厚度、逼尿肌漏尿点压及最大膀胱容量均无明显改变（P〉0．05）。治疗后8周时入选患者逼尿肌厚度为（0．93±0．17）mm，较治疗前下降了17．2％（P〈0．05）；逼尿肌漏尿点压、残余尿量及最大膀胱容量亦较治疗前明显改善（P〈0．05）。结论在超声引导下向尿道外括约肌注射BTX-A可显著降低脊髓损伤后DSD患者逼尿肌厚度，改善膀胱功能，该疗法值得临床推广、应用。

Objective To evaluate the effect of injecting botulinum toxin A （BTX-A） to the external ure- thral sphincter on detrusor wall thickness （DWT） and the bladder function of spinal cord injury patients with detru- sor-sphincter dyssynergia （ DSD）. Methods Twenty-one adult patients with DSD due to spinal cord injury were re- cruited. A single 100 IU dose of botulinum toxin A was injected into their external urethral sphincters via an ultra- sound-guided transperineal route. DWT, detrusor leak-point pressure （DLPP） , post-void residual volume （PRV） and maximum bladder capacity （MBC） were assessed by urodynamic examination and uhrasound evaluation before and 4 and 8 weeks after the injection. Results Four weeks later a significant decrease in PRV was observed, but no significant difference in DWT, DLPP or MBC. After eight weeks the mean DWT value had decreased by 17%, a sig- nificant reduction. There were also significant improvements in DLPP, PRV and MBC at eight weeks compared with the of baseline values. Conclusions BTX-A injection to the external urethral sphincter can reduce DWT and im- prove bladder function in spinal cord injury patients with DSD.