经耻骨后和经闭孔尿道中段无张力悬吊术治疗女性压力性尿失禁的疗效观察

Comparison between retropubic and transobturator tension-free midurethral slings for female stress urinary incontinence

目的：观察经耻骨后和经闭孔尿道无张力悬吊术治疗女性压力性尿失禁（Stressurinaryinconti—nence，SUI）的疗效。方法：选择女性SUI患者198例，病程2-25年，平均7．3年；年龄41～78岁，平均58．3岁。采用经耻骨后无张力阴道吊带术（tension-freevaginaltape，TVT，57例为TVT组）或经闭孔尿道下无张力吊带术（transobturatorvaginaltapeinside-out，TVT—O，141例为TVT—O组）进行治疗。结果：本文患者随访6～120个月，179例（90．4％）治愈，其中TVT组平均随访86个月，治愈51例（89．5％），改善4例（7％）；TVT-O组平均随访38个月，治愈128例（90．7％），改善6例（4．3％）；疗效不佳9例（3．5％）。TVT组2例发生膀胱穿孔（3．5％），TVT-O组3例出现腹股沟血肿伴下肢大腿根部疼痛，2例出现短期单下肢活动障碍，但经保守治疗均好转；术后拔除尿管后排尿困难5例，其中TVT组2例，TVT-O组3例，经多次下压式尿道扩张及延长保留尿管后解除梗阻、恢复正常排尿4例；TVT组中1例采用尿道扩张无效而剪断悬吊带。结论：经阴道中段无张力悬吊术（尤其是TVT-O）操作简便，疗效佳，并发症少，是治疗女性SUI的有效方法。

Objective：To compare clinical effect between retropubic and transobturator tension-free midurethral slings for female stress urinary incontinence （SUI）. Method：One hundred and ninety-eight female patients suffered from SUI were enrolled in this study. The mean course of the disease was 7.3 （range, 2-25） years. The mean age of those patients was 58.3 （range, 41-78） years. The retropubic tension-free vaginal tape （TVT） was used in 57 cases, and the transobturator vaginal tape inside-out （TVT-O） was used in 141 cases. Result： All patients have been followed up for 6 to 120 months. One hundred and seventy-nine cases （90.4%） were cured. The mean fol- low-up period was 86 months in TVT group, and 38 months in TVT-O group. Cure rates of two groups were 89.5% （n=51） for TVT group and 90.7% （n=128） for TVT-O. Four cases （7%） were reported improvement in TVT group, and six cases （4.3%） in TVT-O group. However, the ineffective rate was 3.5% （n=9） in TVT- O group. Bladder perforation appeared in two patients in TVT group. Three cases of TVT-O group complained of the inguinal hematoma combined with pain of the root of the thigh. Transient dysfunction of unilateral lower limb was found in another three patients. The symptom was relieved after the conservative treatment. Five patients suf- fered from dysuria after their urinary catheters were removed, including two cases in TVT group and three in TVT-O group. The obstruction was relieved in four patients by using the down-forced urethral dilation and elon- gating the catheter indwelling. In TVT group, one patient who didfft response to the dilation was treated by cut- ting the sling suture. Conclusion：The tension-free transvaginal midurethral slings is an easy and effective procedure for treating female SUI, especially TVT-O procedure. Both TVT and TVT-O procedures have good clinical effect of few complication.