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目的:探讨经膀胱镜局部注射肉毒素A治疗逼尿肌反射亢进导致的顽固性急迫性尿失禁的方法、有效性及不良反应。方法:选择2001-07/2005-08在昆明医学院第二附属医院确诊为逼尿肌反射亢进且保守治疗无效的急迫性尿失禁患者12例,患者知情同意,于麻醉下行经尿道逼尿肌内注射肉毒素A,每次剂量300U,分20个点注射。采用以患者为试验对象的自身对照试验方法,观察12例患者手术前及术后2个月的尿失禁频率、平均控尿时间、残余尿量、初尿意膀胱容量及膀胱最大容量,并对观察得到的各项数据进行两组间的配对t检验,同时观察有无肉毒素所致的不良反应发生。结果:12例患者均进入结果分析。①手术前后尿失禁频率平均值、平均控尿时间平均值、初尿意膀胱容量平均值、膀胱最大容量平均值差异有非常显著性眼穴13.83±2.72雪和穴4.17±2.08雪次/d,(0.60±0.22)和(1.42±0.40)h,穴68.75±17.34雪和穴122.50±20.50雪mL,穴102.50±13.57雪和穴207.50±47.12雪mL,P<0.001演。②手术前后残余尿量平均值无差异(P>0.05)。③术后无不良反应发生。结论:膀胱镜引导下逼尿肌内注射肉毒素A可明显改善急迫性尿失禁患者的临床症状,增强控尿能力,并且无不良事件发生,是一种微创、简便、有效而安全的治疗顽固性逼尿肌反射亢进的方法。
Objective: To explore the method, effectiveness and adverse reactions of intravesical injection of botulinum toxin A for refractory urinary incontinence caused by detrusor hyperreflexia. Methods: Twelve cases of urgency incontinence diagnosed as detrusor hyperreflexia and conservative treatment ineffective in the Second Affiliated Hospital of Kunming Medical College from July 2001 to August 2005 were selected. Patients were informed consent and underwent transurethral detrusor Botulinum toxin injection A, each dose 300U, points 20 points injection. Urine incontinence frequency, average urinary incontinence time, residual urine volume, urinary bladder capacity and the maximum bladder capacity of 12 patients before and 2 months after surgery were observed by self-control test with patients as the test object. The data obtained were paired t-test between the two groups, while observing the presence or absence of botulinum toxin-induced adverse reactions. Results: All 12 patients entered the result analysis. ① Before and after surgery, the average urinary incontinence frequency, the mean time of controlling urine, the average urinary bladder capacity, the average maximum urinary bladder capacity were significantly different eye point 13.83 ± 2.72 snow and hole 4.17 ± 2.08 snow times / d, ( 0.60 ± 0.22) and (1.42 ± 0.40) h, 68.75 ± 17.34 snow and hole 122.50 ± 20.50 snow mL, 102.50 ± 13.57 snow and hole 207.50 ± 47.12 snow mL, P <0.001. ② There was no difference in the average residual urine volume before and after surgery (P> 0.05). No postoperative adverse reactions occurred. CONCLUSIONS: Cystoscopy-guided detrusor injection of botulinum toxin A can significantly improve the clinical symptoms and urinary incontinence in patients with urinary incontinence without any adverse events and is a minimally invasive, simple, effective and safe treatment Stubborn detrusor hyperreflexia method.