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目的观察A型肉毒毒素(BTX-A)尿道内注射治疗失调性排尿患者的临床效果。方法收集长征医院泌尿外科2011年9月~2013年12月30例经尿流动力学检查证实存在失调性排尿经口服巴氯芬无效的患者,随机分为治疗组和对照组,每组各15例。治疗组采用200 U BTX-A溶解于8 mL生理盐水中,尿道镜下向膜部尿道壁插入尿道注射导管针分8个注射点,2个平面(相隔0.3~0.5 cm),每点1 mL向尿道外括约肌内注射BTX-A溶液,对照组采用等量生理盐水用同样方法尿道外括约肌注射,两组注射后口服抗生素预防感染,比较两组患者治疗前后尿频症状、最大尿流率(Qmax)、最大尿道闭合压(MUCP)及排尿开始和最大尿流率时括约肌肌电图电势比值的常用对数值[TL值,log(T/L)]的变化。对照组在实验结束后予BTX-A尿道内注射治疗。结果治疗后1个月进行随访,治疗组前,尿频症状[(15.00±3.50)次/24 h]、Qmax[(7.00±4.00)mL/s]、MUCP[(60.84±17.33)cm H2O]、TL(-0.15±0.10)与治疗后[(8.00±4.50)次/24 h、(18.00±5.00)mL/s、(43.70±11.50)cm H2O、(0.10±0.01)]比较,差异有统计学意义(P<0.05),对照组治疗前后比较各指标差异无统计学意义(P>0.05)。治疗后两组各指标比较,差异均有统计学意义(P<0.05)。结论 BTX-A注射可以有效改善失调性排尿经巴氯芬治疗无效患者的排尿障碍,但长期疗效及起效时间节点尚需进一步的随访观察。
Objective To observe the clinical effect of intrauterine injection of botulinum toxin type A (BTX-A) in patients with dysfunctional urination. Methods Long-term hospital urology collected from September 2011 to December 2013 30 cases of urodynamics confirmed by the presence of dysfunctional urinary bladder inactivation of baclofen patients were randomly divided into treatment group and control group, 15 cases in each group . Treatment group with 200 U BTX-A dissolved in 8 mL of saline, urethral urethral wall into the urethra into the urethra catheterization points eight injection points, two planes (0.3 ~ 0.5 cm apart), each point 1 mL BTX-A solution was injected into the external urethral sphincter, and the control group was injected with the same method of external urethral sphincter with the same amount of saline. Oral antibiotics were given to prevent infection in both groups before and after treatment. Urinary frequency symptoms and maximal urinary flow rate (Qmax ), Maximal urethral closure pressure (MUCP), and the common logarithm of sphincter EMG potential (TL value, log (T / L)] at the start of urination and maximum flow rate. The control group was given BTX-A urethral injection after the experiment. Results The patients were followed up 1 month after treatment. The symptoms of urinary frequency (15.00 ± 3.50) / 24 h, Qmax [(7.00 ± 4.00) mL / s, MUCP [(60.84 ± 17.33) cm H2O] The difference was statistically significant between TL (-0.15 ± 0.10) and [(8.00 ± 4.50) / 24h, (18.00 ± 5.00) mL / s, (43.70 ± 11.50) cm H2O, (0.10 ± 0.01)] after treatment (P <0.05). There was no significant difference between the control group before and after treatment (P> 0.05). After treatment, there were significant differences between the two groups (P <0.05). Conclusion BTX-A injection can effectively improve dysuria in dysfunctional voiding patients treated with baclofen. However, long-term efficacy and time to onset of action need further follow-up.