女性尿道综合征的诊断与治疗(附36例报告)

目的探讨女性尿道综合征的可能病因与最佳治疗方式。方法对36例临床诊断女性尿道综合征的患者,进行尿流率、尿动力学检查。除应用一般解痉、镇静、a-受体阻滞剂等治疗外,根据检查有针对性地加用尼尔雌醇片,少数患者应用尿道扩张,尿道口成形术。结果所有患者未发现尿路器质性病变。更年期(12例)与绝经后(20例),加用尼尔雌醇,症状改善,达到治愈;育龄期治疗困难,加用尿道扩张,尿道口阴道口间距延长术,3例获治愈,1例效果不佳,仍在诊治中。结论女性尿道综合征病因复杂,尿道高压,不稳定膀胱占绝大多数。雌激素下降,阴道、尿道粘膜萎缩是老年女性尿道综合征的主要病因,治疗上宜加用尼尔雌醇;育龄期女性尿道综合征治疗困难,必要时行尿道扩张或尿道整形,才能收到满意效果。     

A型肉毒毒素治疗梨状肌综合征的临床观察

目的探讨使用A型肉毒毒素治疗梨状肌综合征的临床效果。方法25例保守治疗无效的梨状肌综合征患者随机分为两组。A组患者13例，梨状肌内注射0．25％布比卡因3ml加5mg曲安奈德，B组12例，梨状肌内注射0．25％佰比卡因3ml加5mg曲安奈德和100U的A型肉毒毒素。记录两组患者注射治疗前、治疗后2周、1、2和3月的VAS以及不良反应。结果A组治疗后各时点的VAS明显低于治疗前（P〈0．05），治疗后3月的VAS高于治疗后2周、1和2月（P〈0．05）。B组治疗后各时点的VAS明显低于治疗前（P〈o．05），治疗后1、2和3月的VAS明显低于治疗后2周（P〈0．05）。治疗后1、2和3月的VASB组均显著低于A组（P〈0．05）。B组中有2例患者在注射治疗后1周患侧下肢表现为轻微软弱无力，2周后逐步缓解。结论梨状肌内联合注射A型肉毒毒素、皮质激素和局麻药是较好的治疗梨状肌综合征的疗法，具有疗效佳、维持时间长、不良反应少等优点。     

舒丽启能治疗68例结肠脾（肝）曲综合征的疗效

目的 观察舒丽启能（cerekinon)治疗结肠脾（肝）曲综合征的疗效。方法 将68例结肠脾（肝）曲综合征患者随机分成A组和B组，各组34例，分别用舒丽启能100mg和200mg，1日3次，口服，疗程2周。结果 缓解症状和体征，A组总有效率68％，B组总有效率88％，差别有意义（P＜0．05），缓解上腹部疼痛、触及痉挛肠管和压痛，大剂量用药的疗效要好于小剂量，差别有意义和显著意义（P＜0．05，（P＜0．01）。200mg1日3次的剂量除对脾曲胀气效果好于100mg1日3次（P＜0．05）外，其他部位结肠胀气疗效和总疗效两种剂量效果无差异（P＞0．05）。缓解全部症状和体征的总有效率是78％，而缓解结肠胀气的总有效率81％。结论 每日服用300mg的舒丽启能能缓解结肠脾（肝）曲综合征的症状、体征和消除肠胀气，疗效基本满意，如效果不佳可考虑加量。     

口服坦索罗辛与硝苯地平辅助治疗肾绞痛的临床效果比较

目的 分析比较坦索罗辛与硝苯地平辅助治疗肾绞痛的临床疗效及临床耐受性。方法 500例输尿管结石致肾绞痛患者随机分为两组,A组常规止痛治疗加用坦索罗辛口服0.4mg qd;B组常规止痛治疗加用硝苯地平10mg tid。所有患者被要求饮水2L／天,疗程为4周或至结石排出。观察患者疼痛缓解情况(视觉模拟量表)、结石排出率、生活质量评分以及药物副作用发生率并作统计分析。结果 A组患者疼痛缓解情况(视觉模拟量表)、结石排出率、生活质量评分均优于B组患者（p<0.05）,两组药物副作用发生率无差别。结论 口服坦索罗辛辅助治疗肾绞痛总体效果优于口服硝苯地平,可以减轻患者的绞痛程度、减少止痛药的用量和辅助排石,且临床耐受性好。     

α-受体阻滞剂和抗抑郁药联合治疗Ⅲ型前列腺炎

目的研究α-受体阻滞剂和抗抑郁药联合治疗Ⅲ型前列腺炎的效果。方法本组48例被诊断为Ⅲ型前列腺炎（CP／CPPS）的患者，年龄20-50岁，平均30岁。均有会阴区域疼痛、尿频及紧张、焦虑等症状。病程3月。2年，平均18个月。均有抗生素治疗史，疗效不佳。采用α-受体阻滞剂（多沙唑嗪控释片4mg／d或坦索罗辛2mg／d口服）、抗抑郁药（舍曲林50mg／d或文拉法辛75mg／d口服）联合疗法，3个月为一疗程。在治疗前、治疗后4周、8周和12周对患者进行美国国立卫生研究院慢性前列腺炎症状指数（NIH-CPSI）评分并记录不良反应情况。疗效评定标准为：（1）显效：NIH-CPSI较治疗前下降〉15分：（2）有效：NIH-CPSI较治疗前下降〉5分：（3）无效：NIH-CPSI较治疗前下降〈5分或上升。总有效率为显效率与有效率之和。结果显效16例，有效25例，无效4例，总有效率91％（41／45）。2例患者因药物不良反应退出治疗。结论α-受体阻滞剂和抗抑郁药联合治疗方案安全有效，可以明显缓解Ⅲ型前列腺炎患者的临床症状。     

水飞蓟宾联合葡醛内酯治疗抗精神病药物所致肝损伤45例

摘要目的 探讨水飞蓟宾联合葡醛内酯治疗抗精神病药物所致肝损伤的临床疗效。方法抗精神病药物（利培酮、氯氮平、氟哌啶醇）所致肝损伤患者87例，随机分为两组，治疗组45例，给予水飞蓟宾胶囊70 mg，tid，po，加用葡醛内酯片100 mg，tid，po；对照组42例，给予水飞蓟宾胶囊70 mg，tid，po。治疗时间均为6周。观察两组患者治疗前后血清酶学、临床症状的改善及不良反应。结果治疗组和对照组治疗6周后有效率分别为95.56%，90.48%（P＞0.05）；两组患者治疗2周后血清酶学水平差异无统计学意义（P＞0.05）；治疗4周后治疗组丙氨酸氨基转移酶及天冬氨酸氨基转移酶水平明显低于对照组（P＜0.05），两组均未出现明显不良反应。结论水飞蓟宾联合葡醛内酯能明显改善抗精神病药物所致肝损伤的肝功能血清酶学指标，且迅速改善症状，具有较好的临床疗效。     

索利那新治疗前列腺电切术后膀胱过度活动症的临床观察

目的比较索利那新及托特罗定治疗经尿道前列腺电切术（TURP）术后患者膀胱过度活动症（OAB）的有效性与安全性。方法选取126例TURP后出现OAB症状的患者,随机分为4组：A组（索利那新5mg,1次/d）,B组（索利那新10mg,1次/d）,C组（托特罗定2mg,2次/d）,D组（安慰剂组）。术后6h开始服药,观察治疗前及拔管后7d日间排尿次数、夜间排尿次数、尿急、急迫性尿失禁以及对日常生活造成的影响。进一步进行OAB症状评分表（OABSS）评分和感知膀胱症状量表（PPBC）评分;观察各组口干、便秘、视力模糊症状等不良反应的发生率以及肝功能、肾功能指标变化。结果拔管后7d,A、B、C组与D组OABSS及PPBC评分有显著性差异（P〈0.05）,A、B组,B、C组,A、C组之间无显著性差异（P〉0.05）。A组2例出现口干,1例便秘;B组5例口干,3例便秘,2例视力模糊;C组有4例口干,2例便秘,1例视力模糊;D组仅1例便秘。各组第7d复查的肝功能、肾功能与术前相比无统计学差异（P〉0.05）。结论索利那新治疗TURP术后OAB症状比托特罗定更安全,5mg足以发挥疗效,副作用更少。     

可冲洗尿道的导尿管预防留置尿管所致逆行尿路感染的研究

目的观察专利产品可冲洗尿道的导尿管（专利号ZL00267398．3）预防留置导尿所致逆行尿路感染的临床应用效果。方法可冲洗尿道的导尿管主要特点是包括出液口设在气囊上方的冲洗尿道注入导管。对165例患者留置导尿管，实验前均未留置导尿管且无泌尿系感染症状，尿细菌培养阴性。分短期留置导尿管组（A组）和长期留置导尿管组（B组）。A组128例，留置导尿管时间≤14d，使用可冲洗尿道导尿管者（A1组）65例，使用Foley双腔导尿管者（A2组）63例。B组37例，留置导尿管时间＞14d，使用可冲洗尿道导尿管者（B1组）17例，使用Foley双腔导尿管者（B2组）20例。A1、B1组用生理盐水冲洗尿道，2次／d。各组均密闭式引流袋封闭引流尿液。分别观察尿路感染率，并进行统计学分析。结果A1、A2组尿管留置1、3、7、14d，尿路感染率分别为0％、0％，0％、25．4％，4．6％、49．2％，12．3％、84．1％，3、7、14d 2组比较差异均有统计学意义（P值均＜0．01）。B1、B2组尿管留置2周、4周，尿路感染率分别为11．8％、85．0％，29．4％、100．0％，2组比较差异均有统计学意义（P值均＜0．01）。结论临床应用可冲洗尿道的导尿管预防留置导尿所致逆行尿路感染效果良好。     

庆大霉素局部注射治疗女性尿道综合征的临床研究

目的:研究在"女性前列腺"局部注射抗生素对女性尿道综合征的疗效,为其探索一种有效的治疗方法。方法:选择2009年7月至2010年12月在我院门诊就诊的患者,共入选163例。根据就诊顺序前瞻性随机分为A、B、C 3组,A组58例为实验组,B组55例、C组50例为对照组。A、B、C 3组均进行同样的常规治疗,除此之外A、B组同时采取局部注射治疗,A组注射庆大霉素8万单位(2 ml)+2%利多卡因2 ml的混合药液,B组注射生理盐水2 ml+2%利多卡因2 ml的混合药液。注射方法两组完全一致。浸润性注射在尿道后壁尿道旁腺及其周围,每周治疗2次,6次为1疗程。根据患者自主症状评分的改变评定疗效。疗程结束后第2、4周重复症状评分,症状消失为治愈,分值减少>1/2为为显效,分值减少>1/4分为有效,分值减少<1/4或者反增加为无效。结果:疗程结束后第2周症状评分,疗效A组(有效率为77.5%)明显高于B组(有效率为67.3%)和C组(有效率为68.0%),差异有显著性(P<0.05),而B、C组间无明显差异(P>0.05)。疗程结束后第4周复查,A组有效率略有下降,仍然高于B组和C组,差异有显著性(P<0.05)。结论:"女性前列腺"局部注射庆大霉素治疗女性尿道综合征有一定效果。     

坦索罗辛联合甲基泼尼松龙治疗输尿管下段结石的临床研究

目的：评价坦索罗辛与甲基泼尼松龙联合应用治疗输尿管下段结石的作用。方法：选取120例输尿管下段结石（0．4～1．0cm）患者，随机分为3组。A组为对照组，给予常规治疗；B组在A组治疗方案基础上加坦索罗辛0．4mg，1次／d；C组在B组基础上加甲基泼尼松龙8mg，2次／d。均观察期为2周，统计结石排出率、结石排出时间、使用止痛剂的例数。结果：A组排出结石者为19例，B组为31例，C组为38例，B、C组排石率高于A组（P〈0．05），C组排石率高于B组（P〈0．05）；平均排石时间分别为（9．3&#177;3．5）d，（5．1&#177;2．8）d和（4．9&#177;2．4）d，B、C组短于A组（P〈0．05）；出现肾绞痛而给予哌替啶者分别为10例，2例，1例，B、C组少于A组（P〈0．05）。治疗期间未出现明显副作用。结论：坦索罗辛和甲基泼尼松龙联合治疗可提高输尿管下段结石排石率，缩短排石时间，减少止疼药的用量。     

女性腺性膀胱炎临床表现分析(附72例报告)

目的:分析女性腺性膀胱炎患者各种不同的临床表现,提高诊断水平.方法:回顾性分析2003～2004年145例存在尿道综合征、镜下血尿、反复尿路感染的女性患者及8例并发泌尿科其他疾患或妇科病的患者实施膀胱镜检查及活检.结果:占检查人数49%共72例女性患者经病理证实为腺性膀胱炎,其中10例同时伴有腺性后尿道炎.22例患者伴有尿道外口畸形或其他病变.其他原发病8例:膀胱子宫黏膜异位症1例,膀胱颈梗阻3例,膀胱嗜铬细胞瘤1例,肾炎性肉芽肿1例,妇科手术前输尿管插管定位2例.58例在本院手术(经尿道电切56例,开放手术2例).结论:腺性膀胱炎是女性常见病,可有多种临床表现,医师应该引起足够的重视.     

点阵CO2激光治疗女性轻中度压力性尿失禁的临床疗效分析

目的探究经阴道点阵CO₂激光治疗女性轻、中度压力性尿失禁（SUI）的临床疗效。 方法回顾性研究本院2017年1月至2020年12月收治的轻中度SUI女性患者。激光治疗组41例,进行点阵CO₂激光联合盆底肌训练治疗,每月治疗1次,共治疗3次;生物反馈治疗组20例,采用生物反馈电刺激联合盆底肌训练。比较两组患者治疗后临床疗效、国际尿失禁委员会尿失禁问卷简表（ICI-Q-SF）、尿失禁生活质量问卷（I-QOL）及女性性功能量表（FSFI）评分。 结果治疗后,激光治疗组总有效率为92.68%,疗效强于生物反馈组（P<0.05）;治疗后ICI-Q-SF、I-QOL、FSFI评分均得到改善（P<0.01）;与生物反馈治疗组比较,激光治疗组I-QOL、FSFI增加更显著（P<0.05）,ICI-Q-SF评分明显降低（P<0.01）。3例患者治疗时述阴道烧灼感,休息后好转,5例患者出现一过性的尿急,部分患者阴道分泌物增多后自行恢复,整个治疗过程无其他不良事件发生。 结论点阵CO₂激光治疗能够有效改善轻、中度SUI患者的临床症状,提高患者性功能和生活质量,具有良好临床疗效。     

尿道注射聚(乳酸-羟基乙酸)共聚物微球治疗压力性尿失禁

目的 观察聚(乳酸-羟基乙酸)(PLGA)共聚物微球在大鼠尿道的组织相容性以及对实验大鼠尿失禁模型的治疗作用.方法 双相乳化法制备PLGA微球,电子显微镜及计算机图像分析仪分析其表征;将40只成年雌性SD大鼠随机均分为2组(实验组和对照组),并接受尿道松解术形成压力性尿失禁模型.实验组接受微球尿道注射,对照组仅接受等量生理盐水注射.在注射前1周和注射后2、4和8周,所有大鼠接受腹部漏点压(ALPP)的检测.此外,术后第2、4和8周,每组动物每个时间点处死3只,应用苏木素.伊红(HE)染色方法检测微球在尿道组织的形态学演变,此外应用免疫组织化学方法检测巨噬细胞特异性的炎症标志物CD68在注射部位尿道组织的表达,以评价微球与尿道肌层的组织相容性.结果 PLGA微球可成功地注射于大鼠尿道的肌层,并诱导局部炎症反应;CD68免疫染色证实浸润细胞以单核细胞和巨噬细胞为主.以微球和增生细胞为主的混杂组织位于黏膜下肌层内,发挥尿道填充作用.在术后2周,炎症反应最为明显,以后随着时间逐渐减退.全程未见变性、坏死等破坏性病理改变;实验组ALPP在微球注射后较注射前和对照组明显改善,并可维持到注射后8周.结论 PLGA微球在尿道组织是安全的,可起到尿道填充作用增加尿道阻力,发挥治疗压力性尿失禁的作用.PLGA微球作为可注射的细胞支架可用于尿失禁的组织工程.     

Detrusor sphincter dyssynergia,detrusor instability,and urethral sphincter spasticity as the urodynamic findings in the urethral syndrome: Role of treatment with a combined anticholinergic and alpha blocking agent,bladder drill,and antibiotics

The combined effect of isopropamide 5 mg plus trifluoperazine 1 mg (a combined anticholinergic and alpha-adrenergic antagonist) (Smith, Kline and French Canada Ltd, Ontario, Canada), antibiotics, and bladder drill was retrospectively assessed on 100 consecutive women, aged 16 to 47 years, presenting with the signs and symptoms of the urethral syndrome. Assessment included history, physical examination, routine bacterial and chlamydial cultures (cervical, urethral, vaginal, and urine), cystourethroscopy, and urodynamics. Urodynamic diagnoses included detrusor sphincter dyssynergia (n=84), detrusor instability (n =8), external urethral sphincter spasticity (n=4), and sensory urgency (n=1). Three patients with positive urine cultures were excluded. Urethrotrigonitis was visualized at cystourethroscopy in all patients. Only one case of chlamydial urethritis-cervicitis was identified by culture: 82% of patients had a history of prior antibiotic therapy for lower urinary tract symptoms and 21% were being treated with antibiotics at the time of their initial assessment.Following 1 month of treatment, 44 (45%) patients were cured of all symptoms, 49 (51%) were improved, 3 (3%) were unchanged and 1 (1%) was worse. Significant changes in uroflowmetry included a reduction in postvoid residual urine volume from 49 ± 28 ml to 14 ±21 ml (P=0.029) in the unstable bladder group and a conversion from intermittent to continuous uroflow patterns in the detrusor sphincter dyssynergia group (P <0.005, ²) and overall (P <0.005, ²). A statistically significant number of patients (P <0.025, ²) converted from increased to normal tracings on repeat perianal electromyography, suggesting that the pathophysiology of the urethral syndrome is urethral spasticity related to urethral inflammation rather than actual infection.We conclude that detrusor sphincter dyssynergia, bladder instability, and urethral sphincter spasticity are the common urodynamic findings in the urethral syndrome. A combination of anticholinergic and alpha blocking agent, antibiotics, and a bladder drill markedly improved (96%) symptoms in women with the urethral syndrome.     

Treatment of urethral syndrome: a prospective randomized study with Nd:YAG laser

INTRODUCTION: The urethral syndrome is characterized by irritative disturbances, the urgency-frequency syndrome and/or pain associated with negative urine cultures. Areas of metaplasic tissue in the trigonal-bladder neck region (trigonitis) are sometimes present. We performed a comparative randomized study to assess the efficacy of side- or end-firing neodymium (Nd):YAG laser surgery in destroying metaplasia and relieving symptoms. MATERIALS AND METHODS: Between January 1997 and December 2003, 62 consecutive women with the urethral syndrome and squamous metaplasia of the bladder neck-trigone, who were refractory to drugs, were randomly assigned to treatment with end-firing (group A) or side-firing (group B) Nd:YAG laser. Three, 6 and 12 months after surgery all patients underwent a clinical urological examination and cystoscopy. Surgery was considered successful when patients reported they were satisfied with the outcome or stated on the UDI-6 questionnaire that symptoms were reduced by at least 75%. RESULTS: Group A end-firing laser: patients rapidly improved (2-3 weeks) but symptoms worsened within 3 months. At 6-12 months, symptoms had improved in 19% of the 31 patients and remained unchanged or worsened in 81%. Group B side-firing laser: irritative disturbances worsened in the 7-10 days after therapy but markedly improved within 2-3 months. Symptoms significantly improved in 68% of the 28 patients and remained unchanged or worsened in 32%. Results were significantly better after side-firing laser (p < 0.001) and a trend towards improvements emerged as the joule levels rose. At 3 months, cystoscopy and biopsy showed squamous metaplasia was no longer present in patients whose symptoms had improved. Whitish areas were still present in the bladder neck-trigone in patients whose symptoms had remained unchanged or worsened. These patients were retreated. CONCLUSIONS: In the treatment of the urethral syndrome the few reports on attempts to restore a normal urothelium by means of diathermocoagulation and cryotherapy have been encouraging. Side-firing laser, which produces necrotic coagulation followed by reconstitution of normal functional epithelium, was significantly more successful than end-firing and was associated with a 78% success rate. These results are encouraging in patients who are usually refractory to medical therapy.     

Sensory blockade of S3 dermatome prevents pain during bladder catheterization

PURPOSE: We often encounter patients who do not complain of pain on undergoing invasive urogenital or rectal procedures, despite incomplete epidural blockade of sacral cutaneous sensation. To clarify whether or not urethral pain is blocked faster than sacral cutaneous sensation during lumbar epidural anesthesia, we investigated the correlation between occurrence of urethral pain and loss of cold sensation in the S1-3 dermatomes. METHODS: In 46 gynecological patients, Group A (n=22) received 15 ml of 2% mepivacaine via an epidural catheter inserted cephaladly. Group B (n=24) received 5 ml of 2% mepivacaine directly in the epidural needle directed caudally and 10 ml of 2% mepivacaine via the epidural catheter inserted cephaladly. A Foley catheter was inserted into the urethra 30 min after the injection. RESULTS: Urethral pain, which was defined as a pained facial expression and/or complaint of pain, was observed in seven patients in Group A, and none in Group B. The caudad level of epidural blockade was significantly lower in patients without urethral pain (S3, median) than with urethral pain (L4) (P <0.05). In 39 patients without urethral pain, 19 (49%) experienced loss of cold sensation in the S1 dermatome, 27 (69%) in the S2 and 38 (97%) in the S3 25 min after the injection. CONCLUSION: Blockade of urethral visceral pain often occurs before complete sacral somatosensory blockade, and S3 somatosensory blockade is the important sacral level as an indicator of successful urethral sensory blockade.     

鲑鱼降钙素联合低频脉冲电磁场治疗绝经后妇女骨质疏松症的临床观察

目的 通过对鲑鱼降钙素联合低频脉冲电磁场(pulsed electromagnetic fields,PEMFs)治疗绝经后骨质疏松症患者疗效的观察及分析,为绝经后骨质疏松症寻找到安全可靠,更具有良好疗效的治疗方案。方法 选择90个病例,随机分为3组：A组为试验组：联合应用鲑鱼降钙素及低频电磁场组(30人);B组为对照组1：单纯应用低频电磁场组(30人);C组为对照组2：单纯应用鲑鱼降钙素组(30人),每组同时每日给予一定剂量的钙剂及维生素D;A、C组肌注鲑鱼降钙素（CT）50 U,1次/d,连续1w,然后隔天1次,连续1w,最后每周2次至疗程结束;A 、B组均采用天津市同业科技发展有限公司生产的TY-PEMF-B型OP治疗仪实施低频电磁场治疗,频率8~16Hz,每次治疗40 min,共治疗30 次; 治疗前及治疗后第2、4、8周分别测定患者视觉模拟痛疼评分(VAS),并对3组患者进行治疗前及治疗后3、6个月腰椎及股骨颈BMD的测量。结果 鲑降钙素联合骨质疏松治疗仪与单纯使用降钙素治疗或骨质疏松治疗仪治疗相比骨密度显著提高,试验组与对照组对比P<0.05。结论 鲑降钙素联合骨质疏松治疗仪治疗绝经后妇女骨质疏松症疗是一种安全、疗效更好的方法。     

Low T3 syndrome (3,3',5-triiodothyronine) in relation to the extent of surgical trauma

Thirty patients undergoing extra-thyroid surgery were divided into two groups (A and B) according to the extent of surgical stress (Group A: major surgery; Group B; minor surgery). Thyroid hormone levels were measured before the operation and up to the 3rd postoperative day in Group B and up to the 7th postoperative day in Group A. A low T3 syndrome was observed in all 30 patients examined of the first postoperative day (reduction of T3 and increase in rT3 without alterations of total thyroxin or signs of hypothyroidism) with normalisation of thyroid values by 3rd postoperative in Group B and later in Group A. The persistence of the syndrome in the latter group was due to the extent of surgical stress, the duration of anesthesia, the presence of stress factors such as staying in intensive therapy, painful symptoms and a negative energy balance during the first days following operation. This syndrome is indicative of a physiological adaptation process to reduce O2 consumption, basal metabolism and in particular protein catabolism.