“六步法”经闭孔阴道无张力尿道中段悬吊术治疗女性压力性尿失禁疗效观察

Effect of"six-step method"trans-obturator tape in treatment of female stress urinary incontinence

目的探讨“六步法”经闭孔阴道无张力尿道中段悬吊术治疗女性压力性尿失禁的临床疗效。方法选择2017年1月至2020年12月合肥市第二人民医院泌尿外科收治的30例女性压力性尿失禁患者为研究对象。所有患者行“六步法”经闭孔阴道无张力尿道中段悬吊术。记录患者围术期情况。术前和术后6周于门诊复查所有患者的最大尿流率(Qmax)和残余尿量(PVR)。术前和术后6周,采用国际尿失禁咨询委员会尿失禁问卷表简表(CI-Q-SF)评分、尿失禁影响问卷(IIQ)-7评分评估患者的尿失禁改善状况。术后6周,采用患者满意度Likert量表评分及患者全身状况改善问卷(PGI-I)评分评估患者的满意度及尿失禁主观治愈状况,并计算满意度和尿失禁主观成功率。术后6周,所有患者于门诊行1 h尿垫试验,并根据尿垫试验结果评估患者的临床疗效。观察患者术后早期(术后1~6 d)并发症发生情况。所有患者术后随访1~24个月。结果30例患者均顺利完成手术,手术时间30~75(45.08±9.94)min,术后住院时间4~10(6.40±1.79)d。术中所有患者均未出现膀胱穿孔、阴道穿孔、大血管损伤等严重并发症,术后拔除导尿管,小便能自解,无尿潴留及排尿费力。术前与术后6周患者的Qmax、PVR比较差异无统计学意义(P>0.05)。30例患者术后6周ICI-Q-SF、IIQ-7评分均显著低于术前(P<0.05)。术后6周,患者满意度为100%(30/30),尿失禁主观治愈率为100%(30/30)。术后6周,患者总体有效率为100%(30/30)。术后1~6 d所有患者无畏寒、发热症状。所有患者阴道纱布去除后切口无明显渗血。所有患者术后无下肢深静脉血栓形成,无排尿困难及尿潴留发生。2例患者分别于术后第1天和术后第3天出现大腿内侧疼痛不适,对症处理后疼痛症状好转。1例患者术后第6天阴道切口缝线提前脱落,经治疗愈合。术后6周,1例患者大腿内侧疼痛持续存在,但不影响生活;1例患者剧烈咳嗽稍有尿失禁(尿垫重量增加≤1 g)。所有患者随访期间均无吊带裸露。结论“六步法”经闭孔无张力尿道中段悬吊术治疗压力性尿失禁安全、有效,可提高术后临床疗效及患者满意度。

Objective To investigate the clinical effect of"six-step method"trans-obturator tape in treatment of female stress urinary incontinence.Methods Thirty female patients with stress urinary incontinence admitted to the Department of Urology,the Second People′s Hospital of Hefei from January 2017 to December 2020 were selected as the research objects.All patients underwent the"six-step method"trans-obturator tape operation.The patient′s perioperative condition was recorded.The maximum urine rate(Qmax)and postvoid residual urine volume(PVR)of all patients were reviewed in the outpatient clinic before and six weeks after surgery.Before operation and six weeks after operation,the international consultation incontinence questionnaire short form(ICI-Q-SF)and impact of incontinence questionnaire(IIQ)-7 were used to evaluate the improvement of patiens′urinary incontinence.At six weeks after operation,the Likert scale of patient′s degree of satisfaction and the patient global impression of improvement(PGI-I)score were used to evaluate the pationts′satisfaction and the subjective cure status of urinary incontinence,and the patient′s degree of satisfaction and subjective success rate of urinary incontinence were calculated.At six weeks after operation,all patients underwent the one hour urine pad test in the outpatient clinic,and the clinical efficacy of the patients was evaluated based on the results of the urine pad test.The patient′s early postoperative(1 to 6 days after surgery)complications were observed.All patients were followed up for 1 to 24 months.Results The operation of 30 patients was successfully completed.The operation time was 30-75(45.08±9.94)min,and the postoperative hospital stay was 4-10(6.40±1.79)d.During the operation,all patients had no serious complications such as bladder perforation,vaginal perforation and large blood vessel injury.After the catheter was removed,the urine was self-solving,and there was no urinary retention and urination effort.There was no significant difference in Qmax and PVR of 30 patients before and six weeks after operation(P>0.05).The ICI-Q-SF and IIQ-7 scores of 30 patients at six weeks after operation were significantly lower than those before operation(P<0.05).At six weeks after operation,the patient satisfaction rate was 100%(30/30),and the subjective cure rate of urinary incontinence was 100%(30/30).At six weeks after operation,the patient′s overall effective rate was 100%(30/30).All patients had no symptoms of chills and fever from 1 to 6 days after operation.There was no obvious blood oozing from the incision after vaginal gauze was removed in all patients.All patients had no deep vein thrombosis,dysuria and urinary retention after operation.Two patients developed pain and discomfort in the inner thigh on the first day and the third day after the operation,and the pain symptoms improved after symptomatic treatment.The suture of the vaginal incision in one patient fell off prematurely on the sixth day after the operation and healed after treatment.At six weeks after operation,there was still 1 patient with persistent inner thigh pain,but it did not affect life;1 patient had a severe cough and slight urinary incontinence(increase in pad weight≤1 g).During the follow-up period,all patients had no sling exposed.Conclusion The"six-step method"trans-obturator tape is safe and effective in the treatment of stress urinary incontinence,and which can improve postoperative clinical efficacy and patient′s degree of satisfaction.