经闭孔无张力吊带尿道中段悬吊术治疗女性压力性尿失禁38例临床分析

Treatment for female stress urinary incontinence with tension-free vaginal tape obturator procedure： clinical analysis of 38 cases

目的探讨经闭孔无张力尿道中段悬吊术（TVT—O）治疗女性压力性尿失禁的临床效果及并发症。方法对36例单纯压力性尿失禁（轻度16例，中度18例，重度2例）和2例混合性尿失禁患者行TVT—O治疗。记录手术时间和出血情况，并对术后效果进行随访，观察其疗效及并发症情况。结果患者平均年龄56．4岁，手术时间30～50min，平均为38．3min；术中出血量少。无膀胱及尿道损伤，无静脉损伤（血肿或流血），无神经并发症。术后4例（10．5％）患者尿潴留，其中3例保留尿管10～14d后拔出尿管，再测残余尿〈100ml，1例保留尿管至术后9d仍排尿困难，局部麻醉下调整吊带位置位于尿道中段后即可自行排尿通畅。34例患者随诊2～29个月，平均12．7个月，27例（71．1％）患者主观完全治愈；4例（10．5％）主观症状较术前改善，2例（5．3％）无效，1例混合性尿失禁患者术后压力性尿失禁症状治愈，但急迫性尿失禁症状无缓解。结论TVT—O具有微创、安全、有效的特点，术中不需常规行膀胱镜检查，无术后并发症，但手术的长期效果有待长期随访和观察。

Objective To determine the effectiveness and complications of tension-free vaginal tape obturator procedure （TVT-O） as a new surgical treatment method for female stress urinary incontinence （SUI）. Methods TVT-O was undergone for 36 female patients with established SUI （including 16 mild cases, 18 moderate cases and two severe cases） and two cases with mixed urinary incontinence （MUI）. Operation time and intra-operation bleeding in the patients were analyzed. The patients were followed-up to observe the effectiveness and complications of this new procedure. Results Age of the 38 patients undergone with this procedure averaged 56.4 years, with a mean operation time of 38.3 minutes, ranging from 30 to 50 minutes. Patients were followed up for two to 29 months （averaging 12.7 months） , with four cases lost to follow-up. No bladder or urethral injuries, and no vascular （hematoma or bleeding ） and neurological complications were encountered in 38 of them after the procedure. Among four cases （ 10. 5 percent） complicated with urinary retention, catheter was removed in ten to 14 days after its indwelling in three cases, with residual urine less than 100 ml. Only one patient still had dysuria nine days after catheter indwelling, but her symptoms improved by adjusting the position of sling to the middle of her urethra under local anesthesia. Twenty-seven cases （71.1 percent） were fully cured without any subjective symptoms left, symptoms improved in four cases （10. 5 percent） , no response in two cases （5.3 percent） , and symptoms of SUI disappeared in one case of MUI, but no release in her urgency urinary incontinence. Conclusions TVT-O procedure is a mini-invasive, safe, effective, accurate and quick surgical operation in treatment for female SUI, unnecessary with regular cystoscopy during the procedure. But its long-term effectiveness is still under follow-up and observation.