Jarvis Sherin K, Abbott Jason A, Lenart Meegan B, Steensma Anneke, Vancaillie Thierry G
Department of Endo-Gynaecology, Royal Hospital for Women, University of New South Wales, Sydney, Australia.
Aust N Z J Obstet Gynaecol. 2004 Feb;44(1):46-50. doi: 10.1111/j.1479-828X.2004.00163.x.
To investigate whether botulinum toxin type A (BOTOX) injected into the levator ani muscles of women with objective pelvic floor muscle spasm decreases pain symptoms and improves quality of life.
A prospective cohort study.
Outpatient clinic in a tertiary referral centre, Sydney, Australia.
Twelve women, aged 18-55 years, with objective pelvic floor muscle hypertonicity and a minimum 2-year history of chronic pelvic pain were recruited.
All women completed visual analog scale pain assessments; questionnaires relating to bladder and bowel symptoms and quality of life; and specific examinations. Forty units of BOTOX at three different dilutions were given bilaterally into the puborectalis and pubococcygeus muscles under conscious sedation.
Median visual analog scale scores were significantly improved for dyspareunia (80 vs 28; P=0.01) and dysmenorrhea (67 vs 28; P=0.03), with non-significant reductions in non-menstrual pelvic pain (64 vs 37) and dyschesia (47 vs 29). Pelvic floor muscles manometry showed a 37% reduction in resting pressure at week 4 and a 25% reduction was maintained at week 12 (P <0.0001). Quality of life scores (EQ-5D and SF-12) were improved from baseline at week 12, but did not reach statistical significance. Sexual activity scores were markedly improved, with a significant reduction in discomfort (4.8 vs 2.2; P=0.02) and improvement in habit (0.2 vs 1.9; P=0.03). These results were not influenced by dilution.
There is evidence from the present pilot study suggesting that women with pelvic floor muscles hypertonicity and pelvic pain may respond to BOTOX injections into the pelvic floor muscles. Further research into this novel treatment of chronic pelvic pain is strongly recommended.
研究向存在客观盆底肌痉挛的女性肛提肌注射A型肉毒杆菌毒素（保妥适）是否能减轻疼痛症状并改善生活质量。
一项前瞻性队列研究。
澳大利亚悉尼一家三级转诊中心的门诊。
招募了12名年龄在18至55岁之间、存在客观盆底肌高张力且有至少2年慢性盆腔疼痛病史的女性。
所有女性均完成视觉模拟评分疼痛评估；与膀胱和肠道症状及生活质量相关的问卷；以及特定检查。在清醒镇静状态下，将三种不同稀释度的40单位保妥适双侧注射到耻骨直肠肌和耻骨尾骨肌中。
性交困难（80对28；P = 0.01）和痛经（67对28；P = 0.03）的视觉模拟评分中位数显著改善，非经期盆腔疼痛（64对37）和排便困难（47对29）有非显著降低。盆底肌测压显示第4周静息压力降低37%，第12周维持在降低25%（P <0.0001）。生活质量评分（EQ - 5D和SF - 12）在第12周时较基线有所改善，但未达到统计学显著性。性活动评分显著改善，不适显著减轻（4.8对2.2；P = 0.02），习惯改善（0.2对1.9；P = 0.03）。这些结果不受稀释度影响。
本初步研究有证据表明，存在盆底肌高张力和盆腔疼痛的女性可能对盆底肌注射保妥适有反应。强烈建议对这种慢性盆腔疼痛的新疗法进行进一步研究。
