无张力性阴道吊带治疗女性压力性尿失禁的临床疗效

Clinical results of tension-free vaginal tape for surgical treatment of female stress urinary incontinence

目的探讨无张力性经阴道尿道中段吊带术(TVT)治疗女性压力性尿失禁(SUI)的临床疗效.方法对42例压力性或混合性尿失禁的女性患者进行了TVT手术治疗.年龄31～69岁,平均48岁,病程3～21年.行腹压漏尿点压(ALPP)测定.按照McGurire的方法分型,ALPP＞9.81kPa(Ⅰ型)8例,ALPP6.38～9.81kPa(Ⅱ型)12例,ALPP＜6.38kPa(Ⅲ型)22例.结果平均手术时间40 min(30～90 min),平均术后住院4.5 d(3～8 d).42例随访4～18个月,平均15个月,无SUI复发,34例单纯性SUI患者治愈32例,治愈率94.1%,显效2例(5.9%);8例混合性尿失禁患者中治愈7例,显效1例.术后发生尿潴留4例,1例作松解术,3例延长导尿管留置后缓解.42例术后均无尿失禁.结论TVT是治疗女性SUI安全有效的方法,手术安全易行,创伤小,康复快,近期效果满意.

ObjectiveTo describe the significance and primary clinical results of tension-free vaginal tape (TVT) for surgical treatment of female stress urinary incontinence (SUI).MethodsA prospective open study was conducted using a standardized protocol for pre- and post-operative evaluation.The study included 42 women (age range,31-69 years;mean,48 years; disease course,3-21 years) suffering from genuine stress or mixed urinary incontinence.Urodynamics,including abdominal leak-point pressure (ALPP),were determined. According to McGurire typing,8 cases had ALPP>9.81 kPa (TypeⅠ);12 cases,ALPP 6.38-9.81 kPa (TypeⅡ);22 cases,ALPP<6.38 kPa (Type Ⅲ).ResultsThe mean operative time was 40 min (range, 30-90 min).The mean postoperative hospital stay was 4.5 d (range,3-8 d).During a follow-up of 4-18 months (mean,15 months) no SUI recurred. Of the 34 women with genuine SUI, 32 (94.1%) were cured and 2 (5.9%) had improvement. Of the 8 women with mixed incontinence,7 were cured and 1 had significant improvement.Of the 42 women with SUI,4 developed postoperative retention;of them 1 needed surgical intervention and 3 relieved after 2 weeks’ indwelling catheter.None of the 42 cases had incontinence after surgery.ConclusionsOur results demonstrate that TVT procedure is a safe and effective surgical method for treatment of female stress urinary incontinence.