可调节单切口尿道中段吊带术治疗女性压力性尿失禁的临床疗效与安全性分析

Efficacy and safety of adjustable single incision sling in the treatment of female stress urinary incontinence

目的分析可调节单切口尿道中段吊带术治疗女性压力性尿失禁（SUI）的临床疗效及安全性。方法 2012年11月至2014年5月应用可调节单切口吊带治疗女性SUI患者43例,年龄（58.6±10.1）岁。单纯性SUI 33例,合并急迫性尿失禁（UUI）患者10例。所有患者手术前后均填写国际尿失禁咨询委员会尿失禁问卷简表（ICI-Q-SF）、尿失禁影响问卷简表（IIQ-7）。合并膀胱过度活动症患者手术前后填写膀胱过度活动症症状评分表（OABSS）;仍有性生活患者手术前后填写国际盆底器官脱垂/尿失禁患者性生活质量问卷简表（PISQ-12）。所有患者术后填写患者整体印象改善度问卷（PGI-I）。结果 43例患者手术均顺利,随访7~25个月。手术时间（26.8±6.0）min,估计出血量（21.5±5.1）mL。治愈30例（69.8%）,改善12例（27.9%）,总有效率97.7%,效果不理想1例（2.3%）。手术前后ICI-Q-SF评分分别为（14.2±3.9）、（1.8±3.0）分;IIQ-7评分分别为（9.6±5.0）、（0.8±1.9）分;合并UUI患者OABSS评分分别为（9.2±2.1）、（3.6±2.9）分;有性生活患者PISQ-12评分分别为（30.3±5.1）、（32.3±4.0）分。以上问卷评分结果手术前后均有统计学差异（P〈0.05）。术中均未出现并发症。术后出现一过性尿潴留1例;排尿不畅7例;术后6周内出现疼痛8例。无长期疼痛、盆腔血肿、感染、瘘管等并发症发生。结论可调节单切口尿道中段吊带术操作简单、手术时间短、创伤小、临床疗效显著、并发症少、安全性较高,是治疗女性压力性尿失禁安全、有效的方法。

Objective To evaluate the efficacy and safety of adjustable single incision sling in female stress urinary incontinence（SUI）.Methods Clinical data of 43 female SUI cases treated with adjustable single incision sling during Nov.2012 and May 2014 were retrospectively analyzed.The patients included 33 cases with simple SUI,and 10 cases complicated with urge urinary incontinence（UUI）.The patients’average age was（58.6±10.1）years.All patients filled out ICI-Q-SF and IIQ-7 questionnaires before and after operation.Patients with UUI filled out OABSS questionnaire,and patients who still had sexual life filled out PISQ-12 questionnaire before and after operation.All patients filled out PGI-I questionnaire after operation.Results All operations were successful.The mean operation time was（26.8±6.0）minutes and the mean estimated blood loss was（21.5±5.1）mL.Of all patients,30 were cured（69.8%）,12 were improved（27.9%）,and 1 case remained unimproved（2.3%）.The pre-and post-operative ICI-Q-SF scores and IIQ-7scores were 14.2±3.9 vs.1.8±3.0,and9.6±5.0vs.0.8±1.9,respectively.The pre-and post-operative OABSS scores were 9.2±2.1 vs.3.6±2.9 in the 10 cases with UUI.The preand post-operative PISQ-12 scores were 30.3±5.1 vs.32.3±4.0in the 16 cases who still had sexual life.There were statistical differences between the pre-and post-operative scores（all P〈0.05）.No complications were recorded during the operation.During the follow-up of 7 to 25 months,temporary urinary retention occurred in1 case,mild dysuria occurred in7 cases,and short-term pain occurred in8 cases within six weeks after operation.No long-term pain,pelvic hematoma,infection and fistula were observed.Conclusion Adjustable single incision sling seems to be a simple and minimally invasive procedure with few complications and short operation time,which is safe and reliable in the treatment of female SUI.