CAJ | 학술논문

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<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<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<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。
목적：관찰A형육독독소(BTX-A)뇨도내주사치료실조성배뇨환자적림상효과。방법수집장정의원비뇨외과2011년9월~2013년12월30례경뇨류동역학검사증실존재실조성배뇨경구복파록분무효적환자，수궤분위치료조화대조조，매조각15례。치료조채용200 U BTX-A용해우8 mL생리염수중，뇨도경하향막부뇨도벽삽입뇨도주사도관침분8개주사점，2개평면(상격0.3~0.5 cm)，매점1 mL향뇨도외괄<기내주사BTX-A용액，대조조채용등량생리염수용동양방법뇨도외괄<기주사，량조주사후구복항생소예방감염，비교량조환자치료전후뇨빈증상、최대뇨류솔(Qmax)、최대뇨도폐합압(MUCP)급배뇨개시화최대뇨류솔시괄<기기전도전세비치적상용대수치[TL치，log(T/L)]적변화。대조조재실험결속후여BTX-A뇨도내주사치료。결과치료후1개월진행수방，치료조전，뇨빈증상[(15.00±3.50)차/24 h]、Qmax[(7.00±4.00)mL/s]、MUCP[(60.84±17.33)cm H2O]、TL(-0.15±0.10)여치료후[(8.00±4.50)차/24 h、(18.00±5.00)mL/s、(43.70±11.50)cm H2O、(0.10±0.01)]비교，차이유통계학의의(P<0.05)，대조조치료전후비교각지표차이무통계학의의(P>0.05)。치료후량조각지표비교，차이균유통계학의의(P<0.05)。결론 BTX-A주사가이유효개선실조성배뇨경파록분치료무효환자적배뇨장애，단장기료효급기효시간절점상수진일보적수방관찰。
Objective To evaluate the clinical efficacy of botulinum A toxin (BTX-A)injection into external sphincter in treatment of dysfunctional voiding (DV). Methods From September 2011 to December 2013, in Changzheng Hospital of Second Military Medical University, 30 patients with DV by urodynamic examination confirmed were selected and randomly divided into two groups (treatment group and control group), with 15 cases in each group. The treatment group were given 200 U of BTX-A toxin, the control group were given 8 mL of normal saline, and the solution was injected at 8 different sites (1 mL per site) of the external sphincter via a 5F flexible cystoscopic needle. The urinate frequence, Qmax, MUCP, and TL value were assessed. When this experiment was over, all patients in the control group were given BTX-A treatment for the ethical consideration. Results 1 month after the treatment, compared with before the treatment, the urinate frequence [(8.00±4.50) times/24 h], Qmax [(18.00±5.00) mL/s], MUCP [(43.70±11.50) cm H2O], TL value (0.10±0.01) of patients in treatment group were improved than those before the treatment [(15.00±3.50) times/24 h, (7.00±4.00) mL/s, (60.84±17.33) cm H2O, (-0.15±0.10)], the differences were statistically significant (P< 0.05); whereas the control group had no significant change, the differences were not statistically significant (P>0.05). After the treatment, the indexs of the treatment group were better than those of the control group, the differences were statistically signifi-cant (P < 0.05). Conclusion BTX-A injection into urethral external sphincter can effectively treat DV patients who take Baclofen invalid, but the long-term efficacy and working time still need to be further observed.