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目的 探讨A型肉毒毒素膀胱逼尿肌注射术治疗间质性膀胱炎/膀胱疼痛综合征(IC/BPS)的疗效.方法 回顾性分析2003年1月至2015年12月收治的153例女性IC/BPS患者的病例资料.77例行A型肉毒毒素膀胱逼尿肌注射术(A组),年龄(56.0±4.1)岁,治疗前患者疼痛视觉模拟量表评分(VAS)为(9.4±0.9)分,排尿次数为(47.9±11.2)次,OLeary-Saint症状评分(OSS)为(34.3±1.7)分,生活质量评分(QOL)为(5.3±0.6)分;76例行膀胱水扩张及透明质酸钠膀胱腔内灌注治疗(B组),年龄(58.0±3.3)岁,治疗前VAS为(9.2±0.8),排尿次数为(45.8±11.2)次,OSS为(34.7±1.5)分,QOL为(5.4±0.6)分.分别记录两组治疗后1周以及1、3、6、12个月的VAS、排尿日记、OSS、QOL.结果 A组治疗后1周VAS为(2.2±1.9)分、排尿次数为(31.3±8.6)次、OSS为(19.2±6.3)分、QOL为(3.2±0.6)分;治疗后1个月VAS为(4.1±1.8)分、排尿次数为(34.8±9.3)次、OSS为(25.1±4.4)分、QOL为(3.5±0.8)分;治疗后3个月VAS为(8.1±1.2)分、排尿次数为(40.5±10.8)次、OSS为(31.3±2.5)分、QOL为(4.9±0.4)分,与术前比较差异有统计学意义(均P ＜0.05);治疗后6个月的VAS[(8.8±1.1)分]、排尿次数[(45.5±10.7)次]、OSS[(33.3±1.6)分]与术前比较差异有统计学意义(P＜0.05),QOL[(5.2±0.6)分]与术前比较差异无统计学意义(P＞0.05);治疗后12个月VAS[(9.2±0.8)分]、排尿次数[(47.8±11.8)次]、OSS[(34.5±1.4)分]、QOL[(5.4±0.7)分]与术前比较差异无统计学意义(均P＞0.05).A组2例出现急性尿潴留,27例接受重复注射,28例失访.A组重复注射患者治疗后6个月各项指标与术前比较差异有统计学意义(均P ＜0.05),治疗后12个月各项指标与术前比较差异无统计学意义(均P＞0.05).B组治疗后1周VAS为(3.9±1.7)分、排尿次数为(34.3±9.6)次、OSS为(19.4±6.2)分、QOL为(3.6±0.8)分;治疗后1个月VAS为(7.9±1.3)分、排尿次数为(40.5±10.5)次、OSS为(31.4±2.6)分、QOL为(4.7±0.6)分,与术前比较差异有统计学意义(均P＜0.05);治疗后3个月VAS[(9.3±0.9)分]、OSS[(35.1±1.1)分]、QOL[(5.5±0.6)分]与术前比较差异有统计学意义(均P＜0.05),排尿次数[(46.2±12.3)次]与术前比较差异无统计学意义(P＞0.05);治疗后6、12个月的的各项指标与术前比较差异无统计学意义(均P＞0.05).B组3例出现尿道感染,15例治疗后6个月因疗效不佳改行A型肉毒毒素膀胱逼尿肌注射(退出观察组),31例失访.结论 A型肉毒毒素膀胱逼尿肌注射术是治疗IC/BPS的有效方法,单次剂量的平均作用时间是6个月,重复注射是有效的.

Objective To evaluate the efficacy of the intravesical injection of botulinum toxin A (BTX-A) and bladder hydrodistention plus sodium hyaluronate (Cystistat) instillation in patients with interstitial cystitis/bladder pain syndrome (IC/BPS).Methods We retrospectively reviewed 153 women with IC/BPS from January 2003 to December 2015.Of the 153 patients,77 were treated with BTX-A(group A),the average age was (56.0 ± 4.1) years old.76 underwent bladder hydrodistention plus sodium hyaluronate (Cystistat) instillation (group B),the average age was (58.0 ± 3.3) years old.The patients were evaluated using the O'Leafy-Saint score,visual analog scale pain score,urinary frequency record and quality of life questionnaire before treatment and 1 week,1,3,6 and 12 months after treatment.Results In group A,only 2 had acute urinary retention,27 received a repeat injection,and 28 were lost to follow-up.In group B,3 had urinary tract infection,15 switched to BTX-A injection at 6 months because the treatment of hydrodistention plus Cystistat instillation is not good.31 were lost to follow-up.BTX-A was shown to remain effective for up to 6 months after treatment.After repeated Chinese BTX-A injections,symptoms improved significantly.Hydrodistention plus Cystistat remained effective for up to 3 months after treatment.Conclusions Intravesical injection of BTX-A is a effective therapeutic option for patients with IC/BPS.The average duration of the effect of one dose of Chinese BTX-A was 6 months.Repeated injection of BTX-A is effective.