经闭孔无张力尿道中段悬吊术治疗女性压力性尿失禁的疗效

To evaluate the treatment of stress urinary incontinence by the transobturaor tension-free vaginal tape surgery

目的:探讨经闭孔无张力尿道中段悬吊术(Transobturator tension-free vaginal tape surgery,TVT-O)治疗女性压力性尿失禁(Stress urinary incontinence,SUI)的疗效及安全性。方法:回顾性分析2005年1月-2006年6月接受TVT-O的36例女性SUI患者的临床资料,随访时间1-18个月,其中I型I、I型SUI 32例(88.9%),I型或II型SUI伴内括约肌功能缺陷(ISD)4例(11.1%)。TVT-O的麻醉均采用腰麻。结果:36例女性SUI患者尿垫试验术前为20.6±3.7 g,术后为7.6±2.2 g,两者比较差异有统计学意义(P<0.01);尿失禁症状评分术前为18.2±1.7分,术后为1.2±2.1分,两者比较差异有统计学意义(P<0.01)。术后达到完全控尿者28例(77.8%),有效控尿者8例(22.2%),未出现无效患者。术中无明显并发症,术后并发症主要表现为大腿内侧不适、尿频、尿急及排尿不适,未出现尿潴留、膀胱破裂、阴道壁或尿道糜烂等严重并发症。结论:TVT-O是目前治疗女性SUI的一种有效、安全的微创手术。

Objective：To evaluate the efficacy and safety of the transobturator tension-free vaginal tape （TVT- O） surgery, a minimally invasive surgery for treating patients with the stress urinary incontinence （SUI）. Methyls：There are 36 patients who were diagnosed as the stress urinary incontinence and treated by the TVT-O surgery in review study. The follow-up time is from 1 to 18 months. Of all there were 32 patients（88.9%） in Type Ⅰ or Type Ⅱ of SUI, 4 patients（11. 1%） with the Intrinsic sphincter defieiency（ISD）. All patients had TVT-O surgery under the lumbar anaesthesia. Through comparing the Pad test, the ICI-Q-SF before and after operation, the effect and safe of TVT-O surgery were analysed. And complications during and after surgery were also analysed. Results：The result of Pad test before and after TVT procedure were 20.6±3.7 g and 7.6±2.2 g respectively, and the difference was obviously significant（ P 〈0.01）. The score of the ICI-Q-SF before and after the surgery were 18.2±1.7 and 1.2±2. 1 respectively, and the difference was obviously significant（ P 〈0.01）. 28 patients（77. 8% ） reached complete control after the surgery, effective control in 8 patients（22.2%）, and no failure. No significant intraoperative complications were observed. Postoperative complications included the complaint of femoribus internus, frequency, urgency and the complaint of urination. There were no urinary retention, femoribus internus and vaginal or urethral erosion occurred in 36 patients. Conclusions： TVT-O surgery is an effective, safety minimally invasive management to treat the stress urinary incontinence.