经阴道耻骨上自体筋膜膀胱颈吊带术治疗女性Ⅲ型压力性尿失禁

Pubvaginal fascia sling cystourethropexy treat of type Ⅲ female stress urinary incontinence

目的 探讨经阴道耻骨上自体筋膜膀胱颈吊带术（PV sling）治疗女性Ⅲ型压力性尿失禁（SUI）的疗效.方法 女性Ⅲ型SUI患者9例,其中TVT术后无效3例,先天性尿道括约肌发育不良2例,骨盆骨折致尿道括约肌受损1例,初诊Ⅲ型SUI 3例.9例均接受PV sling手术.选用自体梭形腹直肌筋膜条,调整固定线张力,使筋膜条对膀胱颈保持恰当的悬吊挤压力.术后行1 h尿垫试验和膀胱残余尿测定,术后3个月行最大尿流率（Qmax）、最大尿道闭合压（MUCP）和腹腔漏尿点压（ALPP）测定,评估疗效.结果 9例手术时间平均75（60～90）min,术中出血量平均76（60～100）ml.术中发生膀胱穿孔2例,术后切口感染1例,经引流换药后治愈.术后5 d拔除尿管,排尿良好4例;出现尿潴留1例,经间歇导尿12 d后恢复自主排尿.8例随访3～28个月,外伤后尿失禁1例术后1个月复发,完全控尿7例.1 h尿垫实验由术前平均58（45～75）g降至1.1（0～2）g;平均残余尿〈65（0～80）ml.6例术前Qmax、MUCP和ALPP分别为（10.5±2.7）ml/s,（1 5.5±3.4）cmH2O和（40.4±8.2）cm H2O,术后3个月分别为（26.5±3.9）ml/s,（49.8±6.7）cm H 2O和（98.6±12.2）cm H2O,手术前后比较差异有统计学意义（P〈0.01）.结论 经阴道耻骨上自体筋膜膀胱颈吊带术治疗女性Ⅲ型压力性尿失禁安全有效.

Objective To assess the pubvaginal fascia sling cystourethropexy （PV sling） technique and outcomes of the treatment of female type Ⅲ stress urinary incontinence. Methods From October 2005 to January 2008, 9 women presenting with type Ⅲ stress urinary incontinence were treated with Pubvaginal fascia sling cystourethropexy. All the patients underwent 1 h pad test before discharge and were tested with maximum uroflow rate, volume of postal residual urine, maximum urethral close pressure （MUCP） and abdominal leak point pressure （ALPP） after 3 months. Results The operative time ranged from 60 to 90 min （mean, 75 min）. Estimated blood loss ranged from 60 to 100 ml （mean, 76 ml）. Intraoperative unilateral bladder perforation occurred in 2 cases. One patient with infection of abdominal incision was cured by changed dressings. The urinary catheter was removed 5 days post-operation. 4 patients had normal urination and 1 patient had urine retention. The recovery following intermittent catheterization was 3-12 days. 8 patients got 3-28 months＇ follow up. 7 patients were cured with 1 h pad test decreased from preoperative 58 g （45-75 g） to postoperative 1 g （0-2 g）, mean residual urine was less 65 ml （0-80 ml）. The values of Qmax （ml/s）,MUCP （cm H2O） and ALPP （cm H2O） were 10. 5±2. 7, 15. 5±3. 4 and 40. 4±8.2 pre-opreative,and 26.5±3.9, 49.8±6.7 and 98.6± 12.2 3 months post-operative. There were significant differences of these parameters between pre-and post-operation （p〈0.01）. Conclusions PV sling could be a safe and effective surgical procedure fortreatment of type Ⅲ female stress urinary incontinence.