经阴道无张力尿道中段悬吊术治疗女性压力性尿失禁的临床应用(附21例报告)

TVT therapy for female stress urinary clinical application (21 cases)

目的探讨女性压力性尿失禁的发病机制和微创治疗方法,提高临床治疗效果。方法女性压力性尿失禁患者21例,经临床检查、尿动力学检查或膀胱尿道造影确诊,均为稳定性膀胱,无膀胱出口梗阻。均采用经阴道无张力尿道中段悬吊术(TVT),将聚丙烯吊带无张力置于尿道中段。结果该组21例,手术时间35～55min,平均(45±10)min;术中出血量20～30mL,平均(25±5)mL;术后留置导尿管1～3d,平均2d;术后住院时间3～5d,平均4d。术中膀胱穿孔1例,重新穿刺安装成功,术后保留导尿管2周,痊愈;术后出现尿潴留1例,留置导尿管1周,尿潴留症状消失。术后随访1～27个月,治愈18例,有效3例,治愈率85%,总有效率100%。结论 TVT是治疗女性压力性尿失禁的微创术式,操作简单,手术创伤小,疗效好,并发症少,住院时间短,甚至可以在门诊进行手术,目前是女性压力性尿失禁外科手术治疗的发展方向,已趋向成为治疗女性压力性尿失禁的金标准。

Objective To evaluate the value of mini-invasive treatment in female stress urinary incontinence, improve clinical therapy effects. Methods 21 patients were treating with TVT operation. All the patients were confirmed to have stable bladder without outlet obstruction via clinical routine and urodynamic examination and bladder urethra shadow before operation. TVT was implanted around midurethra. Results In 21 cases, the opera-tion time was 35-55 min, average （45 ± 10） min; the intraoperative bleeding was 20-30 ml, average （25 ± 5） mL; The catheterization time was 1-3 days, average 2 days; hospital stay time was 3-5 days, average 4 days. bladder perforation during procedure 1 cases, over again puncture install succeed, after treatment keep down catheterized for 2 week was cured. urinary retension after TVT 1 cases who were catheterized for 1 week; then the urine retention disappeared. Postoperative got a 1-27months follow up, 18 cases were cured and 3 cases improved greatly, cured rate 85%,overall efficiently rate 100%.Conclusion Simple reliable, mini-invasive surgery, therapeutics right, few complications and with hospital stay time farside, ever operation being in the policlinic,such as TVT, can be widely used to treat FSUI, and incline to become golden standard.