摘要
目的探讨5步序贯法治疗放射性膀胱炎出血的临床效果。方法回顾性分析2015年4月至2018年4月6家省级肿瘤医院泌尿外科收治的512例放射性膀胱炎出血患者的临床资料,其中福建省肿瘤医院134例,湖北省肿瘤医院109例,湖南省肿瘤医院76例,江西省肿瘤医院75例,浙江省肿瘤医院60例,江苏省肿瘤医院58例。男15例,女497例。年龄(60.1±8.2)岁(53~71岁)。血尿均出现于盆腔肿瘤放疗后,放疗结束至出现血尿的时间为(2.9±0.8)年(0.5~13.0年)。按血尿严重程度将放射性膀胱炎患者分为轻症和重症2组,其中轻症480例,重症32例。5步序贯法包括:第1步应用药物保守对症治疗,第2步采用凝血酶溶液或透明质酸钠膀胱灌注,第3步行经尿道电凝止血术,第4步行介入栓塞术,第5步应用高压氧治疗。512例均应用5步序贯法治疗。轻症患者从第1步开始治疗,重症患者从第3步开始治疗,同时辅以第1步。采用膀胱过度活动症症状评分(OABSS)对患者症状改善情况进行评估并观察疗效。结果480例轻症患者均接受第1步治疗,其中223例接受第1+2步治疗,98例接受第1+2+3步治疗,30例患者接受1+2+3+4步治疗,10例接受1+2+3+4+5步治疗。轻症患者经第1步治疗后总有效率65.2%(313/480),第1+2步治疗后总有效率84.2%(404/480),第1+2+3步治疗后总有效率95.6%(459/480),第1+2+3+4步治疗后总有效率98.3%(472/480),第1+2+3+4+5步治疗后总有效率100.0%(480/480)。重症患者经第3+1步治疗后总有效率59.4%(19/32),第3+1+4步治疗后总有效率68.8%(22/32),第3+1+4+5步治疗后总有效率100.O%(32/32)。轻、重症患者治疗后OABSS评分均较治疗前明显下降(P<0.01)。30例轻症患者及19例重症患者行第4步治疗后,其中28例出现轻微臀部疼痛,应用镇痛药后缓解。第4步治疗后轻症患者中2例出现再出血,再出血率6.7%(2/30);重症患者中2例出现再出血,再出血率10.5%(2/19),予止血药物及高压氧治疗后均治愈。结论5步序贯法治疗放射性膀胱炎出血有效率高,无明显并发症。
Objective To investigate the clinical effect of five-step sequential method for hemorrhagic radiation cystitis.Methods From April 2015 to April 2018,512 cases of hemorrhagic radiation cystitis patients in 6 provincial tumor hospital were retrospectively analyzed.12 cases were male patients, and 497 cases were female.Patients' average age was (60.1±8.2)years (53-71 years).Hematuria appeared in 2.9 years on average after radiotherapy(ranged 0.5 to 13 years).According to the severity of hematuria,480 patients were classified as mild and 32 patients as severe.The step 1was drug conservative symptomatic treatment.Thrombin solution or sodium hyaluronate was used for bladder perfusion in step 2.The step 3 was transurethral eleetrocoagulation.The step 4 was interventional embolization.The step 5was hyperbaric oxygen therapy.Mild patients were treated from the first step,and the severe,patients were treated from step 3,and combined with step 1.Overactive bladder symptom score (OABSS)was used to assess the improvement of patients' symptoms.Results No obvious complications occurred in step 1,2,3,5.Mild hip pain occurred at step 4.Recurrent hemorrhage rate were 6.7%(2/30)in mild patients group and 10.5% (2/19)in severe respectively in step 4.The total effective rate of step 1 in mild patients group was 65.2% (313/480),step 1+2 was 84.2%(404/480),step 1+2+3 was 95.6%(459/480),step 1+2+3+4 was 98.3%(472/480),and step 1+2+3+4+5 was 100%(480/480).The effeetive rate of step 3+1 treatment was 59.4%(19/32)in severe patients group,step 3+1+4 was 68.8%(22/32),and step 3+ 1+4+5 was 100%(32/32).The OABSS scores of mild and severe patients deereased after treatment (P <0.01).Conclusion Five-step sequential therapy could be an effective method for the treatment of hemorrhagic radiation cystitis.
作者
居正华
李有元
韩惟青
涂新华
朱绍兴
邹青
余文昌
Ju Zhenghua;Li Youyuan;Han Weiqing;Tu Xinhua;Zhu Shaoxing;Zou Qing;Yu Wenchang(Department of Urology,Fujian Provincial Tumor Hospital,Fuzhou 350014,China)
出处
《中华泌尿外科杂志》
CAS
CSCD
北大核心
2018年第12期890-894,共5页
Chinese Journal of Urology
关键词
放射性膀胱炎
经尿道电凝止血术
介入栓塞术
高压氧
Radioactive cystitis
Transurethral electrocoagulation
Intervene embolize therapy
Hyperbaric oxygen
