三种中段尿道吊带术治疗女性固有括约肌障碍型压力性尿失禁疗效及安全性

Efficacy and safety of tension-free vaginal tape,tension-free obturator tape and Ajust^(TM) system for female stress urinary incontinence with intrinsic sphincter deficiency

目的探讨经阴道无张力尿道中段悬吊术(TVT)、经闭孔无张力尿道吊带术(TOT)和单切口可调节Ajust^(TM)吊带治疗女性固有括约肌障碍型(ISD)压力性尿失禁(SUI)疗效及安全性。方法前瞻性随机对照法选取ISD型SUI患者80例(25例行TVT术、29例行TOT术、26例行Ajust^(TM)吊带术)。观察各组手术时间、术中及术后短、中期并发症发生情况并于术后6个月、1年对患者进行随访。结果 1TVT组手术时间最长(P=0.00),TOT组、Ajust组无显著差异(P>0.05);2TVT组术中耻骨后血肿1例、膀胱损伤1例,TOT组、Ajust组无术中并发症;3术后1年TVT组、Ajust组治愈率、有效率无显著差异(P>0.05),TOT组治愈率、有效率均较前两组低(P<0.05);4TVT组、Ajust组术后短期排尿障碍发生率较TOT组高(P<0.05),TVT组术后远期排尿障碍发生率显著高于其余两组(P<0.05);5TOT组、Ajust组术后1年最大尿流率(Qmax)、膀胱残余尿(PVR)与各组术后6个月指标相比无显著变化(P>0.05);TVT组术后1年Qmax降至(20.1±9.3)mL/s,PVR增至(5.6±8.2)mL,较其术后6个月有显著差异(P<0.05)。结论 TVT术和Ajust^(TM)吊带术治疗女性ISD型SUI疗效均满意。Ajust^(TM)吊带术有更加微创、安全的优势,远期疗效有待进一步随访。

Objective To assess the safety and efficacy of tension-free vaginal tape,tension-free obturator tape and Ajust^（TM）system for the surgical treatment of female stress urinary incontinence（SUI）with intrinsic sphincter deficiency（ISD）.Methods The outcomes of 25 TVT,29 TOT and 26 Ajust^（TM） procedures for SUI were analyzed.The maximum flow rate（Qmax）and postvoid residual urine volume（PVR）before and after operation were collected to evaluate the patients＇ bladder function.Results 1The operation time was（30.8±5.9）min for TVT,which was longer than（21.1±4.3）min for TOT and（20.5±5.2）min for Ajust^（TM）.The difference was significant（P=0.00）.2In the TVT group,retropubic hematoma occurred in 1 case,and bladder injury occurred in1 case.In the TOT and Ajust^（TM）groups,no complications were observed.3The total cure rates of TVT and Ajust^（TM） were not significantly different（P〉0.05）,but they were higher than the cure rate of TOT（P〈0.05）.4TVT and Ajust^（TM）had higher incidence of short-term urination disorder than TOT（P〈0.05）.TVT had higher longterm urination disorder than the other two groups（P〈0.05）.5In the TOT group and Ajust^（TM）group,the Qmax and PVR did not change significantly 12 months after operation（P〉0.05）.In the TVT group,the Qmax dropped from（24.0±7.7）mL/s 6months after operation to（20.1±9.93）mL/s 12 months after operation,while PVR increased from（3.3±6.7）mL to（5.6±8.2）mL（both P〈0.05）.Conclusion TVT and Ajust^（TM） procedures are effective in the treatment of SUI with ISD,and Ajust^（TM）is safer,and minimally invasive,but the long-term efficacy still remains to be observed.