Department of Endo-Gynaecology, Royal Hospital for Women, Sydney, Australia.
Toxicon. 2013 Mar 1;63:83-7. doi: 10.1016/j.toxicon.2012.11.018. Epub 2012 Dec 6.
The aim of this prospective study was to report the outcomes of pain and vaginal pressures of successive botulinum toxin type A injections for women with objective pelvic floor muscle overactivity and a two-year history of pelvic pain. Between 2005 and 2008, 37 women underwent injection of 100 IU of botulinum toxin type A into the puborectalis and pubococcygeous muscles with dysmenorrhoea, dyspareunia, dyschesia, and non-menstrual pelvic pain assessed using a visual analogue scale (VAS), and vaginal pressure measured by vaginal manometry, at 0, 4, 12 and 26 weeks from each injection. 26 women (70%) had one injection of botulinum toxin type A and 11 (30%) had 2 or more injections. The second injection was performed at the earliest at 26 weeks after the first, with subsequent injections having a median time to re-injection of 33.4 weeks (range 9.4-122.7 weeks). Single and repeated injections both demonstrated a statistically significant reduction in dyspareunia by VAS scores from 54 to 30 in the single injection group and from 51 to 23 in the multiple injection group (p = .001), non-menstrual pelvic pain VAS from 37 to 25 (p = .04), as well as vaginal pressures; 40 versus 34 cm H(2)O (p = .02). No statistically significant difference in dysmenorrhoea or dyschesia was observed for either group from their baseline scores. Multiple injections of botulinum toxin type A in women with pelvic floor muscle overactivity provide significant relief from dyspareunia and non-menstrual pelvic pain. The upper limit between re-injection is not yet determined, nor is the maximum number of treatments. Clinical outcomes for single and subsequent injection of botulinum toxin type A for recurrent pelvic pain are equivalent. Women who have had benefit from a single injection of botulinum toxin type A can be reassured that if symptoms reoccur, repeated injections can be expected to be equally efficacious.
本前瞻性研究旨在报告连续注射 100 单位肉毒毒素 A 治疗患有客观盆底肌肉过度活动和两年盆腔疼痛史的女性的疼痛和阴道压力结果。2005 年至 2008 年间，37 名女性接受了肉毒毒素 A 注射治疗，注射剂量为 100IU，注射部位为耻骨直肠肌和耻骨尾骨肌。注射后 0、4、12 和 26 周，使用视觉模拟量表（VAS）评估痛经、性交痛、排便困难和非经期盆腔痛，使用阴道测压法测量阴道压力。26 名女性（70%）接受了 1 次肉毒毒素 A 注射，11 名女性（30%）接受了 2 次或更多次注射。第 2 次注射最早在第 1 次注射后 26 周进行，随后每次注射的再注射中位数时间为 33.4 周（9.4-122.7 周）。单次和重复注射均显示出性交痛 VAS 评分从单次注射组的 54 分显著降低至 30 分（p=0.001），从多重注射组的 51 分显著降低至 23 分（p=0.04），非经期盆腔痛 VAS 评分从 37 分显著降低至 25 分（p=0.04），以及阴道压力也从 40 分显著降低至 34cmH2O（p=0.02）。两组的痛经和排便困难基线评分均无统计学差异。对于患有盆底肌肉过度活动的女性，多次注射肉毒毒素 A 可显著缓解性交痛和非经期盆腔痛。再次注射的上限尚未确定，最大治疗次数也不确定。单次和随后重复注射肉毒毒素 A 治疗复发性盆腔痛的临床效果相当。单次注射肉毒毒素 A 获益的女性可以放心，如果症状再次出现，重复注射也有望同样有效。
