TVT-O治疗女性压力性尿失禁的临床疗效及5年随访观察

Clinical Efficacy of TVT-O for Female Stress Urinary Incontinence and 5-year Following-up Observation

目的 分析经闭孔无张力阴道吊带悬吊术(TVT-O)治疗女性压力性尿失禁的有效性、安全性以及并发症,并通过5年随访分析TVT-O的复发及并发症的原因。方法 2008年7月至2009年8月应用TVT-O术治疗压力性尿失禁患者75例。通过记录手术时长、术中出血量、围手术期并发症及处理,评价该手术的短期临床疗效;并对患者进行随访观察5年,记录患者的主、客观治愈率,分析复发以及远期并发症原因等。结果 75例患者均成功行TVT-O术,手术时间约13~21分钟,平均(17.7±3.2)分钟;术中出血量2~12ml,平均(4.3±2.2)ml;全部患者术中均无膀胱穿孔及继发出血,术后3天拔除导尿管;5例患者拔除导尿管后出现不同程度排尿困难,7例术后大腿内侧疼痛,可耐受,其中6例术后1周内疼痛消失。1例随访1年内症状消失。主观治愈率90.67%,客观治愈率88.0%。术后随访中2例失访,1年随访有3例患者复发,5年随访时共5例患者复发,分析与既往曾行治疗压力性尿失禁(SUI)手术治疗有相关性,但总体治愈率与术后短期治愈率无明显统计学差异,随访时发现部分患者出现膀胱过度活动症(overactive bladder,OAB)。结论 TVT-O治疗女性压力性尿失禁疗效确切,安全有效,并发症少,适用于未行手术治疗过的单纯性压力性尿失禁患者,且5年疗效可靠。

Objectives To analyze the safety,efficacy and complications of transobturator vaginal mid-ure-thral suspension (TVT-O)for female stress urinary incontinence(SUI),and the reason of recurrent and com-plication during the 5-year following-up. Methods A total of 75 patients who were diagnosed SUI underwent TVT-O from July 2008 to August 2009 were evaluated the short-term efficacy through recording the operation time ,bleeding volume and complications. All the patients were followed up for 5 years postoperatively and recor-ded the subjective cure rate,objective cure rate,recurrent cases and long-term complications. Results All the patients underwent the operation were successfully treated. The mean operation time was 13~21 minutes [aver-age (17. 7 ± 3. 2)minutes]. The estimated blood loss in the operation was 2~12ml [average (4. 3 ± 2. 2)ml]. There was no vesical perforation or hematoma in our operation. Catheter was removed 3 days after the operation and 5 patients were troubled with dysuria at different degrees. 7 patients poured tolerated pain located inner thigh,which disappeared in a week postoperatively,except one patient. The postoperative subjective cure rate was 90 . 67% and objective cure rate 88 . 0%. Some patients who were not cured completely had been underwent other failed surgeries. Two patients did not finish the entire following-up. Three patients recurrent in one year after the operation,and another 2 during the next 4 years. It is believed to be associated with the previous anti-incontinence procedures. But there was no statistical difference between postoperation,1-year following-up and 5-year following-up for cure rates,but part of patients occurred OAB. Conclusions TVT-O is a safe and effective method with less complication in the treatment of SUI. It is suitable for the SUI patients who were not underwent other failed surgery for SUI,and TVT-O is effective and reliable in 5-year following-up.