TVT-SECUR“H”术式治疗女性压力性尿失禁短期疗效报告及文献分析

A short-term curative effect report and literature analysis of TVT-SECUR"H"procedure for the treatment of female stress urinary incontinence

目的:探讨新近开发的单切口尿道中段吊带术(TVT-SECUR)治疗女性压力性尿失禁(SUI)的有效性及手术关键。方法:回顾分析2009～2011年共16例SUI患者资料,ALPP均大于60cmH2O,施行"H"术式,术中以示指引导保持穿刺方向及穿刺层面。术后24、48及72h采用直观模拟量表(VAS)对患者术后早期切口疼痛进行评价,3个月时门诊随访评判疗效及并发症。结果:本研究中16例手术平均24min,无尿道膀胱损伤,无阴道穿孔,无吊带暴露、无明显肢体运动障碍及局部血肿形成,无明确伤口感染及排斥反应发生。术后24小时VAS为(2.6±1.5),术后3个月随访时总有效率为93.7%(15/16),一过性并发症包括排尿困难(2/16),急迫性尿失禁(5/16),泌尿系感染(4/16)。结论:TVT-SECUR"H"术式治疗SUI,操作简单,安全有效,并发症少。术中手指触摸引导有利于确定穿刺方向及深度,对保证术后疗效和减少并发症具有重要意义。

To explore the effectiveness of the more recently introduced single-incision mid-urethral sling （MUS） （TVT-SECUR） for female stress urinary incontinence （SUI） and the key factor of successful operation. Method：Analyze retrospectively the data of 16 cases of SUI patients underwent ＂H＂ procedure from 2009 to 2011. The ALPP was greater than 60 cmH20. During operation, index finger was helpful for guiding the direction and keeping the puncture level. Early postoperative incision pain was evaluation by visual analog scale （VAS） at 24 h, 48 h and 72 h postoperatively. Outpatient service followed up to judge the effect and complications for 3 months. Result：The mean operation time of the 16 cases is 24 mins. There were no urethral or bladder injury, no vaginal perfusion, no tape exposure, no significant limb exercise obstacle and local hematoma, no obvious wound infection and rejection reaction. Postoperative VAS was （2.6±1.5） at 24 hours. The total effective rate was 93. 7% （15/16） after 3 months follow-up. The temporary complications included urination difficulties （2/16）, urgency incontinence （5/16）, urinary tract infection （4/16）. Conclusion：TVT-SECUR ＂H＂ procedure is a simple, safe and effective minimal invasive surgery for SUI with fewer complications. In the skill, the fingers touch is of benefit to ascertaining the homing puncture direction and depth, which is of great significance to ensure the curative effect.