无张力阴道吊带及补片植入在女性盆底重建的临床研究

Clinical research of tension free vaginal tape obturator technique and mesh in female pelvic reconstruction surgery

目的探讨经闭孔无张力阴道吊带悬吊术（TVT-O）治疗压力性尿失禁（SUI）临床疗效及阴道壁脱垂补片植入修补临床疗效、手术安全性评价。方法对18例SUI患者行TVT-O手术治疗。采用无张力网状吊带,自阴道前壁切口经耻骨前向两侧股部皱襞穿刺,将吊带无张力置于尿道中段。其中8例合并阴道壁脱垂患者采用放置补片的阴道前后壁修补术。结果18例患者,单纯行TVT-O手术10例,平均手术时间（15±2）min,术中出血（10±3）ml,平均住院时间1.5d。8例前后壁脱垂合并SUI患者,平均手术时间（110±13.5）min,术中出血（152±12.3）ml,平均住院时间5-7d。18例患者全部顺利完成手术,且无一例膀胱、尿道、直肠损伤及吊带、补片侵蚀并发症发生。结论TVT-O及补片在治疗SUI及女性盆底重建手术中的应用操作简便、易于掌握、并发症少、安全性高,术后患者复发率低,新的术式对盆底功能重建治疗具有积极意义,疗效明显、术式安全。

Objective Approach the clinical effect of tension free vaginal tape obturator technique procedure in the treatment of female stress urinary incontinence, simultaneously evaluate the clinical effect arid safety of mesh in colporrhaphia anterior - posterior. Methods Eighteen patiens were underwent the operation of TVT - O. Incising the paries anterior vaginase and puncturing amhi - thigh plica through ante - pubis, then placing the mesh non - tension in urethra midpiece. Among the total,eight SUI patients with vaginal wall prolapse were performed colporrhaphia anterior - posterior with mesh. Results Ten patients were underwent the operation of TVT - O merely, the mean operation time was （15 ± 2）min, the mean hemorrage was （10 ± 3 ）ml, the mean length of stay was 1.5 day. Another 8 SUI patients with vaginal wall prolapse ,the mean operation time was （ 110 ± 13.5 ） min ,the mean hemorrage was（ 152 ± 12.3 ） ml, the mean length of stay was 5 -7 day. All the 18 patients were successfully fulfiled the operation, without any complication such as injuring the bladder,urethra,rectum or erosion of vaginal tape and mesh. Conclusions The application of TVT- O and mesh in female pelvic reconstruction surgery was convenient and easy, furthermore the surgery had less complication, higher security,lower relapse rate. The new technique possesss the obvious therapeutic effect and the reliable security, so it is significant for female pelvic reconstruction surgery.