盆底肌筋膜炎的鉴别与治疗

Differentiation of Pelvic Floor Muscle Fasciitis from Interstitial Cystitis and Treatment

目的将盆底肌筋膜炎与间质性膀胱炎（IC）进行鉴别,并探讨有效治疗方案。方法 2014年2月~2016年2月,对28例主诉耻骨上、盆底疼痛,伴或不伴有下尿路症状的患者中,鉴别出IC（n=11）和盆底肌筋膜炎（n=17）,IC组给予麻醉下水扩张及透明质酸钠40 mg膀胱灌注,共6个月;盆底肌筋膜炎组给予深部肌肉刺激（DMS）,2次/d,共30次。治疗前后行盆底疼痛和尿频、尿急症状（PUF）评分。结果 11例IC患者,1例因泌尿系感染终止治疗,9例治疗后PUF评分显著改善（t=10.854,P〈0.001）,1例膀胱镜下无特征性Hunner溃疡及黏膜下出血,给予DMS治疗后,症状缓解。17例盆底肌筋膜炎患者,1例未完成疗程,2例效果不明显,14例治疗有效（t=19.891,P〈0.001）。结论临床应鉴别IC与盆底肌筋膜炎,分别治疗。

Objective To differentiate pelvic floor muscle fasciitis from interstitial cystitis（IC） to study the effective treatment. Methods From February, 2014 to February, 2016, 28 patients of pelvic floor pain, with or without lower urinary tract symptoms, were differentiated in IC and pelvic floor muscle fasciitis. The IC patients（n=11） accepted hydrodistension and bladder perfusion with sodium hyaluronate 40 mg for six months, and the pelvic floor muscle fasciitis patients（n=17） accepted deep muscle stimulation（DMS） twice a day for 30 times. They were observed with pelvic floor pain and symptoms of urinary frequency, urgency score（PUF） before and after treatment. Results For the IC patients, one terminated for urinary tract infection, nine patients improved in PUF socre after treatment（t=10.854, P〈0.001）; the other one without Hunner ulcer and submucosal hemorrhage, relieved after additional DMS. For the pelvic floor muscle fasciitis patients, fourteen cases improved in PUF socre after treatment（t=19.891, P〈0.001）, one did not finish the course of treatment, and two cases was poorly effective. Conclusion It is needed to differentiate pelvic floor muscle fasciitis from IC, which is different in treatment.