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尿道括约肌内注射A型肉毒毒素治疗脊髓损伤患者逼尿肌_括约肌协同失调的临床观察
2007-07-18   作者:廖利民, 付光,   来源:

【摘要】目的: 观察尿道括约肌内注射A 型肉毒毒素(BTX- A) 治疗脊髓损伤( SCI) 患者逼尿肌- 括约肌协同失调(DSD) 的临床效果。方法: 19 例合并肾积水男性SCI 患者, 年龄26~45 岁, 治疗前1 个月用B 超及影像尿动力学检查测量患者肾盂分离宽度、残余尿量( PRV) 、输尿管返流压( Pdet.reflux) 、逼尿肌漏尿点压(DLPP) 、最大尿道压力( Pura.max) 等指标。对逼尿肌- 外括约肌协同失调(DESD) 的13 例患者, 将200IU BTX- A 溶解于8ml 生理盐水, 在膀胱尿道镜下分点注射于外括约肌内; 对DESD 合并逼尿肌- 膀胱颈协同失调的6 例患者, 将200IU
BTX- A 溶解于12ml 生理盐水, 分点注射于膀胱颈及外括约肌内。1 个月后复查上述检查指标。结果: 1 例治疗无效, 其余患者治疗起效的平均时间为9.5d, 治疗1 个月后, 患者的双肾最大肾盂分离宽度由3.9±1.2cm 降至1.1±0.8cm, PRV 由187±58ml 降至54±18ml, DLPP 由77.6±7.2cmH2O 降至21.6±4.1cmH2O, Pura.max 由88.3±10.5cmH2O降至57.4±3.6cmH2O ( P<0.01) 。疗效持续时间平均3.8 个月, 治疗后1、3 个月时的总有效率分别为94.7%和68.7%。3 例患者接受第2 次注射。随访期间未观察到任何毒副作用。结论: 尿道括约肌内注射BTX- A 可有效减少SCI 后DSD 患者残余尿量、降低DLPP 及尿道压力, 是治疗DSD 有效、微创、安全、可逆、可重复的方法。
【关键词】A 型肉毒毒素; 逼尿肌- 括约肌协同失调; 上尿路功能; 脊髓损伤
中图分类号: R694, R683.2 文献标识码: A 文章编号: 1004- 406X( 2006) - 06- 0409- 04
Botulinum- A toxin injection in ur inary sphincter by endoscope to tr eat detrusor - sphincter dyssynergia in patients with spinal cord injury/LIAO Limin, FU Guang, SHI Wenbo, et al//Chinese Journal of Spine and Spinal Cord, 2006, 16( 6) : 409~412
【Abstract】Objective: To evaluate the effects and feasibilities of Botulinum- A toxin(BTX- A) injection into urinary sphincter endoscopically to treat detrusor- sphincter dyssynergia(DSD) and to retain upper urinary tract function in patients with spinal cord injury( SCI) .Method: Nineteen males with SCI, with the age range of 26~45 years, were included into the study.All patients underwent the B type ultrasound and video- urodynamic examinations to determine the hydronephrosis, post - residual urine volume ( PRV) , detrusor pressure at vesicaureter reflux(VUR) , detrusor leak point pressure(DLPP) and maximum urethral pressure( Pura.max) before and after BTX- A injection.200IU BTX- A was dissolved in 8ml normal saline, and the solution of BTX- A was injected into 8 different points in urinary sphincter using a flexible cystoscopic needle, with each point of 1ml solution.The effects was evaluated and followed up.Result: One month after injection, the hydronephrosis decreased from 3.9±1.2cm to 1.1±0.8cm and PUV did so from 187±58ml to 54±18ml in all patients.DLPP decreased from 77.6 ±7.2cmH2O to 21.6 ±4.1cmH2O and Pura.max did so from 88.3 ±10.5cmH2O to 57.4 ±3.6cmH2O in 9 patients ( P<0.01) .An improvement of PRV was observed at a mean of 9.5 days and sustained for a mean of 3.8 months, 3 patients accepted the reinjection.After treatment, 94.7% of patients displayed urinary functional improvement at 1 month, and 68.7% of patients did so at 3 months.No adverse reactions were
documented during the follow- up.Conclusion: BTX- A injection in urinary sphincter which could effectively decrease PRV, DLPP and urethral pressure is an effective, minimal invasive, safe, reversible, repeatable option for the treatment of DSD as well as the retaining of the upper urinary tract function in patients with SCI.
【Key words】Botulinum- A toxin; Detrusor- sphincter dyssynergia; Upper urinary tract function; Spinal cord injury
【Author's address】Department of Urology, Beijing Boai Hospital, China Rehabilitation Research Center, Beijing,100068, China

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