改良穿刺点由外向内经闭孔无张力尿道吊带术治疗女性压力性尿失禁的临床研究

Modified transobturator tape for female stress urinary incontinence

目的探讨改良穿刺点由外向内经闭孔无张力尿道吊带术(TOT)治疗女性压力性尿失禁(SUI)的疗效及安全性。方法回顾性分析2015年6月至2017年6月收治的87例女性SUI患者的临床资料,患者均行TOT。其中,52例穿刺点定位在尿道外口上方2cm水平线与耻骨降支外侧缘交界外侧0.5cm处(改良TOT组),35例穿刺点定位在尿道外口上方2cm水平线与大腿皮肤皱褶交界外侧2.0cm处(标准TOT组)。改良TOT组和标准TOT组年龄[(56.3±9.1)岁与(59.7±10.3)岁]、体重指数[(24.6±9.3)kg/m^2与(24.1±9.7)kg/m^2]、糖尿病患者比例[26.9%(14/52)与31.4%(11/35)]、混合性尿失禁患者比例[48.1%(25/52)与45.7%(16/35)]、每日尿垫量[(3.9±2.1)片与(4.3±2.7)片]的比较差异均无统计学意义(P>0.05)。比较两组手术时间、术中失血量及术后尿潴留的发生情况,并于术后3、6、12个月对患者进行随访。结果两组手术均顺利完成。改良TOT组和标准TOT组的手术时间[(20.5±5.7)min与(21.1±4.3)min]、术中失血量[(25.7±8.3)ml与(18.3±9.1)ml]和术后尿潴留发生率[3.8%(2/52)与2.9%(1/35)]的比较差异均无统计学意义(P>0.05)。改良TOT组术后大腿内侧或腹股沟区疼痛的发生率显著低于TOT组[1.9%(1/52)与20.0%(7/35),P<0.05]。87例患者均完成12个月的随访。改良TOT组和标准TOT组术后3、6、12个月的主观治愈率[90.1%(48/52)与91.4%(32/35)、90.1%(48/52)与88.6%(31/35)、90.1%(48/52)与88.6%(31/35)]差异均无统计学意义(P>0.05),术后3、6、12个月的客观治愈率[均为88.5%(46/52)与88.6%(31/35)]差异亦均元统计学意义(P>0.05)。结论改良穿刺点的TOT与标准穿刺点的TOT比较,具有相似的治愈率和有效率,但使用改良穿刺点的TOT可以显著降低术后短期大腿内侧或腹股沟区疼痛的发生率。

Objective To explore the efficacy and safety of modified transobturator tape (TOT)for female stress urinary incontinence (SUI).Methods From June 2015 to June 2017,a total of 87 SUI patients,including 35 patients underwent standard TOT operation (standard TOT group)and 52 patients underwent modified TOT operation (modified TOT group ),were retrospectively reviewed .There was no statistical difference of age [(59.7±10.3)years vs.(56.3±9.1)years ],BMI [(24.1±9.7)kg/m^2 vs.(24.6±9.3)kg/m^2],diabetes history [31.4%(11/35)vs.26.9%(14/52)],mixed urinary incontinence [45.7%(16/35)vs.48.1%(25/52)]and the daily amount of urine pad [(4.3±2.7) vs.(3.9±2.1)]between the two groups (P >0.05).The operative time,intraoperative complications,and postoperative complications were coHecteded in two groups.Patients were followed up at 3months,6 months,and 1year after surgery.Results There was no significant difference in operation time [(21.1± 4.3)min vs.(20.5±5.7)mini,intraoperative hemorrhage[(18.3±9.1)ml vs.(25.7±8.3)ml]and postoperative incidence of urinary retention [2.9%(1/35)vs.3.8%(2/52)]between the two groups (P >0.05).The incidence of postoperative leg pain was significantly lower in modified TOT group than in TOT group [1.9%(1/52)vs.20.0%(7/35),P <0.05].There was no significant difference in subjective cure rate and objective cure rate between the two groups at 3months,6months and 1year after surgery (P >0.05).Conclusions Compared with the standard TOT,the modified TOT of modified puncture port has a similar cure rate and efficiency.However,the use of modified TOT can significantly reduce the incidence of postoperative short-term leg pain,but the long-term efficacy still needs to be further followed-up.