A型肉毒毒素膀胱三角区黏膜下注射治疗氯胺酮相关性膀胱炎的临床观察

目的探讨A型肉毒毒素(BTX-A)联合碱化利多卡因膀胱灌注+水压扩张治疗氯胺酮相关性膀胱炎的疗效。方法将33例氯胺酮相关性膀胱炎患者按治疗方式分为2组:A组15例,采用碱化利多卡因膀胱灌注+水压扩张;B组18例,在同A组治疗的基础上,加用膀胱三角区黏膜下注射BTX-A治疗。评估患者治疗前及治疗后1周、1个月、3个月的临床症状改善情况(每日排尿次数、最大排尿量、OLeary-Sant间质性膀胱炎症状评分ICSI及ICPI评分作为疗效评判标准),并记录不良反应的发生情况。结果 B组在治疗后1周、1个月、3个月症状较A组明显改善;各时间点每日排尿次数、最大排尿量、ICSI评分及CIPI评分与A组相比均有显著差异(P0.05)。两组均未出现严重不良反应。结论 BTX-A联合碱化利多卡因水压扩张治疗氯胺酮相关性膀胱炎,是一种安全有效的治疗方法,且无严重并发症。     

Comparison of intravesical botulinum toxin type A injections plus hydrodistention with hydrodistention alone for the treatment of refractory interstitial cystitis/painful bladder syndrome

OBJECTIVE

To compare the clinical effectiveness of botulinum toxin type A (BoNT‐A) injections followed by hydrodistention (HD) with HD alone in patients with interstitial cystitis/painful bladder syndrome (IC/PBS).

PATIENTS AND METHODS

A prospective, randomized study was performed in a urological referral centre. In all, 67 patients with IC/PBS who had failed conventional treatments were enrolled. Of these, 44 patients received suburothelial injection with 200 U (15) or 100 U (29) of BoNT‐A followed by cystoscopic HD 2 weeks later (BoNT‐A groups). The control group (23 patients) received the identical HD procedure with no BoNT‐A injection. All patients remained on baseline medications of pentosan polysulphate throughout the study. Bladder pain visual analogue scale (VAS), O’Leary‐Sant symptom and problem indexes, functional bladder capacity (FBC) and urodynamic variables were measured at baseline and after treatment. Global response assessment was used to evaluate successful treatment response.

RESULTS

The IC/PBS symptom score significantly decreased in all three groups, but VAS reduction, FBC and cystometric bladder capacity increases were significant only in the BoNT‐A groups at 3 months. Of the 44 patients in the BoNT‐A group 31 (71%) had a successful result at 6 months. A successful result at 12 and 24 months was reported in 24 (55%) and 13 (30%) patients in BoNT‐A group, respectively, compared with only six (26%) and four (17%) in the control group (P = 0.002).

CONCLUSION

Intravesical injections of BoNT‐A followed by HD produced significantly better clinical results than HD alone in patients with IC/PBS.     

A型肉毒毒素注射小腿塑形的临床应用探讨

目的：探讨A型肉毒毒素注射小腿塑形的效果。方法：选取11名小腿肌性肥大求美者,双侧小腿注射A型肉毒毒素300～400U,测量术前和术后3个月小腿最大周径。结果：术后3个月小腿最大周径缩小1.62±0.88cm,缩小比例为4.65%±2.42%,术前术后差异有统计学意义（P〈0.01）。结论：A型肉毒毒素能有效地减少小腿周径,小腿塑形效果满意。     

Management of salivary fistula with botulinum toxin type A

A case of postparotidectomy fistula in a 54‐year‐old man treated with a local injection of botulinum toxin type A is described. This case demonstrates a successful outcome with this new form of treatment. Other alternatives are also discussed. Botulinum toxin injection is a safe, effective and non‐invasive method of treatment and should become popular in the future.     

应用A型肉毒素治疗眼睑痉挛

目的：讨论应用A型肉毒素治疗眼睑痉挛的疗法。方法：对30例眼睑痉挛患者用BTXA进行局部眼睑下注射前均行眼部常规检查和确定痉挛强度，按治疗标准进行评估。结果：3天后症状完全缓解20例(66．67％)，6例明显缓解(20％)，4例部分缓解(13．33％)，10天后3例患者治疗效果不理想，再次重复注射，完全缓解，效果达100％。所有患者治疗期间未出现并发症。结论：BTXA局部注射是治疗眼睑痉挛的一种安全、有效、简便的方法，可以推广。     

吸脂术联合A型肉毒毒素注射塑形小腿

目的探讨一种效果较好的小腿塑形方法。方法在行小腿塑形时，首先采用负压吸脂技术。吸脂术后缝合切口，然后将A型肉毒毒素均匀地注射于腓肠肌内，每侧小腿注射10个点50U。术后适当加压包扎。抬高患肢。结果本组26例求美者，术后经6个月至1年的随访，双侧小腿的表面平整，无明显凹凸不平，曲线均匀对称。皮肤色泽与质地良好，行走及其他功能均正常。结论吸脂术联合A型肉毒毒素注射行小腿塑形，具有操作简单。创伤较轻，恢复较快，安全有效，效果稳定等特点，值得在临床上推广应用。     

A型肉毒毒素注射治疗难治性前列腺增生症病例的临床研究

目的：通过对经尿道镜于尿道外括约肌和前列腺内注射A型肉毒毒素（BTX—A）治疗难治性BPH病例的临床疗效的观察,寻求此类病例的最佳治疗方法。方法：具有手术指征但存在手术禁忌证且药物治疗无效的BPH病例35例,经尿道镜于尿道外括约肌、前列腺多点注射BTX—A进行治疗。对治疗前后患者症状及各项尿动力参数变化进行观察比较。结果：35例患者经尿道前列腺及尿道外括约肌注射A型肉毒毒素后5～l3d治疗效果开始显现,平均7．2d。术后随访3～8个月,随访期未发生毒副作用。4例患者治疗后效果减退,准备行第2次注射。结论：BTX—A经尿道镜注射于前列腺治疗具有手术指征但存在手术禁忌证且药物治疗无效的BPH病例。操作简单,治疗效果确切,无毒副作用。     

吸脂术联合A型肉毒毒素注射塑形小腿

目的探讨一种效果较好的小腿塑形方法。方法在行小腿塑形时,首先采用负压吸脂技术,吸脂术后缝合切口,然后将A型肉毒毒素均匀地注射于腓肠肌内,每侧小腿注射10个点50U。术后适当加压包扎,抬高患肢。结果本组26例求美者,术后经6个月至1年的随访,双侧小腿的表面平整,无明显凹凸不平,曲线均匀对称,皮肤色泽与质地良好,行走及其他功能均正常。结论吸脂术联合A型肉毒毒素注射行小腿塑形,具有操作简单,创伤较轻,恢复较快,安全有效,效果稳定等特点,值得在临床上推广应用。     

小切口颏成形联合A型肉毒毒素一针多点咬肌注射面部轮廓塑形

目的:分析咬肌肥厚伴有颏部短小者采用小切口颏成形联合A型肉毒毒素一针多点咬肌注射面部轮廓塑形的效果。方法:本组20例均为女性,年龄18～42岁,平均年龄38岁,均为咬肌肥厚伴下颌短小,按受术者要求雕刻隆颏假体,在下唇距唇龈沟0.5cm口腔粘膜面,尖牙和第一前磨牙之间对应位置设计长约1cm两纵切口,分离并放入假体。在咬肌中心点进针注射0.2ml,然后把针头退至皮下,再向周围各点进针至咬肌内注射0.1ml。平均每侧注射剂量为50U。如两侧咬肌不对称可适当调整注射剂量。结果:本组共20例均为咬肌肥厚伴有颏部短小,经小切口颏成形联合A型肉毒毒素一针多点咬肌注射面部轮廓塑形,经6个月以上随访,均获得满意效果,无并发症。结论:小切口颏成形联合A型肉毒毒素一针多点咬肌注射面部轮廓塑形是一种创伤小、操作简单、并发症少,较适合于咬肌肥大伴下颌短小的患者。     

肌注肉毒毒素A和糖皮质激素治疗咬肌肥大

目的:探讨良性咬肌肥大的非手术治疗方法。方法:每侧咬肌内注射肉毒毒素A约50U和曲安奈德约20mg,注射时使药物均匀分布于咬肌内,避免将曲安奈德注射到皮下组织内以免引起皮下脂肪萎缩凹陷。结果:应用本方法治疗11例,其中单纯咬肌肥大者6例,辅助下颌骨截骨手术治疗咬肌肥大5例,注射治疗后2周即可见咬肌区明显萎缩,8～12周效果稳定,经3～8个月随访未见复发,咬合功能正常,无并发症发生。结论:联合应用肉毒毒素A和曲安奈德肌内注射治疗咬肌肥大,起效快,疗效显著,是非手术治疗咬肌肥大的良好选择。     

Comparison of surgical vs chemical sphincterotomy using botulinum toxin for the treatment of chronic anal fissure: a meta-analysis

Objective  To analyse systematically prospective randomized controlled trials dealing with the effectiveness of surgical sphincterotomy (SS) vs chemical sphincterotomy (CS) using botulinum toxin for the management of chronic anal fissure (CAF).
Method  A systematic review of the literature was undertaken. Prospective randomized controlled trials on the effectiveness of SS vs CS using botulinum toxin were selected and analysed to generate the summative outcome.
Results  Four prospective randomized controlled trials dealing with SS vs CS using botulinum injection, which included 279 CAF patients, were analysed. Based on the random effects model, there was a higher complication rate [Risk ratio (RR) 14.54 (−9.84, −38.9) 95% CI, df = 2, P  < 0.0163] and a higher risk of transient faecal incontinence [RR 6.39 (−2.37, −15.1) 95% CI, df = 3, P  < 0.0001] in the SS group than in the CS group. However, there was significant heterogeneity among the trials ( Q  = 8 408 891, P  < 0.0001), indicating a wide confidence interval range; thus, the inferiority of SS could not be shown. SS had a significantly higher healing rate [RR 1.63, (1.34–1.91) 95% CI, df = 3, P  < 0.0110] and a significantly lower recurrence rate [RR 0.35 (0.33–0.38) 95% CI, df = 3, P  < 0.0221] than CS.
Conclusion  Both CS and SS are comparable in the management of CAF. There are no differences in the complication rates and incontinence rates between the two procedures. SS has a higher healing rate and a lower recurrence rate than CS. As long as the patient is willing to accept a negligible risk of transient faecal incontinence, SS should be the first-line treatment for CAF.     

局部注射少量A型肉毒毒素治疗上半面部皱纹的临床研究

目的：观察局部注射少量A型肉毒毒素（BTXA）去除上半面部皱纹的临床疗效。方法：应用A型肉毒毒素的198例患者,其中眉间纹65例,鱼尾纹80例,额纹20例,鼻背部皱纹33例。所有患者行局部多点注射A型肉毒毒素,浓度为4U/0.1ml,并根据不同的患者调整剂量和浓度。记录患者疗效、维持时间与不良反应。结果：A型肉毒毒素治疗面部上三分之一皱纹有效率为100%,显效率94.4%。肌肉麻痹的效果通常持续3～6个月不等,不良反应主要为4例上睑下垂,3例局部水肿和4例青紫,各占2.0%、1.5%和2.0%。上述症状于3～10内自行完全消失。结论：A型肉毒毒素局部注射治疗面部上三分之一皱纹起效迅速、无创伤、简便易行。     

Cost-effectiveness analysis of sacral neuromodulation and botulinum toxin A treatment for patients with idiopathic overactive bladder

Study Type – Therapy (economic analysis) Level of Evidence 1b

OBJECTIVE

To assess and compare the costs and effects value of either starting with sacral neuromodulation (SNM) or botulinum toxin A (BTX) treatment in patients with refractory idiopathic overactive bladder from a societal perspective.

MATERIALS AND METHODS

An economic model comparing SNM with BTX was developed. A clinical relevant effect (i.e. success) was defined as 50% or greater reduction in incontinence episodes or urgency frequency symptoms. Information on the clinical effectiveness of the two treatments and on the course of the disease with the two treatments were based primarily on published literature and, when required, on expert opinion. Both treatments were assumed to be performed under general anaesthesia and, for SNM treatment, first‐stage tined lead test was used. All costs were based on national data from the year 2008. Analyses from the societal perspective were conducted for a 5‐year duration. Costs were discounted at 4% and effects at 1.5%. In addition, different modelling scenarios were used to see determine any changes in the results obtained.

RESULTS

Starting with SNM resulted in a higher quality adjusted life year (QALY) gain (differenceof 0.23) and a higher cost (difference of €6428) compared to starting with BTX. The corresponding incremental cost‐effectiveness ratio was €27 991/QALY. The probability of this ratio being cost effective (e.g. under €40 000/QALY) is 88%. SNM starts to be cost‐effective after 4 years. SNM was not cost‐effective in some other scenarios, such as when BTX was conducted under local anaesthesia or when peripheral nerve evaluation or bilateral testing was used for SNM.

CONCLUSIONS

Starting with SNM, treatment is cost‐effective after 5 years compared to BTX. However, in some scenarios, such as the use of local anaesthesia for BTX treatment and SNM peripheral nerve evaluation or bilateral test, SNM was not cost‐effective.     

肉毒毒素A腺体内注射对大鼠前列腺增生组织的影响

目的:探讨肉毒毒素A(BTX-A)腺体内注射对大鼠前列腺增生模型的影响。方法:SPF级雄性SD大鼠64只,丙酸睾酮造模成功后,随机均分为BTX-A高、中、低(20U、10U、5U,n=12)剂量组和阴性对照组(生理盐水,n=12)行腺体内注射,假手术组(n=12)为对照。注射后2周和4周切取前列腺,观察各组腺体外观、腹侧叶称重。HE染色观察组织学改变;千屏病理图像分析系统半定量检测各组腺体面积、间质面积。结果:BTX-A20U注射后3d内有2只大鼠死亡,余均存活。2周后,与阴性对照组相比,高、中、低剂量组大鼠前列腺明显萎缩(P<0.01,0.01,0.05),重量减轻,光镜下腺管上皮细胞萎缩,腺管面积和间质面积均缩小。4周后影响有所降低,以5UBTX-A组大鼠最为明显。结论:大鼠前列腺内注射BTX-A可使前列腺体积缩小,组织学变化明显,但大剂量有可能导致大鼠死亡。     

Objective and subjective improvement in children with idiopathic detrusor overactivity after intravesical botulinum toxin injection: A preliminary report

Objective

The purpose of this study is to evaluate the effect of Intravesical Botulinum toxin injection on the symptoms and urodynamic parameters in pediatric patients with idiopathic overactive bladder (iOAB) refractory to medical treatment.