腹腔镜下Mesh网片阴道骶骨前固定治疗膀胱脱垂疗效及安全性分析

Efficacy and safety of laparoscopic sacrocolpopexy with Mesh in the treatment of female with low urinary tract symptoms induced by cystocele

目的探讨腹腔镜下Mesh网片阴道骶骨前固定术（LSC）在治疗膀胱脱垂导致女性顽固下尿路症状（LUTS）中的临床疗效及安全性。方法 2013年3月至2014年6月深圳中山泌尿外科医院应用LSC治疗膀胱脱垂导致女性顽固LUTS患者10例,年龄46-77岁,病程4-12年,比较患者手术前后下尿路症状、性功能改善情况及尿流率、残余尿改善情况。通过Bristol女性下尿路症状问卷表（FLUTS-Q）,分析LSC的疗效和安全性。结果 10例手术均顺利完成,手术时间（195±52）min;术中出血量（150±88）ml。9例患者尿频症状完全消失（90%）,1例较术前明显改善;10例患者排尿困难症状均消失（100%）;术前有尿急症状的患者中,3例症状改善（60%）,无尿急症状的5例患者中,术后新发尿急症状2例（40%）,术后2个月改善;术前有压力性尿失禁的4例患者中2例（50%）症状改善;6例术前无压力性尿失禁,术后新发1例（17%）;手术前后最大尿流率、残余尿量和Bristol（FLUTS-Q）评分比较差异有统计学意义（P〈0.05）。结论 LSC可以有效改善女性膀胱脱垂导致的下尿路症状,微创、并发症少、安全有效。但对腹腔镜技术要求较高,学习曲线较长。

Objective To evaluate the efficacy and safety of laparoscopic sacrocolpopexy（LSC） in treatment of female with low urinary tract symptoms（LUTS） induced by cystocele. Methods A group of 10 patients, age 46-77 years, duration of 4-12 years, with LUTS induced by cystocele who underwent LSC between March 2013 and June 2014 was studied in Shenzhen Zhong-shan Urological Hospital. Pre-and postoperative low urinary tract symptoms, sexual functions, Qmax, residual urine volume（RUV） and Bristol FLUTS-Q scores were compared between the groups to evaluate the efficacy and safety of LSC procedure.Results Operations were successfully underwent in total 10 patients. The operation time was（195±52） min and the intraoperative blood loss was（150±88） ml. The urinary frequency symptoms disappeared completely in 9 cases（90%） and improved in 1 case（10%） postoperatively. The voiding difficulty disappeared completely in 10 cases（100%）. The urgency symptoms in 3 patients（60%） improved and urgency occurred postoperatively in 2 cases（40%） and improved after following up of 2 months. The stress incontinence improved in 2 cases（50%） and the de novo stress incontinence were observed in 1 case（17%）. The pre-and postoperative Qmax, RUV and Bristol FLUTS-Q scores were（ 22. 1 ± 12. 4） ml/s vs（ 32. 4 ± 12.2） ml/s,（116.4 ±32.2） ml vs（26.4 ±6.2） ml and（36 ±8） vs（6 ±2）. The differences were significant（P〈0.05）.Conclusions The LSC procedure was considered as a safe, min-invasive and efficient therapy on LUTS induced by cystocele. However, good laporoscopic techniques and long learning curves were needed.