妇科手术后即时行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

Trans-Obturator Tension Free Vaginal Tape for Female Stress Urinary Incontinence during Gynecologic Surgery

目的探讨妇科手术后即时行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的可行性,并观察疗效。方法对12例妇科良性疾病合并压力性尿失禁患者,实施妇科手术后即时行经闭孔无张力吊带尿道中段悬吊术。对9例患者实施阴式子宫全切＋阴道前后壁修补术,3例行腹腔镜辅助下阴式子宫切除术。记录手术时间、出血量、术后排尿情况,并进行随访、观察疗效及并发症。结果经闭孔无张力吊带尿道中段悬吊术手术时间平均为19.8 min,出血量平均为22 ml。所有患者尿管拔出后均排尿通畅,无膀胱及尿道损伤,无血肿及神经损伤并发症。术后随访时间2-12个月,平均8.2个月;12例患者均无尿失禁发生,主观治愈率100%。结论妇科手术后即时行经闭孔无张力吊带尿道中段悬吊术是可行的。经闭孔无张力吊带尿道中段悬吊术手术时间短,不增加创伤及感染机会,可以避免患者二次手术,减少医疗费用,并且近期疗效可靠。术中损伤膀胱机会小,不需膀胱镜检查,方便妇科医生开展。

Objective To explore the feasibility of trans-obturator tension-free vaginal tape for female stress urinary incontinence （SUI） performed during gynecologic surgery. Methods Twelve females with benign gynecologic disease and stress urinary incontinence were treated with trans-obturator tension free vaginal tape during gynecologic surgery. Nine patients had uterine and vaginal anterior wall prolapse, 2 with uterine myoma and 1 with endometriosis. The operation time, blood loss and complications were recorded. Results The patient＇s average age was 58.5 years. All the TVT-O operations were finished between 15- 25 minutes （mean 19.8 minutes） and with the estimated blood loss of 20--40 ml（mean 22 ml）. None of them had bladder injury, hematoma or nerve damage. During follow up from 2 to 12 months （mean 8.2 month）, 12 patients were cured successfully without urinary incontinence recurring. The cure rate was 100%. Conclusion Trans-obturator tension-free vaginal tape during gynecologic surgery is a practical procedure with little more operating time, less risk of infection, minimal invasion and better outcomes for patients with gynecologic disease and stress urinary incontinence. Colposcopy is not necessary because less risk of injury to the bladder.