雌二醇、盐酸米多君、托特罗定经阴道给药治疗轻中度FSUI临床观察

发布时间：2018-08-13 13:00

【摘要】：目的探讨雌二醇、盐酸米多君、托特罗定经阴道给药治疗轻中度女性压力性尿失禁(FSUI)的临床效果。方法选择轻中度FSUI患者120例,根据入院顺序分为药物组、手术组各60例。药物组经阴道给予雌二醇2 mg、盐酸米多君5 mg、托特罗定2 mg,1次/d,连续3个月。手术组常规行经阴道无张力尿道悬吊术(TVT)。治疗6个月评价临床疗效,手术组观察并发症发生情况,药物组观察不良反应发生情况。治疗前及治疗1、3、6个月,观察两组尿动力学指标[包括最大膀胱容量(MBC)、腹压漏尿点压(VLPP)、最大尿道闭合压(MUCP)和尿失禁量]、国际尿失禁咨询委员会尿失禁问卷表简表(ICI-Q-SF)评分以及盆底功能(包括静息期、应力期膀胱尿道后角、尿道角、近段功能尿道长度)变化。结果药物组总有效率为96.7%(58/60),手术组为98.3%(59/60),两组比较P0.05。两组治疗后MBC、VLPP、MUCP呈上升趋势,尿失禁量呈降低趋势;治疗1个月,手术组MBC、VLPP、MUCP高于药物组,尿失禁量低于药物组(P均0.05);治疗3、6个月,两组上述指标比较差异均无统计学意义(P均0.05)。两组治疗1、3、6个月ICI-Q-SF评分均低于治疗前(P均0.05),除治疗1个月药物组ICI-Q-SF评分高于手术组外,其余时间两组同期比较差异均无统计学意义(P均0.05)。两组静息期膀胱尿道后角呈降低趋势,尿道角呈上升趋势,近段功能尿道长度无明显变化;应力期膀胱尿道后角、近段功能尿道长度呈降低趋势,尿道角呈上升趋势,近段功能尿道长度呈降低趋势。手术组出现排尿困难3例、尿潴留2例,而药物组未出现明显不良反应。结论雌二醇、盐酸米多君、托特罗定经阴道给药治疗轻中度FUSI的疗效与TVT相当,但药物治疗不良反应发生率更低,安全性更高。
[Abstract]:Objective to investigate the clinical effect of transvaginal administration of estradiol, midodrine hydrochloride and tolterodine in the treatment of mild and moderate female stress urinary incontinence (FSUI). Methods one hundred and twenty patients with mild and moderate FSUI were divided into two groups according to their admission order: drug group (n = 60) and operation group (n = 60). In the drug group, estradiol 2 mg, midojun hydrochloride 5 mg and toterodine 2 mg / d were administered via vagina for 3 months. Routine transpaginal tension free urethral suspension (TVT).) in the operation group After 6 months treatment, the clinical effect was evaluated, the complications were observed in the operation group, and the adverse reactions were observed in the drug group. Before and after treatment for 3, 6 months, The urodynamic indexes (including maximum bladder volume (MBC), abdominal pressure leak point pressure, (VLPP), maximum urethral closure pressure (MUCP) and urinary incontinence volume), international urinary incontinence advisory committee urinary incontinence questionnaire summary table (ICI-Q-SF) and pelvic floor function (including resting period) were observed. Changes in the posterior angle of bladder urethra, urethral angle and length of proximal functional urethra during stress period. Results the total effective rate was 96.7% (58 / 60) in the drug group and 98.3% (59 / 60) in the operation group. After one month of treatment, the MUCP of MBCV VLPPN in the operation group was higher than that in the drug group (P 0.05), and the amount of urinary incontinence in the two groups was lower than that in the drug group (P 0.05), and there was no significant difference in the above indexes between the two groups after treatment for 36 months (P 0.05). The ICI-Q-SF score of the two groups was significantly lower than that of the control group at 1 and 6 months after treatment (all P 0.05). The ICI-Q-SF score of the drug group was higher than that of the operation group in one month, but there was no significant difference between the other two groups in the same period (P 0.05). In both groups, the posterior angle of bladder urethra decreased, the angle of urethra increased, but the length of proximal functional urethra did not change, but the length of proximal functional urethra decreased and the angle of urethra increased during stress period. The length of proximal functional urethra decreased. There were 3 cases of dysuria and 2 cases of urinary retention in the operation group, but there was no obvious adverse reaction in the drug group. Conclusion the efficacy of estradiol, midodrine hydrochloride and tolterodine in the treatment of mild to moderate FUSI is similar to that of TVT, but the incidence of adverse reactions is lower and the safety is higher.
【作者单位】：右江民族医学院附属医院;
【基金】：百色市科学研究与技术开发计划项目(150307)
【分类号】：R711.59

【参考文献】