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目的:探讨A型肉毒素膀胱内阻滞治疗女性膀胱过度活动症的临床效果。方法:选择2010年10月至2012年10月,哈尔滨医科大学附属第四医院泌尿外科收治的女性膀胱过度活动症患者24例,随机分为治疗组和对照组,治疗组(A组)选用国产A型肉毒素(衡力)100 IU治疗,用10 mL生理盐水稀释后,通过膀胱镜进行壁内注射;对照组(B组)患者给予口服经典的抗胆碱制剂,酒石酸托特罗定片,每天口服2次,每次2 mg,疗程不少于6周。于治疗前,治疗后1周和4周观察和比较两组患者的IPSS评分、初尿意膀胱容量、最大膀胱容量。结果:与治疗前比较,A组治疗后1周,IPSS评分显著下降(P<0.05),初尿意膀胱容量及最大膀胱容量显著上升(P<0.05),治疗后第2周和第4周均维持在相当水平,残余尿量第1周未见明显下降(P>0.05),第4周时与基线比较下降明显(P<0.05);B组于治疗后第4周时,以上三项指标与治疗前比较才有统计学差异(P<0.05),残余尿量在第1周即有明显下降(P<0.05),并且第4周时仍维持第1周水平(P>0.05)。此外,治疗后第1周两组比较以上指标比较有统计学差异(P<0.05),而治疗后第4周无明显差异(P>0.05)。结论:经尿道膀胱壁内肉毒素A注射和口服酒石酸托特罗定均是治疗女性膀胱过度活动症的有效方法,但A型肉毒素膀胱内注射起效更快,同时由于其接触性和直观性,疗效更确切。
Objective: To investigate the clinical efficacy of botulinum neurotoxin type A (BUCN) block in the treatment of overactive bladder in women. Methods: From October 2010 to October 2012, 24 patients with overactive bladder who were admitted to Department of Urology, the Fourth Affiliated Hospital of Harbin Medical University were randomly divided into treatment group and control group. The treatment group (group A) Botulinum toxin type A (100 IU) was diluted in 10 mL of saline and intramuscularly injected through the cystoscope. Patients in the control group (Group B) were given oral classic anticholinergic agents, tocotrine tartrate tablets , Oral 2 times a day, each 2 mg, treatment of not less than 6 weeks. Before treatment, 1 week and 4 weeks after treatment, IPSS score, urinary bladder capacity and urinary bladder capacity of the two groups were observed and compared. Results: Compared with those before treatment, the IPSS score decreased significantly (P <0.05) and the bladder capacity and maximal bladder volume increased significantly (P <0.05) in group A at 1 week after treatment. After 2 weeks and 4 weeks after treatment, (P> 0.05). The residual urine volume decreased significantly in the first week (P> 0.05) and decreased significantly compared with the baseline in the fourth week (P <0.05). In the fourth week after treatment, the above three indexes (P <0.05). The residual urine volume decreased significantly at the first week (P <0.05), and remained at the first week after the fourth week (P> 0.05). In addition, there was a significant difference between the two groups in the first week after treatment (P <0.05) and no significant difference in the fourth week after treatment (P> 0.05). Conclusion: Botulinum toxin A injection in the transurethral bladder wall and oral administration of tolterodine tartrate are both effective methods for treating overactive bladder in women. However, intravesical injection of botulinum toxin type A has a faster onset of intravesical injections. Because of its contact and visualization, More effective.