重度盆腔器官脱垂复位手术同时治疗隐匿性压力性尿失禁的疗效

Study on reductive surgery for pelvic organ prolapse concomitant with anti-incontinence sling for treatment of occult stress urinary incontinence

目的 评价重度盆腔器官脱垂复位手术同时行抗尿失禁吊带手术治疗隐匿性压力性尿失禁（OSUI）的临床疗效.方法 2003年6月至2012年12月,解放军总医院第一附属医院对符合纳入条件的78例重度盆腔器官脱垂合并OSUI患者行盆腔器官脱垂复位手术,包括宫骶韧带高位悬吊、骶棘韧带固定及骶骨阴道固定术;同时行抗压力性尿失禁（SUI）手术[包括经闭孔无张力尿道中段悬吊带术（TVT-O）、经耻骨后无张力尿道中段悬吊带术（TVT）]的37例患者为加抗SUI手术组,未行抗SUI手术的41例患者为不加抗SUI手术组.对两组患者的各种临床指标及主、客观疗效进行比较.盆腔器官脱垂客观疗效评价采用盆腔器官脱垂定量（POP-Q）分度法,尿失禁主观疗效采用排尿不适量表（UDI-6）和尿失禁影响问卷简表（IIQ-7）中文简体版.结果 两组患者盆腔器官脱垂复位手术在脱垂复位的客观疗效上无差异,盆腔器官脱垂客观治愈率为100％（78/78）,仅加抗SUI手术组比不加抗SUI手术组的手术时间延长16 min.术后2、6、12个月随访,不加抗SUI手术组出现术后尿失禁主观症状的累积发生率分别为12％ （5/41）、15％（6/41）、17％ （7/41）,均高于加抗SUI手术组[分别为3％ （1/37）、3％ （1/37）、3％ （1/37）],但两组无一例为此要求进一步行抗SUI治疗.两组患者术后随访期内UDI-6、ⅡQ-7中文简体版评分较均术前下降,分别比较,差异均有统计学意义（P均＜0.01）;术后2、6、12个月评分两组间分别比较,差异均无统计学意义（P＞0.05）.结论 术前存在OSUI的盆腔器官脱垂患者,脱垂复位手术同时行抗SUI手术是否对患者有益取决于术前的严格评价.尿失禁程度重的患者加抗SUI手术获益大.

Objective To evaluate the clinical outcome of anti-incontinence sling in the treatment of occult stress urinary incontinence （OSUI） during reductive surgery for advanced pelvic organ prolapse （POP）.Methods From Jun.2003 to Dec.2012,78 patients with OSUI underwent reductive surgery for advanced POP such as high uterosacral ligament suspension,sacrospinous ligament suspension and sacral colpopexy in the First Affiliated Hospital,General Hospital of People＆#39;s Liberation Army.Among them,41 patients received reductive surgery alone was enrolled in non-concomitant anti-incontinence group and the other 37 patients who underwent same surgery with tension-free vaginal tape （TVT） or tension-free vaginal tape-obturator technique （TVT-O） was in anti-incontinence group.The patient＆#39;s demography,objective and subjective outcomes,as well as complications and injures were compared between the two groups.The pelvic organ prolapse quantitation （POP-Q） was used to evaluate the objective outcomes of POP.Urinary distress inventory （UDI-6） and incontinence impact questionnaire short form （IIQ-7） were used to evaluate the subjective outcomes of stress urinary incontinence （SUI）.Results Compared with the non-concomitant anti-incontinence group,the objective outcomes of reductive surgery exhibited no significant differences （100%,78/78）,and only the operation time of anti-incontinence group slightly increased 16 minutes.The occurrence rate of postoperative SUI was 12% （5/41）,15% （6/41）,17% （7/41） respectively after the operation at 2-month,6-month and 12-month follow up in the non-concomitant anti-incontinence group; and the occurrence rate of the anti-incontinence group was 3% （1/37）,3% （1/37）,3% （1/37） ; but none of patients in the two groups require further surgery for stress urinary incontinence.Mean score of UDI-6 and IIQ-7 in all the patients decreased significantly after operation at 2-month,6-month and 12-month follow up （all P〈0.01）.However,there was no statistic difference between the two groups （P〉0.05）.Conclusions It is still difficult to make decision for concomitant anti-incontinence procedure in those patients with OSUI,who are undergoing reductive surgery because of advanced POP.Whether the patients will benefit more from anti-incontinence sling depends largely on strct preoperative evaluation for the severity of SUI.The patients with severe SUI are supposed to benefit most from anti-incontinence sling.However,a two-step approach to correct the postoperative stress urinary incontinence is also reasonable.