膀胱扩张术治疗氯胺酮相关性膀胱挛缩的疗效观察

Cystectasia treatment of ketamine-associated urocystic contracture

目的探讨透明质酸钠平衡液膀胱扩张术治疗氯胺酮相关性膀胱挛缩的方法和疗效。方法 2010年07月至2016年02月6家医院共收治滥用氯胺酮所致膀胱挛缩患者18例,男15例,女3例。患者戒断吸食氯胺酮,灌注0.09%透明质酸钠平衡液扩张膀胱,每周1次共3次,首次灌注2倍于术前膀胱容量的平衡液,随后灌注量每次递增100 ml。记录术前及3次扩张术后3、12个月时患者盆腔疼痛及尿频评分(PUF)、O'Leary-Sant IC症状评分(ICSI)及问题评分(ICPI)、生活质量评分(QOL)和膀胱容量情况。结果 18例患者均完成3次膀胱扩张术,术中无大出血、膀胱破裂等严重并发症。术后2例失访,2例8个月后复吸,14例完成最少12个月随访。该14例患者扩张术前及术后3、12个月时平均PUF分别为(20.4±3.6)、(11.5±3.1)和(13.2±3.3)分;ICSI分别为(13.6±2.8)、(7.7±2.3)和(8.2±2.5)分;ICPI分别为(10.6±2.6)、(7.3±2.1)和(7.7±2.5)分;QOL分别为(6.0±0)、(2.1±0.5)和(2.7±0.8)分;膀胱容量分别为(83±27)ml、(234±56)ml和(228±52)ml,所有指标术后与术前比较差异均有统计学意义(P<0.05)。结论透明质酸钠平衡液膀胱扩张术治疗氯胺酮相关性膀胱挛缩安全有效,手术操作简单,耐受性好。

Objective To study the methods and efficiency of cystectasia in the treatment of ketamine-associated urocystic contracture. Methods Eighteen cases including 15 males and 3 females from 6 hospitals with ketamine-associated urocystic contracture from 2010 July to 2016 February were selected and analyzed. All patients were with drawal from ketamine and treated by weekly cystectasia with 0.09% sodium hyaluronate balance solution 3 times. Two times the preoperative bladder capacity balance solution was instilled in the cystoscope under direct vision for the first time, followed by an increase of 100 ml each time through urinary catheter. The Pelvic Pain and Urgency/Frequency symptom score（PUF）, O＇Leary-Sant IC Symptom Index（ICSI） and IC Problem Index（ICPI）, QOL score and bladder capacity were recorded before the surgery, and during three and twelve months follow-up after the third expansion. Results All 18 patients were treated by cystectasia 3 times without significant complications such as intraoperative bleeding and bladder rupture. Two cases were lost after surgery. Two cases took ketamine again after 8 months. Fourteen cases were followed up at least 12 months. The mean PUF before the surgery, and three and twelve months follow-up after the third expansion were（20.4±3.6）,（11.5±3.1） and（13.2±3.3） respectivly. The mean ICSI were（13.6±2.8）,（7.7±2.3） and（8.2±2.5） respectivly. The mean ICPI were（10.6±2.6）,（7.3±2.1） and（7.7±2.5） respectivly. The mean QOL score were（6.0±0）,（2.1±0.5） and（2.7±0.8） respectivly. The mean bladder capacity were（83±27） ml,（234±56） ml and（228±52） ml respectivly. All postoperative indicators showed significant differences compared to the preoperative indicators. Conclusions Cystectasia with sodium hyaluronate balance solution is an effective way in the treatment of ketamine-associated urocystic contracture and the surgery is easy to perform and well tolerated.