治疗女性压力性尿失禁手术吊带松紧不同调整方法的探讨

Comparison of Various methods in the sling adjustment in stress urinary incontinence surgery

目的：探讨经阴道尿道中段悬吊术治疗女性压力性尿失禁吊带松紧不同调整方法的效果及并发症发生情况。方法：回顾性分析2003年8月～2005年12月收治的399例单纯压力性尿失禁（Stress urinary incontinence，SUI）患者临床资料，其中行经耻骨后通路的经阴道无张力尿道中段悬吊术（Tension free vaginal tape，TVT）4例，经阴道悬吊成形术（Intravaginal slingplasty，IVS）126例，童式前路悬吊手术150例。经闭孔通路的阴道无张力尿道中段悬吊术（TVT-O）58例，改良TVT-O手术61例。对吊带松紧的调整分别采用诱发试验法、组织剪法、尿道棒法和艾利斯钳法，观察各种吊带松紧调整方法的效果及并发症。结果：采用诱发试验法128例，基本无效（偏松）2例（2／128），效果满意124例（124／128），尿潴留（偏紧）2例（2／128）；组织剪法98例。基本无效2例（2／98），效果满意93例（93／98），尿潴留3例（3／98）；尿道棒法96例，基本无效4例（4／96），效果满意87例（87／96）。尿潴留5例（5／96）；艾利斯钳法77例，基本无效5例（5／77），效果满意66例（66／77），尿潴留6例（6／77）例。总偏松发生率3．3％（13／399），偏紧发生率4．0％（16／399）。四组中以诱发试验法并发症发生例数最低．艾利斯钳法最高，但经统计学处理，四组间差异无统计学意义（P〉0．05）。结论：TVT是治疗压力性尿失禁非常有效的手术治疗方法，治疗效果的关键在于吊带调整的松紧程度。诱发试验法、组织剪法、尿道棒法和艾利斯钳法均为临床实用的有效调整吊带松紧的手段。其中诱发试验法对初学者较易掌握，并有可靠的治疗效果和很低的并发症发生率。在此方法基础上积累一定经验后采用其他方法可提高手术效率。

Objective：To analyze retrospectively the effect and complications of different methods in the sling adjustment in the treatment of stress urinary incontinence（SUI）. Methods： From August 2003 to December 2005, 399 patients with SUI were treated in Tongji hospital of Tongji University. Among them, 4 underwent tension free vaginal tape （ TVT）, 126 underwent intravaginal slingplasty（ IVS）, 150 underwent Tong＇ s Hammock anterior, 58 underwent tension-free vaginal tape-obturator（TVT-O） and 61 underwent modified TVT-O. Valsalva test, scissors test, stick test and Alice test were used respectively to adjust the stress of the sling, and the postoperative effect and complications of different tests were analyzed. Results：Valsalva test were used in 128 patients, 2 were ineffective（loose）, 124 were satisfied and 2 showed urine retention（tight）; Scissors test were used in 98 patients, 2 were ineffective, 93 were satisfied and 3 showed urine retention; Stick test were used in 96 patients, 4 were ineffective, 87 were satisfied and 5 showed urine retention; Alice test were used in 77 patients, 5 were ineffective, 66 were satisfied and 6 showed urine retention. The overall incidence rate of loose cases was 3.3 % （13/399） and tight cases was 4.0%（16/399）. In the four tests, Valsalva test had least complications while Alice test had most complications. However, no statistical significance was found among these four tests（P〉0.05）. Conclusions： Intravaginal urethra slingplasty was an effective surgery to treat stress urinary incontinence. There were multiple procedures in clinic treatment and the key point lied in the adjustment of the sling , and the difficulty to adjust appropriately the sling stress had limited its extensive use. Valsalva test, scissors test, stick test and Alice test were effective methods to adjust the sling stress based on clinical experience. Compared with other tests, Valsalva test was more complicated, but it was easier to grasp and enjoyed reliable effect and low complications. It could he the spri- ngboard to other methods for freshman so as to improve surgery efficiency.