经尿道膀胱铥激光止血联合高压氧治疗放射性出血性膀胱炎的疗效观察  

Clinical effect of transurethral thulium laser coagulation combined with hyperbaric oxygen therapy in the treatment of radiation-induced hemorrhagic cysti

作　　者：许天源 鄢阳[1] 郑景存[2] 耿江[1] 罗明[1] Xu Tianyuan;Yan Yang;Zheng Jingcun;Geng Jiang;Luo Ming(Department of Urology,Tenth People’s Hospital of Tongji University,Shanghai 200072,China;Department of Urology,Shanghai Pudong New Area Gongli Hospital,Shanghai 200135,China)

机构地区：[1]上海同济大学附属第十人民医院泌尿外科,上海200072 [2]上海市浦东新区公利医院泌尿外科,上海200135

出　　处：《中华航海医学与高气压医学杂志》2022年第2期216-220,共5页Chinese Journal of Nautical Medicine and Hyperbaric Medicine

基　　金：国家自然科学基金青年项目(81702507)。

摘　　要：目的评价经尿道膀胱铥激光止血联合高压氧治疗放射性出血性膀胱炎的临床疗效。方法回顾性分析2014年1月至2020年6月10例因肉眼血尿于同济大学附属第十人民医院泌尿外科就诊的放射性膀胱炎患者的临床资料, 其中男性7例、女性3例;年龄47~81岁, 平均69.4岁;初始血红蛋白水平58~123 g/L, 平均91.4 g/L;膀胱过度活动症状评分(OABSS)3~13分, 平均7.8分。所有患者均接受经尿道膀胱铥激光止血联合高压氧治疗, 治疗结束后1、3、6、12个月进行随访, 包括评估肉眼血尿及OABSS评分、检测血红蛋白水平及尿常规镜下红细胞数;6、12个月时分别进行膀胱镜检查, 判定联合治疗效果。结果所有患者均顺利完成治疗, 围手术期未发生3~4级并发症, 高压氧治疗期间亦未见严重气压伤、氧中毒及减压病等并发症。与治疗前相比, 治疗后1、3、6、12个月时的血红蛋白水平均显著升高、OABSS评分显著降低, 其中1、3个月时血红蛋白升高较前次差异有统计学意义(P<0.05), 1个月时OABSS评分较前次下降, 差异有统计学意义(P<0.05)。第12个月时, 膀胱镜检查显示6名患者治愈, 3名患者症状缓解;1名治疗前严重血尿患者肉眼血尿仍反复发作;联合治疗总体有效率90%。结论经尿道膀胱铥激光止血联合高压氧治疗放射性出血性膀胱炎有效率高, 患者肉眼血尿及尿路刺激症状显著改善, 是一种理想的治疗方法。Objective To evaluate the clinical effects of transurethral thulium laser coagulation combined with hyperbaric oxygen(HBO)therapy in the treatment of radiation-induced hemorrhagic cystitis(RIHC).Methods From January 2014 to June 2020,10 patients with gross hematuria were diagnosed as RIHC in the Department of Urology of the Tenth People’s Hospital of Tongji University.Their clinical data were retrospectively analyzed.There were 7 males and 3 females,with an average age of 69.4 yrs(range 47-81).Their mean baseline hemoglobin level was 91.4 g/L(range 58-123)and mean overactive bladder syndrome score(OABSS)was 7.8(range 3-13).All patients received transurethral thulium laser coagulation combined with HBO therapy and were followed up at 1,3,6,and 12 months after treatment.The follow-up examination included gross hematuria evaluation,OABSS,detection of hemoglobin,and the count of microscopic red blood cells.Cystoscopies were also performed at month 6 and 12 to assess the therapeutic effects.Results All patients completed the treatment.No grade 3-4 perioperative complications occurred,and no severe side effects such as severe barotrauma,oxygen poisoning,and decompression sickness were found during HBO therapy.After treatment,the hemoglobin levels at month 1,3,6 and 12 were significantly increased,and the results of OABSS were significantly decreased at all time points.The increases of hemoglobin at month 1 and 3 as well as the decrease of OABSS at month 1 showed statistically significant difference from their former performance,respectively(P<0.05).In the follow-up at month 12,the cystoscopies showed that 6 patients were cured,3 patients got their symptoms relieved,while 1 patient still suffered from gross hematuria repeatedly.The total effective rate of the combined treatment was 90%.Conclusion Transurethral thulium laser coagulation combined with HBO has a high effective rate.It can significantly improve gross hematuria and relieve urinary tract symptoms.Thus it’s an effective treatment method for RIHC.

关 键 词：放射性膀胱炎 血尿 高压氧 铥激光 

分 类 号：R694.3[医药卫生—泌尿科学]