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botulinum a toxin btx-a
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  botulinum a toxin btx-a
Initial studies suggest that injection of botulinum A toxin (Btx-A) into the antropyloric region inhibits propulsive contractions of the antral pump, with delay in gastric emptying, early satiety and weight loss.
      


Objective To evaluate the effects of Botulinum-A toxin (BTX-A) injection into detrusor to treat detrusor hyperreflexia and neurogenic incontinence in the patients with spinal cord injury (SCI). Methods A total of 31 patients with SCI(mean age,30 years;male 20,female 11) were included into the study.All the patients underwent urodynamic examination and voiding diary was recorded.300 U of BTX-A was dissolved in 15 ml of saline,and the solution of BTX-A was injected into 30 different...

Objective To evaluate the effects of Botulinum-A toxin (BTX-A) injection into detrusor to treat detrusor hyperreflexia and neurogenic incontinence in the patients with spinal cord injury (SCI). Methods A total of 31 patients with SCI(mean age,30 years;male 20,female 11) were included into the study.All the patients underwent urodynamic examination and voiding diary was recorded.300 U of BTX-A was dissolved in 15 ml of saline,and the solution of BTX-A was injected into 30 different points in detrusor using a flexible cystoscopic needle.The evaluation for the effects and follow-up included voiding diary,urodynamic testing and observation of adverse and toxic effects. Results After the first injection,29 of the 31 patients had symptom relief within 3 to 14 days;4 cases received the second injection;4 cases were treated in combination with anticholinergic medication;and 2 cases had no improvement and,therefore,received other treatments.The mean follow-up was 8.5 months. After 3-week treatment of BTX-A,the mean frequency of incontinence decreased from 14.2 to 2.5 times per day.The mean volume of intermittent catheterization (IC) increased from 124 to 495 ml each time.Urodynamic data showed that mean cystometric bladder storage volume increased from 133 to 475 ml,mean maximum storage detrusor pressure decreased from 62.7 to 17.1 cmH 2O(1 cmH 2O=0.098 kPa).No adverse and toxic effect was observed. Conclusions Our initial experience suggests that Botulinum-A toxin injection into detrusor to treat detrusor hyperreflexia and neurogenic incontinence in patients with SCI may be an effective,safe,feasible and micro-invasive treatment choice.However,it is necessary to observe its long term outcome.

目的 评估逼尿肌A型肉毒毒素注射治疗脊髓损伤患者逼尿肌反射亢进和神经原性尿失禁的临床效果。 方法 损伤平面在骶髓以上的完全性脊髓损伤患者 31例 ,男 2 0例、女 11例 ,平均年龄 30岁。均表现为肾积水、输尿管返流及严重尿失禁。将 30 0UA型肉毒毒素溶解于 15ml生理盐水 ,使用膀胱镜注射针分 30个点注射于三角区以外的膀胱壁 ,0 .5ml/点。治疗前后记录排尿日记、行尿动力学检查 ,并观察毒副作用。 结果 治疗后第 3周 ,31例平均尿失禁次数由 14 .2次 /d降至 2 .5次 /d ,平均导尿量由 12 4ml/次增至 4 95ml/次 ,尿动力学结果表明平均最大膀胱测压容积由 133ml增至 4 75ml、平均充盈末逼尿肌压力由 6 2 .7cmH2 O(1cmH2 O =0 .0 98kPa)降至 17.1cmH2 O。起效平均时间为 6 .8d(3~ 14d) ,6 .5 % (2 /31)患者因治疗后症状无改善改用其它方法 ,12 .9% (4 /31)患者因症状再次加重而接受第 2次肉毒素治疗 ,12 .9% (4 /31)患者因症状改善有限而同时服用托特罗定治疗。随访 1~ ...

目的 评估逼尿肌A型肉毒毒素注射治疗脊髓损伤患者逼尿肌反射亢进和神经原性尿失禁的临床效果。 方法 损伤平面在骶髓以上的完全性脊髓损伤患者 31例 ,男 2 0例、女 11例 ,平均年龄 30岁。均表现为肾积水、输尿管返流及严重尿失禁。将 30 0UA型肉毒毒素溶解于 15ml生理盐水 ,使用膀胱镜注射针分 30个点注射于三角区以外的膀胱壁 ,0 .5ml/点。治疗前后记录排尿日记、行尿动力学检查 ,并观察毒副作用。 结果 治疗后第 3周 ,31例平均尿失禁次数由 14 .2次 /d降至 2 .5次 /d ,平均导尿量由 12 4ml/次增至 4 95ml/次 ,尿动力学结果表明平均最大膀胱测压容积由 133ml增至 4 75ml、平均充盈末逼尿肌压力由 6 2 .7cmH2 O(1cmH2 O =0 .0 98kPa)降至 17.1cmH2 O。起效平均时间为 6 .8d(3~ 14d) ,6 .5 % (2 /31)患者因治疗后症状无改善改用其它方法 ,12 .9% (4 /31)患者因症状再次加重而接受第 2次肉毒素治疗 ,12 .9% (4 /31)患者因症状改善有限而同时服用托特罗定治疗。随访 1~ 15个月 ,平均 8.5个月。随访期未观察到任何毒副作用。 结论 逼尿肌A型肉毒毒素注射是一种治疗脊髓损伤患者逼尿肌反射亢进和神经原性尿失禁的有效、安全、可行、可重复的微创方法。

Objective:To evaluate the effects of botulinum-A toxin (BTX-A) injected into bladder wall to deal with neurogenic bladder associated with spinal cord injury(SCI).Method:Seventy-eight patients with SCI, male 59,female 19,with the mean age of 38.9 years,were included in the study.AU patients wrote down the voiding diary,and underwent the urodynamic examination.300IU BTX-A was dissolved in 15ml normal saline, and the solution of BTX-A was injected into 30 different points (0.5ml/point)...

Objective:To evaluate the effects of botulinum-A toxin (BTX-A) injected into bladder wall to deal with neurogenic bladder associated with spinal cord injury(SCI).Method:Seventy-eight patients with SCI, male 59,female 19,with the mean age of 38.9 years,were included in the study.AU patients wrote down the voiding diary,and underwent the urodynamic examination.300IU BTX-A was dissolved in 15ml normal saline, and the solution of BTX-A was injected into 30 different points (0.5ml/point) in detrusor using a flexible cystoscopic needle.The voiding diary and side effects were evaluated.Result:After the first injection of BTXA,the frequency of incontinence decreased from 13.5 to 2.7 times per day,the volume of incontinence reduced from 1690ml to 281ml,the volume for intermittent catheterization(IC) increased from mean 131ml to 389ml. 10 cases received the second injection in 8.9 months after the first one;incontinence decreased from 9.7 to 3.7 times per day,the volume for IC increased from mean 108ml to 387ml.6 cases received the third injection in 5.8 months after the second one;incontinence decreased from 9.2 to 3.9 times per day,the volume for IC increased from mean 116 ml to 364 ml.No side effects were observed.Conclusion:It suggests that Botulinum-A toxin injected into bladder wall to treat neurogenic bladder in the patients with SCI is an effective, safe, repeatable solution.

目的:观察膀胱壁内注射A型肉毒毒素治疗脊髓损伤患者神经原性膀胱的临床效果。方法:78例脊髓损伤后神经原性膀胱患者,男59例,女19例,平均年龄38.9岁。将300单位A型肉毒毒素溶解于15ml生理盐水,使用膀胱镜注射针分30个点注射于膀胱壁,0.5ml/点。治疗前后均记录患者排尿日记,并观察药物毒副作用。结果:78例患者经第1次治疗后平均尿失禁次数由13.5次/d降至2.7次/d、平均导尿量由131ml/次增至389ml/次,平均尿失禁量由1690ml/d降至281ml/d,起效的平均时间为7.6d。10例患者在第1次注射8.9个月后接受第2次注射,平均尿失禁次数由9.7次/d降至3.7次/d,平均导尿量由108ml/次增至387ml/次。6例患者在第2次注射后5.8个月接受第3次注射,平均尿失禁次数由9.2次/d降至3.9次/d,平均导尿量由116ml/次增至364ml/次。随访期间未观察到任何毒副作用。结论:经尿道膀胱壁内A型肉毒毒素注射是治疗脊髓损伤患者神经原性膀胱的有效、安全、可多次重复应用的微创方法。

Objective:To evaluate the effects and feasibilities of Botulinum-A toxin(BTX-A) injection into urinary sphincter endoscopically to treat detrusor-sphincter dyssynergia(DSD) and to retain upper urinary tract function in patients with spinal cord injury(SCI).Method:Nineteen males with SCI,with the age range of 26~45 years,were included into the study.All patients underwent the B type ultrasound and video-urodynamic examinations to determine the hydronephrosis,post-residual urine volume(PRV),detrusor...

Objective:To evaluate the effects and feasibilities of Botulinum-A toxin(BTX-A) injection into urinary sphincter endoscopically to treat detrusor-sphincter dyssynergia(DSD) and to retain upper urinary tract function in patients with spinal cord injury(SCI).Method:Nineteen males with SCI,with the age range of 26~45 years,were included into the study.All patients underwent the B type ultrasound and video-urodynamic examinations to determine the hydronephrosis,post-residual urine volume(PRV),detrusor pressure at vesica ureter reflux(VUR),detrusor leak point pressure(DLPP) and maximum urethral pressure(Pura.max) before and after BTX-A injection.200IU BTX-A was dissolved in 8ml normal saline,and the solution of BTX-A was injected into 8 different points in urinary sphincter using a flexible cystoscopic needle,with each point of 1ml solution.The effects was evaluated and followed up.Result:One month after injection,the hydronephrosis decreased from 3.9±1.2cm to 1.1±0.8cm and PUV did so from 187±58ml to 54±18ml in all patients.DLPP decreased from 77.6±7.2cmH2O to 21.6±4.1cmH2O and Pura.max did so from 88.3±10.5cmH2O to 57.4±3.6cmH2O in 9 patients(P<0.01).An improvement of PRV was observed at a mean of 9.5 days and sustained for a mean of 3.8 months,3 patients accepted the reinjection.After treatment,94.7% of patients displayed urinary functional improvement at 1 month,and 68.7% of patients did so at 3 months.No adverse reactions were documented during the follow-up.Conclusion:BTX-A injection in urinary sphincter which could effectively decrease PRV,DLPP and urethral pressure is an effective,minimal invasive,safe,reversible,repeatable option for the treatment of DSD as well as the retaining of the upper urinary tract function in patients with SCI.

目的:观察尿道括约肌内注射A型肉毒毒素(BTX-A)治疗脊髓损伤(SCI)患者逼尿肌-括约肌协同失调(DSD)的临床效果。方法:19例合并肾积水男性SCI患者,年龄26 ̄45岁,治疗前1个月用B超及影像尿动力学检查测量患者肾盂分离宽度、残余尿量(PRV)、输尿管返流压(Pdet.reflux)、逼尿肌漏尿点压(DLPP)、最大尿道压力(Pura.max)等指标。对逼尿肌-外括约肌协同失调(DESD)的13例患者,将200IUBTX-A溶解于8ml生理盐水,在膀胱尿道镜下分点注射于外括约肌内;对DESD合并逼尿肌-膀胱颈协同失调的6例患者,将200IUBTX-A溶解于12ml生理盐水,分点注射于膀胱颈及外括约肌内。1个月后复查上述检查指标。结果:1例治疗无效,其余患者治疗起效的平均时间为9.5d,治疗1个月后,患者的双肾最大肾盂分离宽度由3.9±1.2cm降至1.1±0.8cm,PRV由187±58ml降至54±18ml,DLPP由77.6±7.2cmH2O降至21.6±4.1cmH2O,Puram.ax由88.3±10.5cmH2O降至57.4±3.6cmH2O(P<0.01)。疗效持续时间平均3.8个月,治...

目的:观察尿道括约肌内注射A型肉毒毒素(BTX-A)治疗脊髓损伤(SCI)患者逼尿肌-括约肌协同失调(DSD)的临床效果。方法:19例合并肾积水男性SCI患者,年龄26 ̄45岁,治疗前1个月用B超及影像尿动力学检查测量患者肾盂分离宽度、残余尿量(PRV)、输尿管返流压(Pdet.reflux)、逼尿肌漏尿点压(DLPP)、最大尿道压力(Pura.max)等指标。对逼尿肌-外括约肌协同失调(DESD)的13例患者,将200IUBTX-A溶解于8ml生理盐水,在膀胱尿道镜下分点注射于外括约肌内;对DESD合并逼尿肌-膀胱颈协同失调的6例患者,将200IUBTX-A溶解于12ml生理盐水,分点注射于膀胱颈及外括约肌内。1个月后复查上述检查指标。结果:1例治疗无效,其余患者治疗起效的平均时间为9.5d,治疗1个月后,患者的双肾最大肾盂分离宽度由3.9±1.2cm降至1.1±0.8cm,PRV由187±58ml降至54±18ml,DLPP由77.6±7.2cmH2O降至21.6±4.1cmH2O,Puram.ax由88.3±10.5cmH2O降至57.4±3.6cmH2O(P<0.01)。疗效持续时间平均3.8个月,治疗后1、3个月时的总有效率分别为94.7%和68.7%。3例患者接受第2次注射。随访期间未观察到任何毒副作用。结论:尿道括约肌内注射BTX-A可有效减少SCI后DSD患者残余尿量、降低DLPP及尿道压力,是治疗DSD有效、微创、安全、可逆、可重复的方法。

 
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