单切口微小Ajust吊带与经闭孔无张力尿道中段悬吊带治疗女性压力性尿失禁的比较

Comparison of Ajust sling vs. tension - free vaginal tape - obturator sling in the treatment of female stress urinary incontinence

目的通过与经闭孔无张力尿道中段悬吊带（TVT-O）的比较，探讨单切口微小Ajust吊带在女性压力性尿失禁（SUI）治疗中的有效性和安全性。方法入组80例初治女性SUI患者，采取信封法随机均分为两组，分别接受单切口微小Ajust吊带与TVT-O吊带治疗，并比较观察两组患者的基线资料、围手术期情况、并发症发生情况、治疗效果。结果Ajust组的手术时间、术中出血量、术后24 h视觉模拟评分（VAS）分别为（14.7±3.9） min、（14.5±5.7） ml、（2.7±0.8）分，均优于TVT-O组的（21.8±7.3） min、（20.4±7.9） ml、（3.8±1.1）分（t＝5.426，P＝0.000；t＝3.830，P＝0.000；t＝5.115，P＝0.000）。Ajust组腹股沟疼痛及并发症总例数分别为2、5例，均少于TVT-O组的10、21例（χ2＝6.275，P＝0.012；χ2＝14.587，P＝0.000）。Ajust组客观治愈率、主观治愈率分别为95.0%、95.0%，TVT-O组分别为95.0%、92.5%（P＝1.000，P＝0.000）。Ajust组和TVT-O组术后尿失禁问卷评分表（ICIQ-SF）评分、尿失禁生活质量问卷（I-QOL）评分、女性性功能指数（FSFI）评分分别为（1.6±0.9）、（95.8±5.6）、（29.5±7.9）和（1.5±1.1）、（96.5±4.4）、（30.3±7.1）分，均较术前的（13.2±2.9）、（55.7±10.3）、（22.4±6.8）和（13.8±2.4）、（57.0±7.7）、（21.9±7.2）分明显改善（Ajust组：t＝24.161，P＝0.000；t＝21.632，P＝0.000；t＝4.308，P＝0.000；TVT-O组：t＝29.466，P＝0.000；t＝28.169，P＝0.000；t＝5.254，P＝0.000），但两组间比较差异均无统计学意义（t＝0.445，P＝0.658；t＝0.622，P＝0.536；t＝0.476，P＝0.635）。 结论 单切口微小Ajust吊带与TVT-O吊带治疗女性压力性尿失禁的疗效相近，但是手术操作更简单，并发症更少，更安全。

Objective To compare the efficacy and safety of Ajust sling vs. tension-free vaginal tape-obturator （TVT-O） sling in the treatment of female stress urinary incontinence （SUI）.Methods Eighty female patients with SUI of initial treatment were randomized by envelope technique to either Ajust sling or TVT-O sling, and the baseline data, perioperative index, complications and treatment effect were compared between the two groups.Results The operation time was shorter, intraoperative blood loss was less, and postoperative visual analogue scale （VAS） score was better in the Ajust group [（14.7±3.9） min, （14.5±5.7） ml, （2.7±0.8） score] than those in the TVT-O group [（21.8±7.3） min, （20.4±7.9） ml, and （3.8±1.1） score; t=5.426, P=0.000; t=3.830, P=0.000; t=5.115, P=0.000]. The groin pain （2 cases） and the overall complication （5 cases） in the Ajust group were significantly decreased as compared with those in the TVT-O group （10 and 21 cases; χ2=6.275, P=0.012; χ2=14.587, P=0.000）. The objective cure rate and the subjective cure rate in the Ajust group were 95.0% and 95.0%, and those were 95.0% and 92.5% in the TVT-O group （P=1.000, P=0.000）. The postoperative ICIQ-SF score, I-QOL score, FSFI score in the Ajust group [（1.6±0.9）, （95.8±5.6）, （29.5±7.9） score] and those in the TVT-O group [（1.5±1.1）, （96.5±4.4）, （30.3±7.1） score] were significant different from those preoperation [（13.2±2.9）, （55.7±10.3）, （22.4±6.8） score in the Ajust group; （13.8±2.4）, （57.0±7.7）, （21.9±7.2） score in the TVT-O group; the Ajuest group： t=24.161, P=0.000; t=21.632, P=0.000; t=4.308, P=0.000; the TVT-O group： t=29.466, P=0.000; t=28.169, P=0.000; t=5.254, P=0.000], but there was no statistically significant difference between the two groups （t=0.445, P=0.658; t=0.622, P=0.536; t=0.476, P=0.635）.Conclusion As compared with TVT-O sling, Ajust sling is safe and effect in the treatment of female SUI with less complications.