无张力经阴道经闭孔尿道中段吊带术与其改良法在治疗女性压力性尿失禁的临床观察

Clinical observation of treating female stress urinary incontinence with TVT-Abbrevo and TVTObturator

目的比较无张力经阴道经闭孔尿道中段吊带术(TVT-O)和改良经阴道经闭孔无张力尿道中段吊带术(TVT-A)治疗女性压力性尿失禁(FSUI)的临床疗效和并发症情况。方法 2006年7月~2015年12月先后对39例和26例确诊为压力性尿失禁的女性患者分别采用TVT-O和TVT-A术治疗,比较分析两种术式的临床疗效和并发症情况。结果两组患者在手术时间、术中出血量、术后导尿管留置天数、住院时间比较差异均无统计学意义(P>0.05)。65例患者出院时均有明显疗效,59例患者尿失禁症状完全消失,6例好转,其中TVT-A组治愈24例(92.3%),好转2例(7.7%);TVT-O组治愈35例(89.7%),好转4例(10.3%);两组患者疗效比较差异均无统计学意义(P>0.05)。术后24 h、术后1周和1月,TVT-A组患者大腿内侧疼痛的发生率和严重程度明显低于TVT-O组(P均<0.05);术后3个月、半年及术后1年TVT-A组疼痛发生率和疼痛严重程度与TVT-O组比较,差异无统计学意义(P>0.05)。TVT-A组和TVT-O组分别有2例和4例患者出现排尿费力,经再次导尿3天后症状消失;分别有2例和3例患者出现尿频,口服舍尼亭后症状消失。两组患者出现排尿费力和尿频的发生率比较差异均无统计学意义(P>0.05)。两组手术术中均无血管、神经、膀胱损伤,术后均无耻骨后血肿、吊带腐蚀等其他并发症发生。随访1年,均无复发。结论 TVT-A与TVT-O临床疗效相当,均可作为治疗FSUI患者的有效方法,但TVT-A可降低患者术后近期的大腿内侧疼痛发生率。

Objectives To compare the effectiveness and complications of TVT-A and TVT-O for thetreatment of female stress urinary incontinence.Methods From July2006to December2015,65patients suffering from FSUI were treated with TVT-O(n=39)or TVT-A(n=26)procedure.The clinicalefficacy and operation-correlated complications were observed.Results There were no significantdifferences in perioperative data including operating time,intraoperative bleeding,days of indwellingcatheter,length of stay between the two groups(P>0.05).Of65cases in two groups,59cases of urinaryincontinence symptoms disappeared completely,6cases were improved.Twenty?four cases(92.3%)werecured and2cases(7.7%)were improved in TVT-A group.Thirty-five cases(89.7%)were cured and4cases(10.3%)were improved in TVT-O group.No significant differences could be found for the curingrates between two groups(P>0.05).Compared with the TVT-O group,the TVT-A group had lowerincidence and more insignificant degree of inner thigh pain at24h,l W and1month after surgery(P<0.05).No significant differences were observed for the incidence and degree of inner thigh pain at3month,6month and1year after surgery between TVT-O and TVT?O group(P>0.05).Two cases in TVT-A group and4cases in TVT-O group suffered from postoperative dysuria,and given the indwellingcatheter for3days.Two cases in TVT-A group and3cases in TVT-O group were found urinary frequency,and treated with Tolterodine Tartrate Tablets2mg twice a day for two weeks.No significant differenceswere observed for the incidence of postoperative dysuria and urinary frequency between TVT-O and TVT-Ogroup(P>0.05).No intraoperative complications such as blood vessel,nerve,bladder damage wererecorded and no postoperative retropubic hematoma,tape adjustment and other complications occurred intwo groups.No recurrence after l year follow-up.Conclusion The study shows that TVT-A procedure issafe and efficacy in treatment of FSUI,but associated with low incidence of recent postoperative innerthigh pain.