经闭孔尿道中段无张力吊带术治疗女性压力性尿失禁疗效分析

Efficacy analysis of TOT operations alone and associated with other pelvic procedures in women with stress urinary incontinence

目的评价经闭孔尿道中段无张力吊带术（TOT）治疗女性压力性尿失禁的疗效和安全性。方法回顾性分析接受TOT手术的138例压力性尿失禁患者的临床资料,单纯行TOT手术患者103例作为单纯组,行TOT术联合子宫切除和/或阴道修补、盆底重建术患者35例作为联合组。所有患者随访3～48个月,平均19.3个月。采用ICI-Q-SF和PISQ-12量表评估手术效果,比较患者手术前后膀胱残尿量（PVR）和最大尿流率（Qmax）变化,评估手术造成远期膀胱出口梗阻（BOO）的风险。结果所有患者无膀胱损伤、尿道损伤、闭孔血管及神经损伤。单纯组治愈率90.8%,有效率95.6%;联合组治愈率87.1%,有效率91.4%。2组治愈率及有效率比较差异均无统计学意义（P均＞0.05）。2组患者各自术后症状及QOL评分较术前均显著改善（P均〈0.01）。2组有性生活患者术后PISQ-12评分与术前相比有明显改善（P均〈0.05）。2组各自手术前后Qmax及PVR比较差异均无统计学意义（P均＞0.05）。结论 TOT术治疗女性压力性尿失禁有着微创、安全、有效的特点,值得临床推广应用。

Objective It is to assess the safety and efficacy of transobturator tape （TOT） in the surgical treatment of fe- male stress urinary incontinence （SUI）. Methods The outcome of 138 TOT procedures for female stress urinary incontinence was retrospectively analyzed, in which 103 patients treated with TOT procedure alone as simple group and 35 patients treated with TOT procedure associated with other pelvic procedures as combination group. All the patients were followed up for 3 - 48 months, and the mean follow-up time was 19.3 months. All the patients＇ ICI - Q - SF scores and PISQ - 12 scores were used to assess the effect,the changes of Qmax and PVR before and after operation were compared to evaluate the risk of future BOO induced by the surgery. Results There were no cases of bladder injury or injury of obturator nerves or vessels in all the patients. The cure rate of simple group was 90.8% , effective rate was 95.6% ;the cure rate of combination group was 87.1% , effective rate was 91.4%. There was no significant differences in the cure rate and effective rate between the two groups（P 〉 0.05）. The post-operative symptoms and QOL scores were significantly improved in both groups compared with that before treatment（ P 〈 0.01 ）. Compared with that before treatment, PISQ - 12 scores were obviously improved in the patients with sex life in both groups （ P 〈 0.05 ）. There was no significant difference in the changes of Qmax and PVR before and after operation in both groups（P 〉 0.05 ）. Conclusion The TOT procedure is a safe , effective and minimally invasive treatment for SUI, and is worthy of wide application in clinic.