中段尿道吊带术治疗女性压力性尿失禁的多中心研究

A multicenter study of mid urethral sling procedures in treatment of female stress urinary incontinence

目的探讨中段尿道吊带术治疗女性压力性尿失禁的临床疗效、手术指征和并发症的处理。方法单纯压力性尿失禁的患者304例和混合性尿失禁的患者8例，均为女性，纳入本研究。其中接受TVT吊带术134例，TVTO吊带术167例，Monarc吊带术11例。围手术期评估包括：手术时间、出血量、术中术后并发症。手术效果分为治愈、显效、无效。在患者出院时、术后3个月、术后每年评价疗效和并发症。结果TVT组手术时间（18．5±9．6）min和出血量（32．2±12．6）ml多于TVTO组（11．5±3．1）min，（12．8±8．5）ml和Monarc组（11．1±2．6）min，（12．3±3．5）ml（P〈0．05）。三种术式均有较高的治愈率和显效率，小同术式的近期和中长期治愈率、显效率和无效率差异无统计学意义（P〉0．05）。单纯压力性尿失禁患者治愈率（95．7％）显著高于混合性尿失禁患者（37．5％）（P〈0．01）。3种术式的总并发症发牛率差异无统计学意义，但膀胱损伤仅发生在TVT组，闭孔神经损伤和阴道损伤仅发生在TVTO组。术后排尿困难和尿潴留是中段尿道吊带术的最常见并发症。结论经耻骨上途径（TVT）和经闭孔途径（TVTO、Monarc）中段尿道吊带术治疗压力性尿失禁均具有手术简单、微创、中长期疗效好、并发症少等优点。

Objective To investigate the clinical efficacy, surgical indications and postoperative complications of mid urethral sling procedures in treatment of female stress urinary incontinence. Methods A multicenter clinical trial was conducted from April 2002 to April 2008 in five hospitals, 304 cases of genuine stress urinary incontinence and 8 cases of mixed incontinence were included. TVT procedures were carried out in 134 patients, TVTO procedures in 167 patients, Monarc procedures in 11 patients. Perioperative evaluations included： operating time, bleeding volume, and perioperative complications. Operative efficacy was classified into three categories： cure, improved and failure and evaluated before discharge, 3 months after surgery and then every year. Results TVT group had longer operating time [ （ 18.5 ±9.6） min] and more bleeding volume [ （32. 2 ± 12. 6） ml] than those in TVTO group [ （ 11.5 ± 3.1）min,（12.8±8.5）ml] and in Monarc group [（11.1 ±2.6）min,（12.3±3.5） roll with P〈0.05. Monarc and TVTO procedures had higher cure rates and improve rates comparing with TVT, but the differences were of no significance. The cure rate （95.7%） in patients with genuine stress incontinence were significantly higher than that in patients with mixed incontinence （37.5%）. No significant differences of total intra- and postoperative complications were noted for all of the three procedures. However, bladder injury tended to occurred in TVT group and obturator nerve injury and vaginal injury tended to occurre in TVTO group. Transient voiding dysfunction and urinary retention were the most common complications. Conclusions Mid urethral sling procedures have excellent clinical outcomes in the treatment of female stress urinary incontinence.