经阴道前壁尿道悬吊器对经闭孔途径治疗失败的女性压力性尿失禁的疗效

Efficacy of TVT-EXACT in the treatment of female SUI patients with a failed transobturator sling history

目的探讨经耻骨后经阴道前壁尿道悬吊器（TVT-EXACT）治疗经闭孔途径治疗女性压力性尿失禁（SUI）失败后患者的手术方法、并发症的发生及预防、有效性及其安全性。方法女性SUI患者12例采用耻骨后经阴道前壁尿道悬吊器治疗。于术前及术后2个月进行国际尿失禁咨询委员会尿失禁问卷表简表（ICI-Q-SF）评分。结果 12例患者均顺利完成手术,无膀胱穿刺伤、无耻骨后血肿形成。2例发生术后排尿困难、尿潴留：1例经留置尿管2周后缓解;另1例留置尿管4周后缓解,控尿正常,SUI未复发。术后随访12~24个月,平均16.5个月,无SUI复发。完全改善率91.67%（11/12）,1例患者明显改善,但有偶尔少量漏尿。术后生活质量评分明显改善,ICI-Q-SF评分术后2个月（0.33±0.33）明显好于术前（15.50±0.94）（P〈0.01）。结论经耻骨后经阴道前壁尿道悬吊器（TVT-EXACT）治疗经闭孔途径治疗女性SUI失败后患者简单易行,操作安全,并发症发生率低.术后效果满意。

Objective To investigate the surgical approach,safety,efficacy and complications of retropubic vaginal anterior urethral suspension（TVT-EXACT）in the treatment of female stress urinary incontinence（SUI）with a failed history of transobturator midurethral sling.Methods TVT-EXACT surgery was performed in 12 female SUI patients.The ICI-Q-SF score was assessed before and 2 months after surgery.Results All operations were successful without bladder perforation or retropubic hematoma.Postoperative dysuria and urinary retention occurred in 2 cases;1 case was relieved after the catheter was indwelt for 2 weeks;another was relieved after 4 weeks.The urinary continence was normal without SUI recurrence.During the follow-up of 12~24 months（average 16.5 months）,no recurrence of SUI was observed.The complete improvement rate was 91.67%（11/12）.One patient was obviously improved,with only occasional urine leakage.The ICI-Q-SF score decreased from（15.50±0.94）before operation to（0.33±0.33）2 months after operation（P0.01）.Conclusion TVT-EXACT is feasible for the treatment of SUI with a failed history of transobturater sling.The procedure is simple and safe,causing low incidence of complications and producing satisfactory outcomes.