TVT-O治疗女性压力性尿失禁的临床疗效分析

Clinical analysis of the TVT-O treatment of female stress urinary incontinence

目的探讨经闭孔无张力尿道中段悬吊术（TVT-O）治疗女性压力性尿失禁（FSUI）的临床疗效。方法分析采用TVT-O手术治疗38例中、重度FSUI患者的临床疗效,随访患者1个月、6个月最大尿流率及B超残余尿测定,采用ICI-Q-SF评分评价TVT-O手术临床效果及手术安全性。结果所有患者均顺利完成手术,手术成功率为100%,手术时间（16±4）min,术中出血（10±3）ml,术后留置导尿管时间2~5 d,平均2.9 d,住院时间3~6 d,平均4.2 d。术后1个月、6个月随访尿流率及B超残余尿测定,最大尿流率无下降趋势（P〉0.05）,残余尿无增加（P〉0.05）,ICI-Q-SF评分明显改善（P〈0.01）。术后仅1例患者拔出导尿管1周后出现排尿困难,经膀胱训练、理疗等保守治疗后症状好转,其余患者术后均获得满意的尿控效果。所有患者术后均有不同程度切口渗血,无膀胱、尿道、直肠损伤,无耻骨后血肿形成,无植入物排斥、感染等并发症。结论 TVT-O治疗FSUI临床疗效确切,安全性高,尤其对重度FSUI患者,症状改善更为显著。

Objective To investigate the clinical efficacy of tapeobturator tension-free vaginal tape（ TVT-O） treatment on female stress urinary incontinence（ FSUI）. Methods The clinical data of 38 female patients with stress urinary incontinence treated by TVT-O were analyzed retrospectively. The 1 month,6 months maximum flow rates were followed up and residual urine was measured by B ultrasoud. Using ICI-Q-SF score,the clinical effect and safety of TVT-O surgery was evaluated. Results All of the patients had successful operation. The surgical success rate was 100%,the average operative time was（ 16 ± 4） min,blood loss was（ 10 ±3） ml,postoperative catheterization time was 2-5 d,averaged 2. 9 d,the average length of hospital stay was 3-6 d,averaged 4. 2 d. The Qmax of flow rate had no downward trend（ P〉0. 05）,and there was no increase in residual urine（ P〉0. 05）.ICI-Q-SF score was significantly improved（ P〈0. 01）. Only one case had postoperative dysuria after one week of pull out the catheter,after bladder training,physical therapy and other symptoms improved with conservative treatment,and the remaining patients had satisfactory urinary results. All patients had varying degrees of incision bleeding,no bladder,urethra,rectum injury,there was no retropubic hematoma formation,no implant rejection,infection or other complications. Conclusion The clinical efficacy of TVT-O on FSUI is good and safe,especially in patients with severe FSUI,symptom improvement is remarkable.