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观察

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）100IU治疗，用10mL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2mg，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1PSS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。

Observation on the Efficacy of Block in the Bladder by Trebotulinum toxin-A in the Treatment of Female Overactive Bladder

Objective： To investigate the clinical effect of bladder block relieved by botulinum toxin-A on the female overactive bladder. Methods： From Oct 2010 to Oct 2012, 24 female patients with overactive bladder in the Department of Urology, the fourth affiliated of Harbin Medical University were chosen and randomly assigned to trebotulinum toxin-A （Hengli） in their wall of urinary bladder（A group）. 100 IU botulinum toxin-A was diluted in 10ml physiologie saline. The control group（B group） was asked to take orally tartaric acid Tolteroine stator twice everyday, 2 mg every time, lasting more than 6 weeks. It was requested to record patients＇ I-PSS, initial micturition desire bladder capacity, maximum bladder capacity in the pre-therapy and the 1st week, 4th week, 6th week of post-therapy. The data was analyzed with the application of the SPSS12.0 statistic software. Results： Compared with the pre-therapy, the IPPS score of A group was decreased significantly （P〈0.05）, the increment of initial micturition desire bladder capacity（P〈0.05）and maximum bladder capacity （P〈0.05） were both increased markedly atter 1 week treatment, which maintained the equal level in the 2nd weeks and 4th week, no significant difference of residual urine volume was found in the 1 st week, which was significantly decreased in the 4th week （P〈0.05）. In regard to the control group, these 3 indexes showed differences in the 4th week compared with pre-therapy （P〈0.05）, the residual urine volume was significantly decreased in the 1st week（P〈0.05） and maintained the equal level until the 4th week （P〉0.05）. Moreover, The index mentioned above showed significant difference in the 1st week between 2 groups （P〈0.05）, but no significant difference was found in the 4th week between 2 groups （P〉0.05）. Conclusion： The results presented that these were effective methods of botulinum toxin-A （Hengli） in their wall of urinary bladder and oral tartaric acid Tolteroine stator in the treatment of female overactive bladder. Further, it is faster in the method ofbotulinum toxin-A （Hengli） in their wall of urinary bladder. Besides, the method has an advantage of more accurate curative effect due to contact and intuitive features.