经闭孔无张力尿道中段悬吊改良术式治疗女性压力性尿失禁的中长期疗效分析

Medium and long-term efficacy of TVT-A for the treatment of female stress urinary incontinence

目的:探讨经闭孔无张力尿道中段悬吊改良术式(modified tension-free vaginal tape Abbrevo,TVTA)治疗女性压力性尿失禁的中长期疗效。方法:回顾性分析2013年3月~2016年8月我院经闭孔无张力尿道中段悬吊术治疗的97例女性压力性尿失禁患者的临床资料,根据术式分为TVT-O组38例,TVT-A组59例,术后随访6~32个月,通过尿流动力学、咳嗽诱发试验、国际尿失禁咨询委员会尿失禁问卷表简表(ICI-Q-SF)、视觉模拟评分(VAS)、泌尿生殖困扰简表(UDI-6)、尿失禁影响问卷简表(IIQ-7)及组间对比来评价TVT-A术的中长期主客观疗效。结果:97例手术均顺利完成,未出现膀胱穿孔、大血管损伤及吊带外漏等较严重并发症,两组各1例术后出现排尿困难,经尿道扩张并保留导尿1周后均恢复正常排尿,4例出现术后尿路感染,每组各2例,经抗感染治疗3~5天后症状消失。TVT-O组与TVT-A组术后24小时腹股沟区疼痛发生率分别为7例(18.4%)、2例(3.4%);1周时分别为5例(13.2%)、0例(0);差异均具有统计学意义(P<0.05)。97例于门诊完成随访。TVT-O与TVT-A组中长期主观有效(完全治愈+改善,其中诱发试验阴性为完全治愈)分别为36例(94.7%)、56例(94.9%);客观有效(治愈+改善)分别为35例(92.1%)、55例(93.2%);满意度分别为36例(94.7%)、57例(96.6%),两组比较差异均无统计学意义(P>0.05)。ICI-Q-SF、UDI-6、VAS和IIQ-7评分与术前比较差异均有统计学意义(P<0.05)。结论:TVT-A术能提高ALPP,但对正常储尿排尿功能无影响;TVT-A具有安全有效、中长期疗效稳定的优点,同时可降低术后短期内腹股沟区疼痛的发生率。

Objective：To evaluate the medium and long-term efficacy of TVT-Abbrevo for the treatment of female stress urinary incontinence（SUI）.Method：Clinical data of 97 consecutive female patients with SUI who underwent transobturator tension-free vaginal tape（38patients for TVT-O and 59 patients for TVT-A）from March2013 to August 2016 were reviewed.Patients were followed up for 6to 32 months after surgery.Preoperative and postoperative urodynamic paremeters,cough test,international consultation committee on incontinence questionnaire short form（ICI-Q-SF）,Urogenital Distress Inventory Short Form（UDI-6）,visual analogue scale（VAS）and incontinence impact questionnaire scores（IIQ-7）were recorded to assess the medium and long-term subjective and objective efficacy of the TVT-A for SUI（by contrast to TVT-O）.Result：Operations were all finished smoothly.There was no serious complication such as bladder perforation,great vessels injury or sling exposure to vagina.One patient in each group had dysuria,but normal micturation had been achieved in both of the patients after urethral dilation and keeping catheter for one week.Two patients in each group had urinary tract infection,but they all discovered after antiinflammation therapy for 3 to 5 days.Incidence of inguinal region pain was 18.4% versus 3.4% in TVT-O group and TVT-A group 24 h after surgery.One week later,their incidence changed to 13.2% versus 0respectively.The difference between two groups had statistical significance（P〈0.05）.All patients were followed up.There was no significant difference in subjective and objective response rate and satisfaction rate between TVT-O group and TVT-A group in the medium and long term（94.7% versus 94.9%,92.1%versus 93.2%,94.7% versus 96.6% respectively）.There were significant improvements in ICI-Q-SF,UDI-6,VAS and IIQ-7scores between preoperative and postoperative data,but there was no significant difference between two groups.Conclusion：TVT-A procedure can improve ALPP,but did not influence the function of bladder and urethra.It can reduce the incidence of postoperative inguinal region pain in the short term,also it＇s safe and effective in the medium and long term for the treatment of SUI in women.