经阴道悬带成形术治疗女性压力性尿失禁临床分析

Analysis on the Treatment of Female Stress Urinary Incontinence with Intravaginal Slingplasty

目的 评价经阴道悬带成形术 (intravaginalslingplasty ,IVS)治疗女性压力性尿失禁的疗效。 方法 从 2 0 0 3年 7月至 2 0 0 4年 1月在我院女性尿失禁特需门诊检查确诊为压力性尿失禁的 4 2例患者 ,在局麻下采用IVS治疗。对手术中的情况进行分析及治疗后的效果进行定期随访。结果 全部患者在局麻下完成手术 ,平均手术时间 2 9.5min ,术中出血量平均为 4 2 .6ml,37例患者术后 2h去除导尿管后能自行排尿 ,2 4h后导尿测残余尿 <10 0ml,术后4 8h出院 ;5例术后 2h去除导尿管后出现不同程度急迫性尿失禁症状 ,留置导尿管 4 8h后症状消失 ;出院时 4 2例中 4 0例主观完全治愈 ,2例轻微漏尿患者经定时训练排尿 5d后恢复正常排尿。 38例患者得到 1～ 6个月的随访。所有患者术后尿失禁症状都得到控制 ,无尿潴留、尿路感染和膀胱功能障碍。结论 IVS方法简单易学、操作安全、调节悬带松紧方便、术后恢复时间短且效果确切。

Objective To evaluate the effect of intravaginal slingplasty(IVS) in treatment of female stress urinary continence.Methods From July 2003 to Jan. 2004,forty-two patients with stress urinary incontinence were treated with IVS.The IVS tunneller with a blue stylet was punctured through median incision on anterior wall of vagina to reach posterior surface of pubis.After same procedure was finished on the other side,the cystoscopy was carried out to examine whether the bladder and ureter were injuried or not.The ends of the polypropylene tape were passed through the eye of each stylet,which was then brought up through the abdominal incision.Finally,the tension of the tape was adjusted to no leakage of urine.Results 42 patients were operated under local anesthesia.Mean blood loss was 42.6 ml,and mean operation time was 29.5 min.37 patients were able to micturate spontaneously 2 hours after operation and their volumes of residual urine were all less than 100 ml 24 hours after operation.They were discharged on the next day.In the remaining 5 cases,an in-dwelling catheter had to be used for 48 hours because of urge urinary incontinence.According to patients' self-assessment,40 of 42 patients were satisfied, and felt being cured.The rest of 2 patients with leakage of urine were able to mictuarat as normal person after 5 days of in-dwelling catheter.Thirty-eight patients were followed up for 1 to 6 months and urinary continence was controlled in every case.There was no urine retention,infection or bladder dysfunction.Conclusion IVS provides a simple,safe,short hospital stay and effective way to cure stress urinary incontinence