放射性膀胱炎出血患者44例治疗体会

目的 探讨放射性膀胱炎出血的治疗方法。方法 放射性膀胱炎出血患者44例。治疗采用分步进行，未愈者进入下一步治疗。第一步：基本治疗，给予妊马雌酮口服5mg／d或静脉滴注1mg／kg及对症治疗。止血后继续口服妊马雌酮1．25mg/d。第二步：高压氧治疗。第三步：经尿道电凝治疗。第四步：膀胱灌注1％福尔马林或开放手术治疗，采用临时性尿流改道术加膀胱填塞绷带或选择性栓塞双侧膀胱动脉。结果 经第一步治疗后，治愈22例，治愈率50％(22／44)；11例缓解；11例无效。第二步治疗，16例治愈，治愈率72．7％(16／22)；4例缓解；2例无效。经前两步治疗后，总治愈率达86．4％(38／44)。第三步治疗，3例治愈，治愈率50％(3／6)；2例缓解；1例无效。经三步治疗后，总治愈率达93．2％(41／44)。未愈3例分别进行介入、膀胱灌注和开放手术治疗，均治愈。经四步治疗后，治愈率达100％。结论 采用妊马雌酮、高压氧疗、经尿道电凝、栓塞双侧膀胱动脉(或膀胱灌注、开放手术)的四步疗法，分步治疗放射性膀胱炎出血，疗效满意。

Treatment of hemorrhagic radiation cystitis in 44 cases

Objective To explore the treatment of hemorrhagic radiation cystitis.Methods 44 patients with hemorrhagic radiation cystitis were treated step by step.The first step was basic therapy(the patients were systematically treated with conjugated estrogen,5mg /d orally or 1 mg/kg intravenously,who were given oral conjugated estrogen 1.25mg/d after bleeding was prevented).The second step was hyperbaric oxygen therapy.The third step was transurethral electric coagulation.The fourth step was intravesical 1% formalin or open cystotomy.Temporary urinary diversion and bladder packing with gauze or percutaneous embolization of both vesical arteries were adopted.Results After the first step,22 cases were cured(50%),11 cases were alleviated and 11 did not respond.Complete response was seen in 16 cases(72.7%),partial response in 4 patients and no response in 2 patients to hyperbaric oxygen therapy of the second step.The total cure rate was 86.4%(38/44) after treatment of the first two steps.Complete response to transurethral electric coagulation of the third step was seen in 3 of 6 cases(50%),2 cases were alleviated and 1 case was of no effect.The total cure rate was 93.2%(41/44) after the treatment of the third step.The left 3 cases were cured by intervention,bladder perfusion and open cystotomy,respectively.The total cure rate was 100% after the fourth step.Conclusion Conjugated Four-step therapy of estrogen,hyperbaric oxygen therapy,transurethral electric coagulation and percuaneous embolization of both vesical arteries(intravesical therapy or open cystotomy) may cure hemorrhagic radiation cystitis,with satisfying effect.