盆底重建术同时行TVT-O治疗盆腔器官脱垂及压力性尿失禁临床疗效评价

Study on concomitant surgical correction of pelvic organ prolapse and TVT-O for treatment of stress urinary incontinence

目的 探讨经阴道盆底重建术同时行经闭孔途径聚丙烯网带尿道中段悬吊术（TVTO）治疗盆腔器官脱垂（POP）及压力性尿失禁（SUI）的临床疗效.方法 2005年1月至2010年12月首都医科大学附属北京朝阳医院共对符合纳入条件的302例POP患者行经阴道盆底重建术,其中合并轻～重度SUI而同时行TVT-O的92例患者为TVT-O联合手术组,90例合并轻度SUI但不同意同时行抗SUI手术患者为非联合手术组,无SUI也未行TVT-O联合手术的120患者作为对照组.对3组患者临床指标、疗效进行比较.结果 TVT-O联合手术组患者平均年龄[（62±11）岁]显著低于非联合手术组[（66±10）岁]和对照组[（65±10）岁]分别比较,差异均有统计学意义（P=0.007、0.038）；TVT-O联合手术组的手术时间比非联合手术组和对照组分别增加12.8 min及12.9 min分别比较,差异均有统计学意义（P=0.043、0.028）；术中出血量和术后住院时间各组间比较,差异无统计学意义（P＞0.05）.TVT-O联合手术组治疗SUI总有效率为96.7％ （89/92）,非联合手术组74.4％（67/90）的患者SUI症状无改善,对照组SUI新发病率9.2％（11/120）.结论 对POP患者行经阴道盆底重建术同时行TVT-O简便安全,能有效治疗SUI和预防其进展；单纯POP盆底重建术对SUI疗效有限,但术前从无SUI症状者的新发病率并不高于一般人群,不建议行预防性TVT-O.

Objective To investigate the necessity,safety and efficacy of transobturator tension-free vaginal tape （TVT-O） for treatment of stress urinary incontinence （SUI） during transvaginal corrective operation of pelvic organ prolapse （POP）.Methods From Jan.2005 to Dec.2010,92 patients undergoing transvaginal pelvic reconstruction surgery for correction of POP concomitant TVT-O for treatment of SUI in Department of Obstetrics and Gynecology affiliated to Beijing Chaoyang Hospital as concomitant surgery group were enrolled in this retrospective study matched with 90 patients with mild SUI without SUI surgery as nonconcomitant surgery group and 120 patients without SUI as control group.Variable clinical index,clinical efficacy and complications were compared among those three groups.Results Compared with those in the other two groups,the mean age [（62 ± 11） years] was lower （P =0.007,0.038）,the operation time only slightly increased （12.8 min and 12.9 min respectively） significantly in concomitant TVT-O group.The bleeding loss and the length of staying hospital after operation all exhibited no significant differences within three groups （P 〉 0.05）.The effective rate for SUI was 96.7% （89/92） in concomitant TVT-O group,corrective operation of POP was ineffective for 74.4% （67/90） SUI,9.2% （11/120） patients presented new SUI in the patients without SUI preoperatively.Conclusions TVT-O is a simple,safe and effective method in the treatment of SUI,which is more suitable for performing simultaneously during the corrective operation of POP.Efficacy of SUI correction was limited in those patients undergoing only pelvic reconstructive surgery.However,a preventive anti-incontinence procedure is not recommended because of the lower incidence in POP patients without SUI preoperatively.