全腹腔镜下回肠膀胱扩大术治疗氯胺酮相关性膀胱炎的疗效

doi:10.3877/cma.j.issn.1674-3253.2026.02.005

目的

通过影像及尿流动力学评估完全腹腔镜下回肠膀胱扩大术治疗挛缩性氯胺酮相关性膀胱炎的疗效。

方法

本研究共纳入13例患者，诊断为挛缩性氯胺酮相关性膀胱炎，年龄20~66岁，氯胺酮滥用年限0.3~10.0年。患者接受手术治疗前均被要求戒断氯胺酮，并且皆为接受保守治疗效果不佳导致症状反复甚至病情加重。对于重度膀胱挛缩（膀胱容量<50 mL）、低顺应性膀胱（<20 mL/cmH₂O）的患者接受回肠膀胱扩大术。

结果

术后患者疼痛视觉模拟评分（VAS）[（5.69±1.93） vs（9.62±2.66）分]、日间排尿次数[（5.00±1.58）vs （14.15±3.05）次]、夜尿次数[（3.85±1.52）vs（6.69±1.84）次]、膀胱容量[（241.92±29.41）vs（39.62±8.60）mL]、最大尿流率[（15.85±1.68）vs（11.39±2.43）mL/s]、膀胱顺应性[（33.92±7.81）vs（23.15±7.82）mL/cmH₂O]、储尿期最大逼尿肌压力[（21.77±3.14）vs（30.31±6.81）cmH₂O]明显改善（P均<0.001）。所有患者术后膀胱疼痛得到有效的缓解，10例术前肌酐水平升高的患者中5例术后恢复正常。

结论

完全腹腔镜下回肠膀胱扩大术能够有效改善挛缩性氯胺酮相关性膀胱炎导致的下尿路症状和膀胱储尿功能，进一步保护肾功能。

关键词: 氯胺酮相关性膀胱炎, 膀胱挛缩, 完全腹腔镜, 回肠膀胱扩大术

Objective

To explore the effect of total laparoscopic ileum augmentation cystoplasty in the treatment of contracted ketamine-related cystitis evaluated by imaging and urodynamics.

Methods

A total of 13 patients with contracted ketamine-related cystitis were included in this study. The age was 20-66 years. Duration of ketamine abuse ranged from 0.3 to 10.0 years. The patients were required to abstain from ketamine prior to treatment, and their symptoms were repeated or even worsened due to poor response to initial conservative treatment. Patients with severe bladder contracture (bladder volume <50 mL) and low compliance of bladder (<20 mL/cmH₂O) underwent total laparoscopic ileum augmentation cystoplasty.

Results

After operations, the VAS score [(5.69±1.93)vs (9.62±2.66) ], the number of daytime urinations [(5.00±1.58) vs (14.15±3.05)], nocturnal urinations [(3.85±1.52) vs (6.69±1.84)], bladder capacity [(241.92±29.41) vs (39.62±8.60) mL], maximum urine flow rate [(15.85±1.68) vs (11.39±2.43) mL/s], bladder compliance[(33.92±7.81) vs (23.15±7.82) mL/cmH₂O], and maximum detrusor pressure during the filling phase [(21.77±3.14) vs (30.31±6.81) cmH₂O] were significantly improved (all P<0.001). All patients experienced effective relief of bladder pain after operations, and 5 out of 10 patients with elevated creatinine levels before the operation had their creatinine levels return to normal after the operation.

Conclusion

Total laparoscopic ileum augmentation cystoplasty can effectively improve the lower urinary tract symptoms and urinary bladder storage function caused by contracted ketamine related cystitis, and further protect renal function.

Key words: Ketamine-related cystitis, Bladder contracture, Total laparoscopic, Ileum augmentation cystoplasty

图1 氯胺酮相关性膀胱炎患者术前膀胱造影注：膀胱壁不光滑，膀胱重度挛缩（图a和b分别为腹部正位片和侧位片）

图2 氯胺酮相关性膀胱炎患者回肠代膀胱扩大术后6个月膀胱造影注：膀胱形态不规则，边缘不光滑，膀胱容量增多（图a和b分别为腹部正位片和侧位片）

表1 氯胺酮相关性膀胱炎患者术前及术后6个月临床特征和尿流动力学参数比较

组别	例数	日间排尿次数(±s)	夜尿次数(±s)	上尿路积水[例(%)]	膀胱壁厚度[mm，(±s)]	膀胱容量[mL，(±s)]	最大尿流率[mL/s，(±s)]
手术前	13	14.15±3.05	6.69±1.84	11（84.62）	9.23±2.05	39.62±8.60	11.39±2.43
术后第6个月	13	5.00±1.58	3.85±1.52	5（38.46）	8.08±1.44	241.92±29.41	15.85±1.68
统计值		t=11.540	t=3.933	-	t=2.044	t=-28.085	t=-6.036
P值		<0.001	<0.001	<0.001	0.063	<0.001	<0.001
组别	膀胱顺应性[mL/cmH₂O，(±s)]	储尿期最大逼尿肌压力[cmH₂O，(±s)]	残余尿量[mL，M(Q)]	泌尿系感染[例(%)]	肝功能异常[例(%)]	肾功能异常[例(%)]	VAS评分[分，(±s)]
手术前	23.15±7.82	30.31±6.81	6.0（0，9.5）	13（100）	7（53.85）	10（76.92）	9.62±2.66
术后第6个月	33.92±7.81	21.77±3.14	5.0（0，8.5）	3（23.08）	6（46.15）	5（38.46）	5.69±1.93
统计值	t=-3.513	t=4.671	Z=-1.021	-	-	-	t=4.977
P值	<0.001	<0.001	0.308	<0.001	>0.999	<0.001	<0.001

表1 氯胺酮相关性膀胱炎患者术前及术后6个月临床特征和尿流动力学参数比较

组别	例数	日间排尿次数(±s)	夜尿次数(±s)	上尿路积水[例(%)]	膀胱壁厚度[mm，(±s)]	膀胱容量[mL，(±s)]	最大尿流率[mL/s，(±s)]
手术前	13	14.15±3.05	6.69±1.84	11（84.62）	9.23±2.05	39.62±8.60	11.39±2.43
术后第6个月	13	5.00±1.58	3.85±1.52	5（38.46）	8.08±1.44	241.92±29.41	15.85±1.68
统计值		t=11.540	t=3.933	-	t=2.044	t=-28.085	t=-6.036
P值		<0.001	<0.001	<0.001	0.063	<0.001	<0.001
组别	膀胱顺应性[mL/cmH₂O，(±s)]	储尿期最大逼尿肌压力[cmH₂O，(±s)]	残余尿量[mL，M(Q)]	泌尿系感染[例(%)]	肝功能异常[例(%)]	肾功能异常[例(%)]	VAS评分[分，(±s)]
手术前	23.15±7.82	30.31±6.81	6.0（0，9.5）	13（100）	7（53.85）	10（76.92）	9.62±2.66
术后第6个月	33.92±7.81	21.77±3.14	5.0（0，8.5）	3（23.08）	6（46.15）	5（38.46）	5.69±1.93
统计值	t=-3.513	t=4.671	Z=-1.021	-	-	-	t=4.977
P值	<0.001	<0.001	0.308	<0.001	>0.999	<0.001	<0.001

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Effect of total laparoscopic ileum augmentation cystoplasty in the treatment of contracted ketamine-related cystitis

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Effect of total laparoscopic ileum augmentation cystoplasty in the treatment of contracted ketamine-related cystitis