中段尿道无张力吊带术对女性压力性尿失禁患者性功能的影响

Influence of tension-free midurethral sling surgery on sexual function in women with stress urinary incontinence

目的:评估经阴道无张力尿道中段悬吊术(tension free vaginal tape,TVT)、经闭孔阴道无张力悬吊术(transobturator suburethral tape,TVT-O)对女性压力性尿失禁患者性功能的影响。方法:应用女性性功能指数(female sexual function index,FSFI)问卷,对北京大学人民医院TVT、TVT-O术后3个月至5年的66例患者进行随访,按照手术方式(TVT/TVT-O)、术后时间(1年以内与1年以上)及术前有无性交漏尿(concomitant coital incontinence,CCI)进行分组,应用多元协方差分析比较手术前后FSFI评分的变化,评分越高,提示性功能质量越好。结果:最终回收有效问卷51例,术前TVT组及TVT-O组患者年龄、FSFI、体重指数(body mass index,BMI)差异无统计学意义。多元协方差分析中,在校正术后时间及术前有无性交漏尿对患者性功能的影响后,TVT组与TVT-O组患者术后FSFI评分升高值(difference of FSFI,dFSFI)差异无统计学意义(F=2.52,P=0.119),且两组患者相比术后性生活改善率差异无统计学意义(40.0%vs.44.4%,P>0.05)。但在协变量分析中CCI组与nCCI组术后性功能变化差异显著(F=7.41,P<0.05),CCI组dFSFI值更高(1.86±1.95 vs.-0.09±2.24)。结论:TVT与TVT-O两种手术方式对患者性功能影响无明显差异,但术前有性交时漏尿的患者术后性功能改善明显。

Objective：To investigate the change of the female patients＇ sexual function after tension free vaginal tape （TVT） or transobturator suburethral tape （TVT-O） surgery for stress urinary inconti- nence （SUI）. Methods： Female sexual function index （FSFI） was sent to 66 female patients who un- derwent a TVT/TVT-O surgery at least 3 months after the operation, to a maximum of 5 years. All The patients were divided into two groups according to different surgical methods, different follow-up intervals （ more than or less than 1 year） and whether there was concomitant coital incontinence （CCI） before the operation. The changes of FSFI scores before and after the operation were compared between the two groups by multiple covariances analysis. The total score was higher, and the sexual function was better. Results： In the study, 60 patients answered the questionnaire, and 51 questionnaires were available. Be- fore surgery, there were no significant difference between TVT and TVT-O groups in FSFI, age, body mass index （BMI）. As to patients who had TVT/TVT-O surgery, when the influence of the postoperative period and symptoms accompanying intercourse were corrected, the two groups had no significant difference in difference of FSFI （dFSFI） scores after operation （F = 2.52, P = 0.119 ）, and they had similar sexual function improvement ratio （40.0% vs. 44.4% , P 〉0.05）. But to the patients who had concomitant coital incontinence before the operations, the dFSFI scores was higher than patients who did not have concomitant coital incontinence （ 1.86 ±1.95 vs. - 0.09 ± 2.24, P 〈 0.05 ）. Conclusion： TVT and TVT-O surgery have no significant each other, but the patients who suffer from provement. difference in influence on sexual CCI before the surgery will have function in women between a better sexual function im-