压力性尿失禁4种不同手术方式治疗的临床效果分析

Effects Analysis of Four Different Surgical Treatments of Stress Urinary Incontinence

目的:分析应用尿道折叠术、耻骨后库柏韧带悬吊术(Burch)、阴道无张力尿道中段悬吊带术(TVT)以及经闭孔经阴道尿道中段悬吊带术(TVT-O)治疗压力性尿失禁(SUI)患者的临床效果。方法:回顾分析83例尿失禁合并子宫、阴道脱垂患者的临床资料,根据行不同手术治疗,将其分为行尿道折叠术组(32例)、Burch组(15例)、TVT组(22例)以及TVT-O组(14例),并对4组的术中、术后及并发症情况进行比较。结果:①TVT-O组患者手术时间最短77.6±4.0分钟,与其他3组比较,差异有统计学意义(P<0.05)。TVT-O组和TVT组的患者在手术时间、留置尿管时间和住院天数上,与尿道折叠术组和Burch组比较,差异均有统计学意义(P<0.05)。②TVT-O组吊带侵蚀1例,术后排尿困难1例;TVT组吊带侵蚀1例,术后排尿困难3例;Burch组排尿困难4例;尿道折叠术组外阴血肿2例,下肢静脉血栓形成1例,术后排尿困难7例。③TVT-O组手术治愈率最高100%,TVT-O组患者2年治愈率92.86%。结论:TVT-O操作简单、治愈率高,在保证较低手术并发症的同时,实现了2年随访期限内理想稳定的治疗效果。TVT-O术是目前治疗压力性尿失禁的比较理想的手术方法。

Objective：Four surgical treatments of stress urinary incontinence（SUI）were evaluated,which included urethral plication,retropubic cooper ligament suspension（Burch）surgery,middle urethral tension-free vaginal tape sling（TVT）transobturator tension-free vaginal tape sling（TVT-O）.Methods：Retrospective analysis of 83 patients with urinary incontinence caused by uterine and/or vaginal prolapsed was done.Their surgeries included urethral plication（32 cases）,Burch surgery（15 cases）,TVT（22 cases）,and TVT-O（14 cases）.Results：① TVT-O group had the shortest operation time 77.6 ± 4.0 minutes,compared with the other three groups,the difference was significant（P〈0.05）.The operation time,keeping catheter time and hospitalization in TVT-O and TVT groups were different from those in urethra plication group and the Burch group（P〈0.05）.② There was one case of sling erosion and one case of postoperative urine voiding difficulty in TVT-O group,one case of sling erosion and 3 cases of postoperative urine voiding difficulty in TVT group,4 cases of urine voiding difficulty in Burch group,2 cases of vulva hematoma,one case of lower extremity venous thrombosis,7 cases of postoperative urine voiding difficulty in urethral plication group.③ The cure rate was 100% in TVT-O group,the cure rate in two years after TVT-O was 92.86%.Conclusions：TVT-O technique has the characteristics of simple procedure,high cure rate,few complications,and stable therapeutic effect.TVT-O surgery is currently the ideal treatment of stress urinary incontinence.