目的 评估逼尿肌A型肉毒毒素(BAT)注射治疗脊髓损伤患者神经原性膀胱的临床效果.方法 78例脊髓损伤患者(男性59例、女性19例)采取BAT(300 U溶于15 ml生理盐水)经尿道膀胱壁注射(分30个点,0.5 ml/点),治疗前后均记录排尿日记,并观察毒副作用.结果 78例患者经第1次治疗后,平均尿失禁次数由13.5次/d降至2.7次/d,平均导尿量由131 ml/次增至389 ml/次,平均尿失禁量由1 690 ml/d降致281 ml/d,起效的平均时间为7.6 d;10例患者在第1次注射8.9个月后接受第2次注射,平均尿失禁次数由9.7次/d降至3.7次/d,平均导尿量由108 ml/次增至387 ml/次;6例患者在第2次注射后5.8个月接受第3次注射,平均尿失禁次数由9.2次/d降至3.9次/d,平均导尿量由116 ml/次增至364 ml/次.随访期间未观察到任何毒副作用.结论 经尿道膀胱壁BAT注射是一种治疗脊髓损伤患者神经原性膀胱的有效、安全、可行、可多次重复应用的微创方法.%Objective To evaluate the effectiveness and safety of Botulinum toxin-A (BTX-A) injection into detrusor to treat neurogenic detrusor overactivity in patients with spinal cord injury (SCI).Methods A total of 78 patients with SCI were treated with transurethral injection of BTX-A (300 IU dissolved in 15 ml of saline) into 30 different points of detrusor with 15 ml in every patients. Urodynamic parameters and voiding diary were assessed at baseline and 3 weeks and 3 months after the injections. Adverse events were recorded after the injection if present.Results After the first injection, 78 patients showed that the mean frequencies of incontinence decreased from 13.5 to 2.7 times per day, the mean volume of intermittent catheterization (IC) increased from 131 ml to 389 ml per time, the mean volume of incontinence decreased from 1 690 ml to 281 ml per day, the mean getting effect time was 7.6 days. 10 patients received second injection at 8.9 months after first injection, the results showed that the mean frequencies of incontinence decreased from 9.7 to 3.7 times per day, the mean IC volume increased from 108 ml to 387 ml. 6 patients received third injection at 5.8 months after second injection, the results showed that the mean frequencies of incontinence decreased from 9.2 to 3.9 times per day, the mean IC volume increased from 116 ml to 364 ml. No side effects were observed during the follow-up.Conclusion BTX-A injection into detrusor to treat neurogenic detrusor overactivity in patients with SCI seems to be an effective, safe and miniinvasive solution.
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