逼尿肌注射A型肉毒毒素治疗氯胺酮相关性膀胱炎的疗效及安全性分析

The efficacy and safety of intradetrusor injection of botulinum toxin type A in treatment of ketaminerelated cystitis

目的评估逼尿肌注射A型肉毒毒素治疗氯胺酮相关性膀胱炎的疗效及安全性。方法回顾性分析2010年8月至2015年12月我们收治的行逼尿肌注射A型肉毒毒素治疗的36例氯胺酮相关性膀胱炎患者的临床资料。男31例，女5例。年龄18～39岁，平均25．5岁。首次注射将200U的A型肉毒毒素溶解在15ml的生理盐水中，在膀胱镜下避开膀胱i角区，于膀胱两侧壁、底部、顶部的膀胱逼尿肌内均匀分布共注射30针，每针注射0．5ml（6．67U）。采用3d排尿日记、间质性膀胱炎症状指数（interstitial cystitis symptom index, ICSI）、间质性膀胱炎问题指数（interstitial cystitis problem index, ICPI）和盆腔疼痛及尿频尿急症状评分（pelvic pain and urinary frequency/urgency symptom score, PUF）进行疗效评价，并监测患者出现的并发症。当A型肉毒毒素疗效减低、患者症状恢复至治疗前水平时，重复注射A型肉毒毒素，剂量、方法同首次注射。结果36例氯胺酮相关性膀胱炎患者接受逼尿肌注射A型肉毒毒素治疗，其中16例接受2次治疗，2例接受3次治疗，重复注射治疗的间隔时间为4～18个月，平均12．5个月。随访12～48个月，平均18．5个月，3d排尿日记、ICSI、ICPI和PUF显示患者在首次治疗后4周与治疗前相比疗效显著，第2次、第3次治疗后的效果仍然显著。3例在首次注射治疗后出现泌尿系感染，2例在第2次注射治疗后出现泌尿系感染。15例在首次注射治疗后出现轻度肉眼血尿，7例在第2次注射治疗后出现轻度肉眼血尿，观察1～2d后均陆续好转。所有患者均未出现急性尿潴留等药物不良反应。结论逼尿肌注射A型肉毒毒素治疗氯胺酮相关性膀胱炎是一种安全有效的方法，重复注射治疗仍然安全有效。

Objective To evaluate the efficacy and safety of intradetrusor injection of botulinum toxin type A in the treatment of ketamine-related cystitis. Methods A retrospective analysis of clinical data of 36 ketamine-related cystitis patients with intradetrusor injection of botulinum toxin type A treatment in our hospital during August 2010 to December 2015 was conducted, including 31 males and 5 females with a mean age of 25.5 years. All patients had failed to conventional treatment options including cessation of ketamine, antibiotics, M-blockers. At the time of the first injection, patients were injected with 200 U botulinum toxin type A diluted in 15 ml of 0. 9% saline into the detrusor muscle at 30 sites, sparing the trigone, under cystoscopic guidance. 3-d voiding diary, interstitial cystitis symptom index （ICSI）, interstitial cystitis problem index （ICPI） , pelvic pain and urinary frequency/urgency symptom score （PUF） were recorded to evaluate the efficacy. The treatment-related complications were recorded. When the efficacy of botulinum toxin type A decreased and the patient ~ symptoms returned to baseline before treatment, the patient received repeated injections of botulinum toxin type A with the same dose and method as the first injection. Results Thirty-six patients with ketamine-related cystitis were treated with intradetrusor injection of botulinum toxin type A. Sixteen patients received two injection treatments and two patients received three injection treatments. During the follow-up, 3-d urinary diaries, ICSI, ICPI, and PUF showed a significant improvement in outcome at 4 weeks after the first injection. The efficacy of the second and third injection treatment was also remarkable. Three patients developed urinary tract infection after the first injection, and two patients developed urinary tract infection after the second injection. Mild hematuria occurred in 15 patients after the first injection, and mild hematuria occurred in 7 patients after the second injection, which was improved in 1 to 2 days. All patients did not appear acute urinary retention and other adverse drug reactions. Conclusions Intradetrusor injection of botulinum toxin type A could be a safe and effective method for the treatment of ketamine-related cystitis. Repeated injection therapy is still safe and effective.