A型肉毒杆菌毒素膀胱注射治疗儿童神经源性膀胱逼尿肌过度活动的效果评价  

Evaluations of botulinum toxin injection into detrusor for neurogenic detrusor overactivity in children

作　　者：刘嘉林 刘颖 汤梁峰 毕允力 沈剑 王安乐 周燕华 万嫣敏 王翔 Liu Jialin;Liu Ying;Tang Liangfeng;Bi Yunli;Shen Jian;Wang Anle;Zhou Yanhua;Wan Yanmin;Wang Xiang(Department of Pediatric Urological Surgery,Children's Hospital of Fudan University,Shanghai 201102,China;Department of Pediatric Urological Surgery,Affiliated Children's Hospital,Soochow University,Suzhou 215002,China)

机构地区：[1]复旦大学附属儿科医院泌尿外科,上海201102 [2]苏州大学附属苏州儿童医院泌尿外科,苏州215002

出　　处：《临床小儿外科杂志》2022年第8期752-757,共6页Journal of Clinical Pediatric Surgery

摘　　要：目的评价经膀胱镜A型肉毒杆菌毒素膀胱注射治疗儿童神经源性膀胱逼尿肌过度活动的临床效果。方法收集2020年4月至2021年6月在复旦大学附属儿科医院行A型肉毒杆菌毒素膀胱注射治疗的神经源性膀胱患儿临床资料,进行自身前后对照分析。患儿在注射治疗前均已接受清洁间歇导尿、持续性预防性抗生素及抗胆碱药物治疗,但效果不理想。分别比较注射前及注射后1个月、3个月、6个月的清洁间歇导尿最大单次导尿量及发热性尿路感染发生率的变化;比较注射前、注射后3个月充盈期膀胱壁厚度以及膀胱最大灌注量、膀胱安全容量、膀胱顺应性变化;观察注射治疗后并发症情况。结果共11例患儿纳入研究,其中男1例,女10例。注射治疗时年龄(80.36±43.35)个月,体重(21.86±7.47)kg。注射前导尿频率为(5.86±1.60)次/天,单次最大导尿量为(152.73±58.10)mL,发热性尿路感染发生率为100%,膀胱壁厚度为(4.41±1.95)mm,尿动力检查膀胱最大灌注量(158.44±57.26)mL,膀胱安全容量(139.78±66.09)mL,膀胱顺应性(4.37±2.16)mL/cmH 2O。注射后1个月、3个月、6个月的导尿频率分别为(6.18±2.31)次/天(P=0.652)、(5.91±2.38)次/天(P=0.948)、(5.68±1.91)次/天(P=0.736)。注射后1个月、3个月、6个月最大单次导尿量分别增加至(206.82±72.05)mL(P=0.004)、(227.28±94.67)mL(P=0.003)、(185.46±75.38)mL(P=0.024)。发热性尿路感染发生率注射后1个月、3个月均为9%(P<0.001),注射后6个月为27%(P=0.001)。注射后3个月膀胱壁厚度(2.75±0.84)mm,较术前显著改善(P=0.004);尿动力检查膀胱最大灌注量(225.44±94.03)mL(P=0.041)、膀胱安全容量(216.11±106.44)mL(P=0.049)、膀胱顺应性(9.43±5.74)mL/cmH 2O(P=0.023),均较术前明显改善。随访周期内11例均未观察到与注射治疗相关的并发症。结论经膀胱镜A型肉毒杆菌毒素膀胱注射对增加神经源性膀胱患儿膀胱功能性容量、降低膀胱压�Objective To evaluate the clinical efficacy of botulinum toxin injection for pediatric neurogenic detrusor overactivity.Methods From April 2020 to June 2021,a retrospective observational self-control study was performed for neurogenic detrusor overactive children receiving an injection of botulinum toxin at Department of Pediatric Urological Surgery of Children's Hospital of Fudan University.All cases received continuous antibiotic prophylaxis with limited effect.Febrile urinary tract infection,maximal voiding volume at Month 1/3/6 post-injection,bladder wall thickness on ultrasound,maximal bladder capacity,safe bladder capacity and bladder urodynamic compliance at Month 3 post-injection were compared before and after injection.Results There were 1 boy and 10 girls with a mean age of(80.36±43.35)months and a mean weight of(21.86±7.47)kg.Prior to injection,mean clean intermittent catheterization frequency was(5.86±1.60)times per day,maximal bladder capacity(152.73±58.10)mL,rate of febrile urinary tract infection 100%and bladder wall thickness(4.41±1.95)mm.In pre-injection urodynamic tests,maximal bladder capacity was(158.44±57.26)mL,safe bladder capacity(139.78±66.09)mL and bladder compliance(4.37±2.16)mL/cmH 2O.After injection,mean clean intermittent catheterization frequency at Month 1 was(6.18±2.31)times per day(P=0.652),Month 3(5.91±2.38)times per day(P=0.948),Month 6(5.68±1.91)times per day(P=0.736),maximal voiding volume at Month 1(206.82±72.05)mL(P=0.004),Month 3(227.28±94.67)mL(P=0.003)and Month 6(227.28±94.67)mL(P=0.024).Febrile urinary tract infection rate at Month 1 was 1(9%)(P<0.001),Month 31(9%)(P<0.001)and Month 63(27%)(P=0.001).There were marked improvements.And at Month 3,bladder wall thickness was(2.75±0.84)mm(P=0.004),maximal bladder capacity(225.44±94.03)mL(P=0.041),safe bladder capacity(216.11±106.44)mL(P=0.049)and bladder compliance(9.43±5.74)mL/cmH 2O(P=0.023).There were marked improvements.No severe side effects were recorded.Conclusion An injection of botulinum toxin has m

关 键 词：膀胱 神经原性/药物疗法 膀胱 神经原性/外科学 肉毒杆菌毒素类 A型 治疗结果 儿童基金项目:复旦大学附属儿科医院专病队列项目(2020ZBDL11)神经源性膀胱专病队列 

分 类 号：R726.9[医药卫生—儿科]