经会阴肉毒素注射治疗脊髓损伤所致逼尿肌外括约肌不协调  

Treatment of detrusor-external sphincter dyssynergia caused by spinal cord injury with transperineal injection of botulin A toxin

作　　者：石晶[1] 周国昌[1] 

机构地区：[1]中国康复研究中心附属博爱医院脊柱脊髓外科,北京100077

出　　处：《中华泌尿外科杂志》2003年第11期769-771,共3页Chinese Journal of Urology

摘　　要：目的　观察经会阴肉毒素注射治疗脊柱脊髓损伤所致逼尿肌外括约肌不协调的疗效。　方法　对 3例颈髓损伤和 3例胸髓损伤合并逼尿肌外括约肌不协调患者行经会阴尿道外括约肌肉毒素注射 ,治疗分两次进行 ,间隔 3d ,每次 5 5U。观察治疗前后剩余尿量 ,并于治疗前和治疗后 1个月行尿动力学检查 ,观察尿道压变化。　结果　 3例患者治疗后剩余尿量较治疗前减少 (133.3±70 .9)ml,尿道压较术前降低 (35 .4± 2 5 .8)cmH2 O(1cmH2 O =0 .0 98kPa) ,P均 <0 .0 5。 2例颈髓损伤者自主神经过度反射消失 ;4例患者排便功能改善。 5例疗效持续 3个月 ,1例疗效持续 15个月。6例均未见药物副作用。　结论　经会阴肉毒素注射治疗脊髓损伤所致逼尿肌外括约肌不协调的疗效可靠。Objective To observe the effect of transperineal injection of botulin A toxin on patients with detrusor-external sphincter dyssynergia caused by spinal cord injury. Methods Transperineal injection of botulin A toxin were performed in 6 patients with spinal cord injury (3 with cervical spinal cord injury and 3 with thoraco-lumbar spinal cord injury) complicated by detrusor-external sphincter dyssynergia.55 U of botulin A toxin was injected twice separately. The interval between 2 injections was 3 days.Before treatment, the residual volume of urine after voiding was determined and the maximum urethral pressure was measured by urodynamic testing.One month after treatment the examination mentioned above was repeated. Results The decrease in residual volume of urine was (133.3±70.9)ml.The decrease in maximum urethral pressure was (35.4±25.8)cmH 2O(both P<0.05).Symptoms of automatic dysreflexia in 2 patients with cervical spinal cord injury disappeared.Defecating function was improved in 4 patients. The therapeutic effect lasted for 3 months,with the longest being 15 months. Conclusions The transperineal injection of botulin A toxin is an effective and reliable therapy for detrusor-external sphincter dyssynergia caused by spinal cord injury.

关 键 词：经会阴肉毒素注射治疗 脊髓损伤 逼尿肌外括约肌不协调 排尿障碍 

分 类 号：R651.2[医药卫生—外科学] R693[医药卫生—临床医学]