CO<sub>2</sub>点阵激光与行为训练治疗女性膀胱过度活动症的对比研究

马瀚博; 吴丝雨; 童晓文; 李怀芳

doi:10.16766/j.cnki.issn.1674-4152.002128

CO₂点阵激光与行为训练治疗女性膀胱过度活动症的对比研究

doi: 10.16766/j.cnki.issn.1674-4152.002128

同济大学附属同济医院妇产科，上海 200065

基金项目:

国家自然科学基金面上项目 81771560

国家自然科学基金面上项目 81873827

国家自然科学基金面上项目 82071630

详细信息

通讯作者:
李怀芳，E-mail：huaifangli@126.com

中图分类号: R694 R454.2
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- 被引次数: 0
出版历程
- 收稿日期: 2020-10-15
- 网络出版日期: 2022-02-15

Comparative study of fractional CO₂ laser and behavioural training in the treatment of overactive bladder in women

Department of Obstetrics and Gynecology, Tongji Hospital, Tongji University School of Medicine ，Shanghai 200065，China

摘要

摘要: 目的探讨与行为训练治疗相比使用CO₂点阵激光治疗女性膀胱过度活动症(overactive bladder, OAB)的疗效及安全性。方法选取2018年8月1日—2020年1月30日就诊于上海市同济医院妇科的女性OAB患者共60例，采用随机数字表分为CO₂点阵激光治疗组(观察组)与行为训练治疗组(对照组)，各30例。治疗1个月及3个月后分别进行随访，以膀胱过度活动症症状评分(OABSS)、尿急症状评分、24 h排尿次数、盆腔脏器脱垂/尿失禁性功能问卷(PISQ-12)及尿动力学等指标评估治疗效果。结果治疗3个月后，观察组的治疗效果明显优于对照组。观察组和对照组的OABSS、尿急症状评分、24 h排尿次数分别为(1.87±0.81)分和(5.61±1.62)分、(1.04±0.27)分和(1.64±1.17)分、(6.41±1.28)次和(10.07±3.21)次，差异有统计学意义(均P < 0.05)。2组的PISQ-12问卷总分、情感因素、生理因素评分分别为(47.75±5.16)分和(35.97±5.65)分、(21.68±2.43)分和(14.96±3.76)分、(21.05±2.52)分和(15.45±4.43)分，差异有统计学意义(均P < 0.001)，伴侣因素比较差异无统计学意义(P＞0.05)。2组患者治疗后均无尿路症状加重等不良反应发生。结论相比于行为训练治疗方式，CO₂点阵激光治疗女性OAB具有较好的疗效及安全性，并且能明显提高患者性生活质量，值得在临床中推广应用。
- 女性膀胱过度活动症 /
- CO₂点阵激光 /
- 行为训练治疗
Abstract: Objective To investigate the therapeutic effect and safety of fractional CO₂ laser on overactive bladder (OAB) in women compared with behavioural training. Methods A total of 60 female OAB patients who visited the Department of Gynecology, Tongji Hospital from August 1, 2018 to January 30, 2020 were selected. They were randomly divided into the fractional CO₂ laser group and behavioural training group, with 30 cases in each group, using a random number table. Follow-up was performed at 1 and 3 months after treatment. The overactive bladder symptom score (OABSS), urgency score, 24 h voiding frequency, pelvic organ prolapse/urinary incontinence sexual questionnaire (PISQ-12) and urodynamics were used to evaluate the therapeutic effect. Results Three months after treatment, the therapeutic effect of the fractional CO₂ laser group was significantly better than that of the behavioural training group. The OABSS, urination symptom score and 24 h voiding frequency between the fractional CO₂ laser group and behavioural training group were (1.87±0.81) points and (5.61±1.62) points, (1.04±0.27) points and (1.64±1.17) points, and (6.41±1.28) times and (10.07±3.21) times (all P < 0.05). The scores of the PISQ-12 questionnaire, including emotional factor and physiological factor, of the two groups were (47.75±5.16) points and (35.97±5.65) points, (21.68±2.43) points and (14.96±3.76) points, and (21.05±2.52) points and (15.45±4.43) points, and the difference was statistically significant (all P < 0.001). No significant difference was observed in partner factor (P>0.05). However, the PISQ-12 scores in the behavioural training group did not significantly differ before and after treatment. No adverse reactions such as aggravation of urinary tract symptoms occurred in both groups after treatment. Conclusion Compared with behavioural training, fractional CO₂ laser has better efficacy and safety in the treatment of female OAB and can significantly improve the quality of sexual life of patients, which is worth promoting in clinical applications.
- Female overactive bladder /
- Fractional CO₂ laser /
- Behavioural training treatment

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表 1 2组OAB患者一般临床资料比较(x ±s)

组别	例数	年龄(岁)	病程(月)	BMI	尿急症状评分(分)
观察组	30	56.48±5.77	3.22±0.71	23.42±2.88	23.11±2.56
对照组	30	54.73±6.12	3.07±0.82	22.98±3.11	24.01±2.17
t值		1.139	0.757	0.569	1.469
P值		0.259	0.451	0.572	0.147

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表 2 2组OAB患者治疗前后OABSS评分比较(x ±s，分)

组别	例数	治疗前	治疗1个月后	治疗3个月后	F值	P值
观察组	30	8.64±2.68	4.87±2.47^a	1.87±0.81^ab	74.300	< 0.001
对照组	30	8.43±2.27	7.24±1.67	5.61±1.62^ab	17.070	< 0.001
t值		0.328	4.354	11.310
P值		0.376	0.039	< 0.001
注：与同组治疗前比较，^aP < 0.05; 与同组治疗1个月后比较，^bP < 0.05。组别与时间存在交互作用(F_交互=21.784，P < 0.001)。

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表 3 2组OAB患者治疗前后尿急症状评分比较(x ±s，分)

组别	例数	治疗前	治疗1个月后	治疗3个月后	F值	P值
观察组	30	3.80±2.31	1.80±1.26^a	1.04±0.27^ab	26.150	< 0.001
对照组	30	3.60±2.72	2.57±1.21^a	1.64±1.17^ab	10.830	< 0.001
t值		0.338	2.414	2.737
P值		0.736	0.019	0.008
注：与同组治疗前比较，^aP < 0.05;与同组治疗1个月后比较，^bP < 0.05。组别与时间存在交互作用(F_交互=8.842，P < 0.001)。

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表 4 2组OAB患者治疗前后24 h排尿次数比较(x ±s，次)

组别	例数	治疗前	治疗1个月后	治疗3个月后	F值	P值
观察组	30	18.63±5.68	7.12±3.12^a	6.41±1.28^ab	97.050	< 0.001
对照组	30	16.14±6.24	12.37±4.07^a	10.07±3.21^ab	12.840	< 0.001
t值		1.616	5.607	5.801
P值		0.616	< 0.001	< 0.001
注：与同组治疗前比较，^aP < 0.05;与同组治疗1个月后比较，^bP < 0.05。组别与时间存在交互作用(F_交互=17.052，P < 0.001)。

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表 5 2组OAB患者PISQ-12问卷对比(x ±s，分)

组别	例数	治疗前				治疗1个月后				治疗3个月后
组别	例数	总分	情感因素	生理因素	伴侣因素	总分	情感因素	生理因素	伴侣因素	总分	情感因素	生理因素	伴侣因素
观察组	30	33.77±4.98	12.54±3.37	15.82±4.19	4.81±2.16	48.42±4.87^a	21.55±3.11^a	21.81±2.98^a	5.06±2.24	47.75±5.16^a	21.68±2.43^a	21.05±2.52^a	5.02±2.13
对照组	30	34.12±5.01	13.72±3.86	14.47±5.52	5.93±3.31	36.05±5.86	15.11±4.42	15.15±4.82	5.79±2.34	35.97±5.65	14.96±3.76	15.45±4.43	5.56±2.55
t值		0.271	1.261	1.067	1.552	8.892	6.527	6.437	1.234	8.432	8.222	6.018	0.890
P值		0.787	0.212	0.290	0.126	< 0.001	< 0.001	< 0.001	0.222	< 0.001	< 0.001	< 0.001	0.377
注：与同组治疗前比较，^aP < 0.001。在总分、情感因素、生理因素上组别与时间存在交互作用(F_交互分别为4.250，5.451，3.709，均P < 0.001)，伴侣因素组别与时间不存在交互作用(F_交互=0.477，P=0.819)。

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表 6 2组OAB患者治疗3个月后的尿动力学指标比较(x ±s)

组别	例数	RUV(mL)	MFR(mL/s)	BC(mL/cm H₂O)	MCC(mL)	FDV(mL)	SDV(mL)
对照组	30	17.74±2.33	18.25±2.25	22.87±4.77	238.85±19.21	118.41±15.48	169.79±18.87
观察组	30	11.05±3.15	19.17±2.37	27.74±4.84	271.75±19.97	138.56±14.87	183.51±16.98
t值		9.352	1.542	3.925	6.503	5.142	2.960
P值		< 0.001	0.129	< 0.001	< 0.001	< 0.001	0.004
注：1 cm H₂O=0.098 kPa。

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表 7 2组OAB患者治疗3个月后的SUC检查指标比较(x ±s，cm H₂0)

组别	例数	MUP	MCUP
观察组	30	68.77±13.13	77.24±12.89
对照组	30	52.50±12.31	59.47±12.16
t值		4.951	5.493
P值		< 0.001	< 0.001

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