膀胱扩张术治疗氯胺酮相关性膀胱挛缩的疗效观察

doi:10.3877/cma.j.issn.1674-3253.2018.01.012

中华腔镜泌尿外科杂志(电子版) ›› 2018, Vol. 12 ›› Issue (01) : 43 -46. doi: 10.3877/cma.j.issn.1674-3253.2018.01.012

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临床研究

膀胱扩张术治疗氯胺酮相关性膀胱挛缩的疗效观察

吴忠亮¹, 陈征², 张俊夫², 徐晓龙³, 江东根², 林佳钦⁴, 刘宏⁵, 狄金明², 刘肖瑛⁶^,^†(

)

^1. 437400　湖北，通城县人民医院泌尿外科
^2. 510630　广州，中山大学附属第三医院泌尿外科
^3. 523320　广东，东莞市第三人民医院泌尿外科
^4. 523110　广东，东莞市东华医院泌尿外科
^5. 441900　广东，东莞市长安医院泌尿外科
^6. 523080　广东，东莞康华医院检验科

收稿日期:2017-02-22 出版日期:2018-02-01
通信作者: 刘肖瑛
基金资助:
广州市科技计划项目(201709010038); 国家自然科学基金面上项目(81772752); 广东省科技计划项目(2017A020215122)

Cystectasia treatment of ketamine-associated urocystic contracture

Zhongliang Wu¹, Zheng Chen², Junfu Zhang², Xiaolong Xu³, Donggen Jiang², Jiaqin Lin⁴, Hong Liu⁵, Jinming Di², Xiaoying Liu⁶^,^†()

^1. Department of Urology, Tongcheng People's Hospital, Hubei 437400, China
^2. Department of Urology, the Third Affiliated Hospital of Sun Yet-Sen University, Guangzhou 510630, China
^3. Department of Urology, the Third People's Hospital of Dongguan, Guangdong 523320, China
^4. Department of Urology, Dongguan Donghua Hospital, Guangdong 523110, China
^5. Department of Urology, Chang'an Hospital of Dongguan, Guangdong 441900, China
^6. Department of Clinical Laboratory, Dongguan Kanghua hospital, Guangdong 523080, China

Received:2017-02-22 Published:2018-02-01
Corresponding author: Xiaoying Liu
About author:
Corresponding author: Liu Xiaoying, Email: 76346830@qq.com

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引用本文：

吴忠亮, 陈征, 张俊夫, 徐晓龙, 江东根, 林佳钦, 刘宏, 狄金明, 刘肖瑛. 膀胱扩张术治疗氯胺酮相关性膀胱挛缩的疗效观察[J/OL]. 中华腔镜泌尿外科杂志(电子版), 2018, 12(01): 43-46.

Zhongliang Wu, Zheng Chen, Junfu Zhang, Xiaolong Xu, Donggen Jiang, Jiaqin Lin, Hong Liu, Jinming Di, Xiaoying Liu. Cystectasia treatment of ketamine-associated urocystic contracture[J/OL]. Chinese Journal of Endourology(Electronic Edition), 2018, 12(01): 43-46.

目的

探讨透明质酸钠平衡液膀胱扩张术治疗氯胺酮相关性膀胱挛缩的方法和疗效。

方法

2010年07月至2016年02月6家医院共收治滥用氯胺酮所致膀胱挛缩患者18例，男15例，女3例。患者戒断吸食氯胺酮，灌注0.09%透明质酸钠平衡液扩张膀胱，每周1次共3次，首次灌注2倍于术前膀胱容量的平衡液，随后灌注量每次递增100 ml。记录术前及3次扩张术后3、12个月时患者盆腔疼痛及尿频评分（PUF）、O'Leary-SantIC症状评分（ICSI）及问题评分（ICPI）、生活质量评分（QOL）和膀胱容量情况。

结果

18例患者均完成3次膀胱扩张术，术中无大出血、膀胱破裂等严重并发症。术后2例失访，2例8个月后复吸，14例完成最少12个月随访。该14例患者扩张术前及术后3、12个月时平均PUF分别为（20.4±3.6）、（11.5±3.1）和（13.2±3.3）分；ICSI分别为（13.6±2.8）、（7.7±2.3）和（8.2±2.5）分；ICPI分别为（10.6±2.6）、（7.3±2.1）和（7.7±2.5）分；QOL分别为（6.0±0）、（2.1±0.5）和（2.7±0.8）分；膀胱容量分别为（83±27）ml、（234±56）ml和（228±52）ml，所有指标术后与术前比较差异均有统计学意义（P<0.05）。

结论

透明质酸钠平衡液膀胱扩张术治疗氯胺酮相关性膀胱挛缩安全有效，手术操作简单，耐受性好。

关键词: 氯胺酮, 膀胱挛缩, 膀胱扩张术, 透明质酸钠

Objective

To study the methods and efficiency of cystectasia in the treatment of ketamine-associated urocystic contracture.

Methods

Eighteen cases including 15 males and 3 females from 6 hospitals with ketamine-associated urocystic contracture from 2010 July to 2016 February were selected and analyzed. All patients were with drawal from ketamine and treated by weekly cystectasia with 0.09% sodium hyaluronate balance solution 3 times. Two times the preoperative bladder capacity balance solution was instilled in the cystoscope under direct vision for the first time, followed by an increase of 100 ml each time through urinary catheter. The Pelvic Pain and Urgency/Frequency symptom score (PUF), O'Leary-Sant IC Symptom Index (ICSI) and IC Problem Index (ICPI), QOL score and bladder capacity were recorded before the surgery, and during three and twelve months follow-up after the third expansion.

Results

All 18 patients were treated by cystectasia 3 times without significant complications such as intraoperative bleeding and bladder rupture. Two cases were lost after surgery. Two cases took ketamine again after 8 months. Fourteen cases were followed up at least 12 months. The mean PUF before the surgery, and three and twelve months follow-up after the third expansion were (20.4±3.6), (11.5±3.1) and (13.2±3.3) respectivly. The mean ICSI were (13.6±2.8), (7.7±2.3) and (8.2±2.5) respectivly. The mean ICPI were (10.6±2.6), (7.3±2.1) and (7.7±2.5) respectivly. The mean QOL score were (6.0±0), (2.1±0.5) and (2.7±0.8) respectivly. The mean bladder capacity were (83±27) ml, (234±56) ml and (228±52) ml respectivly. All postoperative indicators showed significant differences compared to the preoperative indicators.

Conclusions

Cystectasia with sodium hyaluronate balance solution is an effective way in the treatment of ketamine-associated urocystic contracture and the surgery is easy to perform and well tolerated.

Key words: Ketamine, Urocystic contracture, Cystectasia, Sodium hyaluronate

图1 术前及3次扩张术后3个月的超声及CT对比图

表1 术前及3次扩张术后3、12个月时相关指标的比较（±s）

指标	例数	PUF评分	ICSI评分	ICPI评分	QOL评分	膀胱容量（ml）
术前	18	20.4±3.6	13.6±2.8	10.6±2.6	6.0±0.0.	83±27
术后3个月	16	11.5±3.1	7.7±2.3	7.3±2.1	2.1±0.5	234±56
术后12个月	14	13.2±3.3	8.2±2.5	7.7±2.5	2.7±0.8	228±52
F值	?	133.18	203.39	70.47	457.49	980.39
P值	?	<0.001	<0.001	<0.001	<0.001	<0.001

表1 术前及3次扩张术后3、12个月时相关指标的比较（±s）

指标	例数	PUF评分	ICSI评分	ICPI评分	QOL评分	膀胱容量（ml）
术前	18	20.4±3.6	13.6±2.8	10.6±2.6	6.0±0.0.	83±27
术后3个月	16	11.5±3.1	7.7±2.3	7.3±2.1	2.1±0.5	234±56
术后12个月	14	13.2±3.3	8.2±2.5	7.7±2.5	2.7±0.8	228±52
F值	?	133.18	203.39	70.47	457.49	980.39
P值	?	<0.001	<0.001	<0.001	<0.001	<0.001

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