经阴手术治疗女性盆腔器官脱垂合并隐匿性压力性尿失禁临床分析

Clinical analysis of pelvic floor reconstructive surgery and tension free vaginal tape-obturate in the pelvic organ prolapse combined with occult stress urinary incontinence

目的:探讨盆底重建术联合尿道中段悬吊术治疗膀胱脱垂合并隐匿性压力性尿失禁的临床疗效及安全性分析。方法:回顾分析我院收治的21例盆腔器官脱垂合并隐匿性压力性尿失禁行经阴道前盆重建术+经阴道无张力尿道中段悬吊(TVT-O)术患者,盆腔器官脱垂量化分期法(POP-Q)分期为Ⅲ~Ⅳ期。记录患者一般临床资料和围手术期手术资料,门诊定期随访,分析测量患者术前及术后最大尿流率及残余尿的变化,评价手术治愈率和并发症发生情况。结果:所有患者手术均顺利完成,平均手术时间65(45~130)min;术中平均出血量40(30~100)mL;术后导尿时间为4~5d;平均住院7(5~9)d;拔除尿管后均排尿通畅,无一例尿失禁的患者。出院前测评POP-Q分期均降低为0~Ⅰ期。术后随访时间为3~30个月,无一例补片及尿道悬吊带裸漏或感染;无一例阴道感染及尿路感染等;1例患者有腹股沟不适感;1例患者术后1个月出现排尿困难症状,给予尿道扩张后症状消失。所有患者术后复查尿动力较术前均明显改善,差异有统计学意义(P<0.05)。结论:盆腔器官脱垂患者常合并隐匿性压力性尿失禁,手术治疗时应注意。经阴道前盆重建术+TVT-O术是治疗老年女性膀胱脱垂合并隐匿性压力性尿失禁的有效方法,安全性高。

Objective:To analyze the clinical efficacy and safety of pelvic floor reconstructive surgery and ten-sion free vaginal tape-obturate(TVT-O)in the pelvic organ prolapse combined with occult stress urinary inconti-nence.Methods:Twenty-one cases suffered from the pelvic organ prolapse combined with occult stress urinary in-continence were treated with pelvic floor reconstructive surgery and TVT-O.General clinical data and perioperative data were recorded.All patients were regularly followed up.The changes of maximum flow rate and residual urine before and after operation were analyzed to evaluate the cure rate and complications.Results:All the patients were treated successfully.The operative time was 65(45-130)min,volume of blood loss was 40(30-100)mL,in-dwelling catheter time was 4-5d,postoperative hospital stay was 7(5-9)d.After the removal of the catheter,the urination was unobstructed and there was no case of urinary incontinence.Before discharge,POP-Q stage was reduced to 0-Ⅰdegree.During the follow-up period of 3-30months,there was no leakage or infection of patch and urethral sling,no vaginal infection or urinary tract infection.However,one patient had groin discomfort.An-other patient had dysuria 1 month after operation,and the symptoms disappeared after urethral dilatation.The urodynamics of all patients were significantly improved after operation(P<0.05).Conclusion:Patients with pel-vic organ prolapse are often complicated with occult stress urinary incontinence.Pelvic floor reconstructive surgery combined with TVT-O is an effective and safe method for the treatment of the pelvic organ prolapse combined with occult stress urinary incontinence.