经耻骨后无张力尿道悬吊术治疗女性复发性压力性尿失禁的临床分析

Efficacy and safety of tension free vaginal tape retropubic technique in females recurrent stress urinary incontinence

目的 分析经耻骨后无张力尿道吊带术（TVT-EXAT）治疗女性复发性压力性尿失禁（stress urinary incontinence,SUI）的临床疗效及安全性.方法 回顾性分析2012年1月至2016年8月26例应用TVT-EXAT治疗女性复发性SUI患者的临床资料.患者年龄52～ 78岁,平均（66.5±11.9）岁,第1次手术均采取经闭孔途径,术前SUI病程（8.7±5.4）年,术后（1.7±1.4）年SUI复发.单纯性SUI 22例（84.6％）,混合性SUI 4例（15.4％）.患者均填写国际尿失禁咨询委员会尿失禁问卷简表（ICI-Q-SF）和尿失禁生活质量问卷（I-QOL）,分析TVT-EXAT治疗女性复发性SUI的疗效和安全性.结果 26例患者均顺利完成手术,术中无膀胱、尿道、阴道损伤.术中在尿道中段找到既往手术吊带23例,其中9例吊带位于阴道肌层,3例未找到既往吊带.随访2～44个月,平均（28.6±12.2）个月.26例患者中22例（84.6％）治愈,2例（7.7％）改善,总有效率为92.3％.术前症状评分、生活质量评分分别为（8.4±2.2）分、（24.5±9.2）分,术后分别为（0.5±1.2）分、（93.8±8.9）分,手术前后各项指标差异均有统计学意义（均P＜0.05）.术后无盆腔血肿、感染、瘘管等并发症.术后出现暂时性尿潴留1例（3.8％）,经留置导尿2周后好转.无长期疼痛、吊带侵蚀及反复泌尿系感染等远期并发症.结论 对于手术治疗SUI症状复发的患者,采用TVT-EXAT再次手术治疗具有良好的有效性和安全性.

Objective To evaluate the efficacy and safety of tension free vaginal tape retropubic technique （TVT-EXAT） in females recurrent stress urinary incontinence （SUI）.Methods From January 2012 to August 2016,26 cases of female recurrent SUI were treated with TVT-EXAT in our hospital.They all treated with tension free vaginal tape obturator technique （TVT-O） at the first time.The mean age was （66.5 ± 11.9） years.The mean course of SUI before surgery was （8.7 ± 5.4） years,and the mean course of recurrent SUI was （1.7 ± 1.4） years.There were 84.6% patients who suffered simple SUI while 15.4% patients with SUI and mixed urinary incontinence.The mean follow-up time was 28.6 ± 12.2 months.All patient＇s ICI-Q-SF scores and I-QOL scores were collected.The efficacy and safety of TVT-EXAT were analyzed.Results All the patients were treated with TVT-EXAT and no bladder、urethral、vaginal injury was recorded during the procedures.In the process of operations,23 patients＇ slings were found at the middle of urethra,9 patients＇ slings were found at the tunica muscularis of vaginal and 3 patients＇ slings were not found.Twenty two cases were cured with TVT-EXAT （84.6%） while 2 cases were improved （7.7%）.The preoperative and postoperative ICI-Q-SF symptom scores were 8.4 ± 2.2 and 0.5 ± 1.2 while the I-QOL life quality scores were 24.5 ± 9.2 and 93.8 ± 8.9 respectively.There was statistical difference between the preoperative and postoperative scores （P 〈 0.05）.No pelvic hematoma,long-term pain,sling erosion,infection and fistula were found in all cases.One cases （3.8%）suffered temporary urinary retention and were cured by two weeks catheterization.Conclusion TVT-EXAT technique supports its safety and reliability in the treatment of female recurrent SUI.