目的 探讨膀胱水扩张联合肝素+利多卡因+碳酸氢钠膀胱灌注治疗间质性膀胱炎/膀胱疼痛综合征患者的安全性及有效性。方法 回顾性分析2014-01至2019-02武警特色医学中心泌尿外科全麻下行膀胱镜下水扩张术25例患者,采用三联药物(注射用低分子肝素钠4万U+2%利多卡因10 ml+5%碳酸氢钠10 ml与生理盐水配成50 ml溶液)膀胱灌注,每周灌注1次,共8次后改为每月1次。对比治疗前后间质性膀胱炎症状评分及间质性膀胱炎问题评分、视觉模拟疼痛评分及排尿日记,并进行疗效评估。结果 在治疗后1、3、6、12个月,症状改善率分别为92%、88%、80%、60%。 O'Leary-Sant症状评分、O'Leary-Sant问题评分、排尿次数、夜尿次数、疼痛评分均有改善,与治疗前比较,差异有统计学意义(P<0.01),最大膀胱容量在治疗后1、3、6个月增加,到第12个月时,最大膀胱容量缩小至治疗前水平,所有患者均未出现毒性反应及不良反应。结论 膀胱水扩张联合肝素、利多卡因、碳酸氢钠膀胱灌注治疗膀胱疼痛综合征及间质性膀胱炎是安全、有效的,能明显减轻患者的临床症状。
Abstract
Objective To investigate the safety and effectiveness of bladder hydrodistention combined with intravesical instillation of three drugs (heparin, lidocaine and sodium bicarbonate) in the treatment of patients with interstitial cystitis/bladder pain syndrome. Methods The clinical data of 25 patients who had undergone bladder hydrodistention under general anesthesia between January 2014 and February 2019 in the Department of Urology was retrospectively analyzed. Intravesical instillation of three-drug combination (low-molecular-weight heparin aodium for injection 40,000 u , 2% lidocaine 10ml, and 5% sodium bicarbonate 10ml ) was administered once per week for 8 weeks, and then once a month. The interstitial cystitis symptom index, interstitial cystitis problem index (O'Leary-Sant problem index), visual analog score for pain, voiding frequency, bladder capacity, and side effects were recorded. Results At 1, 3, 6 and 12 months after treatment, the remission rate was 92%,88%,80% and 60% respectively. The O'Leary-Sant symptom index, O'Leary-Sant problem index, voiding frequency and pain score were improved after treatment(P<0.01). The maximum bladder capacity improved at 1,3 and 6 months, and was reduced to the pretreatment level at 12 months. No significant adverse reactions occurred in any of the patients. Conclusions Bladder hydrodistention combined with intravesical instillation of three drugs for bladder pain syndrome and interstitial cystitis is safe and effective, which can significantly reduce clinical symptoms and improve the quality of life of patients.
关键词
间质性膀胱炎/膀胱疼痛综合征 /
膀胱水扩张 /
膀胱腔内治疗 /
肝素 /
碱化利多卡因
Key words
interstitial cystitis/bladder pain syndrome /
bladder hydrodistention /
intravesical therapy /
heparin /
alkalinized lidocaine
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参考文献
[1] Malde S, Palmisani S, Kaisy A, et al. Guideline of guidelines: bladder pain syndrome[J]. BJU Int,2018,122(5):729-743.
[2] Hanno P M, Erickson D, Moldwin R, et al. Diagnosis and treatment of interstitial cystitis/bladder pain syndrome: AUA guideline amendment[J]. J Urol,2015,193(5):1545-1553.
[3] 俞丽婷,徐哲丰,栾 涛,等. 影像尿动力学检查对女性复杂性下尿路感染的诊断价值[J]. 武警医学,2019,30(12):1072-1074.
[4] Ens G, Garrido G L. Role of cystoscopy and hydrodistention in the diagnosis of interstitial cystitis/bladder pain syndrome[J]. Transl Androl Urol,2015,4(6):624-628.
[5] 方志伟,张晓鹏,胡 浩,等. 四联药物与透明质酸钠膀胱灌注治疗间质性膀胱炎/膀胱疼痛综合征的疗效比较[J]. 中华泌尿外科杂志,2015,36(4):280-284.
[6] Santos T, Miranda I, Nygaard C C, et al. Systematic review of oral therapy for the treatment of symptoms of bladder pain syndrome: the brazilian guidelines[J]. Rev Bras Ginecol Obstet,2018,40(2):96-102.
[7] Ha T, Xu J H. Interstitial cystitis intravesical therapy[J]. Transl Androl Urol,2017,6(Suppl 2):S171-S179.
[8] Wang J, Chen Y, Chen J, et al. Sacral Neuromodulation for refractory bladder pain syndrome/interstitial cystitis: a global systematic review and meta-analysis[J]. Sci Rep,2017,7(1):11031.
[9] Pyo J S, Cho W J. Systematic review and meta-analysis of intravesical hyaluronic acid and hyaluronic acid/chondroitin sulfate instillation for interstitial cystitis/painful bladder syndrome[J].Cell Physiol Biochem,2016,39(4):1618-1625.
[10] Giannantoni A, Gubbiotti M, Bini V. Botulinum neurotoxin a intravesical injections in interstitial cystitis/bladder painful syndrome: a systematic review with meta-analysis[J]. Toxins (Basel),2019,11(9):451.
[11] Marcu I, Campian E C, Tu F F. Interstitial cystitis/bladder pain syndrome[J]. Semin Reprod Med,2018,36(2):123-135.
[12] Mckernan L C, Walsh C G, Reynolds W S, et al. Psychosocial co-morbidities in interstitial cystitis/bladder pain syndrome (ic/bps): a systematic review[J]. Neurourol Urodyn,2018,37(3):926-941.
[13] Walker S J, Plair A, Hemal K, et al. Bladder hydrodistention does not result in a significant change in bladder capacity for interstitial cystitis/bladder pain syndrome patients[J]. Urology,2019,132:81-86.
[14] Tomoe H, Yamashita K. Does repeated hydrodistension with transurethral fulguration for interstitial cystitis with Hunner's lesion cause bladder contraction?[J]. Arab J Urol,2019,17(1):77-81.
[15] Otsuka A, Suzuki T, Aki R, et al. Clinical characteristics of self-reported nocturia in patients with interstitial cystitis, and effects of bladder hydrodistention (with fulguration of Hunner lesions) on nocturia[J]. Low Urin Tract Symptoms,2019,11(2):141-146.
[16] Lee S W, Kim W B, Lee K W, et al. Transurethral resection alone vs resection combined with therapeutic hydrodistention as treatment for ulcerative interstitial cystitis: initial experience with propensity score matching studies[J]. Urology,2017,99:62-68.
[17] 李振华,于秀月,郭金昊,等. 经尿道电灼联合肝素及碱化利多卡因膀胱灌注在间质性膀胱炎治疗中的作用[J]. 中国医科大学学报,2017,46(4):326-329.
[18] Cervigni M. Interstitial cystitis/bladder pain syndrome and glycosaminoglycans replacement therapy[J]. Transl Androl Urol,2015,4(6):638-642.
[19] Parsons C L, Zupkas P, Proctor J, et al. Alkalinized lidocaine and heparin provide immediate relief of pain and urgency in patients with interstitial cystitis[J]. J Sex Med,2012,9(1):207-212.
[20] Parsons C L, Koziol J A, Proctor J G, et al. Heparin and alkalinized lidocaine versus alkalinized lidocaine for treatment of interstitial cystitis symptoms[J]. Can J Urol,2015,22(2):7739-7744.
[21] Nomiya A, Naruse T, Niimi A, et al. On- and post-treatment symptom relief by repeated instillations of heparin and alkalized lidocaine in interstitial cystitis[J]. Int J Urol,2013,20(11):1118-1122.
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