逼尿肌及尿道外括约肌A型肉毒毒素注射治疗儿童逼尿肌过度活动并收缩受损的疗效与安全性分析  

Efficacy and safety of detrusor and external urethral sphincter injections of botulinum toxin A in children with detrusor overactivity and impaired contractility

作　　者：左金明 王庆伟[1] 朱文[1] 张钦涌 王钏宇 张国贤[1] 张瑞莉[2] 车英玉[3] 文建国[4] Zuo Jinming;Wang Qingwei;Zhu Wen;Zhang Qinyong;Wang Chuanyu;Zhang Guoxian;Zhang Ruili;Che Yingyu;Wen Jianguo(Department of Urology,First Affiliated Hospital,Zhengzhou University,Zhengzhou 450052,China;Department of Urology&Urodynamic Center,First Affiliated Hospital,Zhengzhou University,Zhengzhou 450052,China;Department of Magnetic Resonance Imaging,First Affiliated Hospital,Zhengzhou University,Zhengzhou 450052,China;Henan Provincial Joint International Pediatric Urodynamic Laboratory,First Affiliated Hospital,Zhengzhou University,Zhengzhou 450052,China)

机构地区：[1]郑州大学第一附属医院泌尿外科,郑州450052 [2]郑州大学第一附属医院泌尿外科尿动力学中心,郑州450052 [3]郑州大学第一附属医院磁共振科,郑州450052 [4]郑州大学第一附属医院泌尿外科,河南省小儿尿动力国际联合实验室,郑州450052

出　　处：《临床小儿外科杂志》2024年第4期348-354,共7页Journal of Clinical Pediatric Surgery

基　　金：国家自然科学基金(U1904208)

摘　　要：目的初步评估逼尿肌及尿道外括约肌A型肉毒毒素(botulinum toxin A,BTX-A)注射治疗儿童逼尿肌过度活动并收缩功能受损(detrusor overactivity and impaired contractility,DOIC)的疗效与安全性。方法本研究为回顾性研究,以2022年5月至2023年6月在郑州大学第一附属医院接受逼尿肌及尿道外括约肌BTX-A注射治疗的25例DOIC患儿为研究对象,男18例、女7例,年龄(11.0±3.8)岁。分别于治疗前及治疗后1个月、6个月收集连续3 d排尿日记及尿失禁生活质量问卷评分表(incontinence specific quality of life,I-QOL)、生活质量评分量表、膀胱过度活动症评分量表(overactive bladder symptom score,OABSS)评分情况,于治疗前和治疗后1个月行影像尿动力学检查,术后6个月行自由尿流率和超声残余尿量测定,并收集治疗后不良事件。结果患儿术前平均每日尿失禁次数和排尿次数分别为(6.9±1.5)次和(10.8±1.7)次,生活质量评分(8.8±0.7)分,OABSS评分(10.5±1.8)分,I-QOL评分(43.6±4.6)分,每次排尿量(127.4±37.9)mL,功能性膀胱容量(functional bladder capacity,FBC)为(160.7±29.4)mL,最大尿流率(maximum flow rate,MFR)为(9.7±3.3)mL/s;导尿患儿每日导尿次数(8.0±0.5)次,残余尿量(postvoid residual,PVR)为(190.6±99.2)mL,膀胱排空效率(32.8±4.9)%。术后1个月和术后6个月随访中,每日尿失禁次数和排尿次数分别减少至(3.5±1.3)次、(4.9±1.4)次和(7.6±1.1)次、(8.5±1.4)次;生活质量评分减少至(5.8±0.9)分、(7.1±0.8)分;OABSS评分减少至(8.5±1.0)分、(9.0±1.3)分;每日导尿次数减少至(6.4±0.7)次、(7.3±0.8)次;PVR减少至(91.3±36.7)mL、(121.9±42.7)mL;I-QOL评分增加至(59.7±5.8)分、(50.1±4.7)分;每次排尿量增加至(164.9±31.1)mL、(146.0±24.5)mL;FBC增加至(198.3±27.5)mL、(176.2±24.3)mL;MFR增加至(13.8±3.1)mL/s、(11.0±2.5)mL/s;膀胱排空效率增加至(62.0±6.4)%、(47.8±6.7)%。术后1个月影像尿动力学随访情况与术前相比,最大膀胱压�Objective To assess the efficacy and safety of detrusor and external urethral sphincter injections of botulinum toxin A in children with detrusor overactivity and impaired contractility(DOIC).Methods From May 2022 to June 2023,a total of 25 DOIC children received injections of botulinum toxin A in detrusor and external urethral sphincter.There were 18 boys and 7 girls with a mean age of(11.0±3.8)year.Three-day voiding diaries,quality of life questionnaires and incontinence-specific quality of life(I-QOL)assessments and overactive bladder symptom score(OABSS)were completed at baseline and Month 1/6.Also video-urodynamic examination at baseline and Month 1 and free uroflowmetry and residual urine measurement at baseline and Month 6 were performed.And the occurrences of adverse events were recorded.Results At baseline,mean urinary incontinence episode and daily voiding frequency were(6.9±1.5)and(10.8±1.7),quality of life questionnaire(8.8±0.7),OABSS(10.5±1.8),I-QOL score(43.6±4.6),mean voiding volume(127.4±37.9)ml,functional bladder capacity(FBC)(160.7±29.4)ml,maximum flow rate(MFR)(9.7±3.3)ml/s,mean daily frequency of catheterization(8.0±0.5),postvoid residual(PVR)(190.6±99.2)ml and bladder emptying efficiency(32.8±4.9)%in children undergoing intermittent catheterization(IC).At Month 1/6 post-injection,mean urinary incontinence episode and daily voiding frequency decreased to(3.5±1.3),(4.9±1.4)and(7.6±1.1),(8.5±1.4);quality of life questionnaire declined to(5.8±0.9),(7.1±0.8);OABSS score dropped to(8.5±1.0),(9.0±1.3);mean daily frequency of catheterization dipped to(6.4±0.7),(7.3±0.8),PVR decreased to(91.3±36.7),(121.9±42.7)ml;I-QOL score jumped to(59.7±5.8),(50.1±4.7);mean voiding volume increased to(164.9±31.1),(146.0±24.5)ml;FBC rose to(198.3±27.5),(176.2±24.3)ml;MFR spiked to(13.8±3.1),(11.0±2.5)ml/s;bladder emptying efficiency increased to(62.0±6.4),(47.8±6.7)%;Furthermore,the results of video-urodynamic examinations were compared between Month 1 and baseline.Maximum cystometr

关 键 词：膀胱 过度活动性 肉毒毒素类 注射 肌肉内 治疗结果 儿童 

分 类 号：R726.9[医药卫生—儿科]