经尿道膀胱病灶电灼联合膀胱黏膜下注射A型肉毒毒素治疗女性膀胱过度活动症合并腺性膀胱炎的临床疗效观察

The clinical effect of botulinum toxin A in the treatment of female overactive bladder complicated with cystitis by transurethral resection of bladder lesions

目的 观察膀胱黏膜下注射A型肉毒毒素（botulinum toxin A,BTX-A）治疗女性膀胱过度活动症（overactive bladder,OAB）合并腺性膀胱炎（cystitis glandularis,CG）的效果及安全性.方法 选择本院2013年1月至2014年6月收治的女性OAB合并CG患者40例,采用随机对照原则分为A组（20例）和B组（20例）,A组行经尿道膀胱病灶电灼联合膀胱黏膜下注射BTX-A,其中BTX-A注射剂量为100 U;B组行经尿道膀胱病灶电灼联合口服托特罗定.记录两组治疗14 d后及治疗3个月后24 h平均排尿减少次数、24 h平均尿失禁减少次数及初始尿意时膀胱增加容量、膀胱最大增加容量;观察口干、尿潴留、排尿困难及泌尿系感染等并发症发生情况.结果 治疗14 d后及治疗3个月后A组24 h平均排尿减少次数、24 h平均尿失禁减少次数及初始尿意时膀胱增加容量、膀胱最大增加容量均显著大于B组（P＜0.05）;治疗14d后,A组有4例泌尿系感染患者,B组有3例泌尿系感染,9例口干,5例便秘,3例视物模糊,两组均无尿潴留及排尿困难出现.结论 膀胱黏膜下注射BTX-A为治疗OAB合并CG患者提供了一种新的治疗途径,是一种有效,安全的治疗方法,明显地提高了患者的生活质量,特别对患者的尿急,尿频症状改善尤为显著.

Objectives To observe the efficacy and safety of botulinum toxin A （BTX-A） in the treatment of female overactive bladder （OAB） complicated with cystitis.Methods A total of 40 female patients with OAB with CG in our hospital from January 2013 to June 2014 were collected and randomly divided into group A （n =20） and group B （n =20）.The patients in group A were treated by transurethral resection of bladder lesion fulguration and bladder mucosa injection of BTX-A,and the injection dose of BTX-A was 100 U.Group B underwent transurethral resection of bladder lesions fulguration ＋ oral trottidine.The initial urine bladder increased capacity,maximum increased bladder capacity,24 hours reduction of average number of micturition and urinary incontinence in two groups after 14 days and 3 months of treatment were recoreded,and the occurrence of complications,dry mouth,retention of urine,difficulty urinating and urinary tract infection were observed.Results After 14 days and 3 months of treatment,24 hours reduction of average number of urinary incontinence,initial urine bladder increased capacity and maximum increased bladder capacity in groups A were significantly higher than that of the group B （P ＜0.05）.After 14 days of treatment,4 cases of urinary tract infection patients in group A,3 cases of urinary tract infection,9 cases of dry mouth,5 cases of constipation,3 cases of blurred vision in group B were found,two groups had no urinary retention and dysuria appears.Conclusions Bladder mucous membrane BTX-A for the treatment of OAB with CG patients provides a new therapeutic approach which is an effective,safe treatment method,obviously improves the patients＇ quality of life,especially for the urgency of patients,frequent micturition symptom improvement is particularly significant.