阴道前壁吊带松解术治疗阴道前壁吊带术后排尿困难的疗效和安全性分析

Clinical efficacy and safety of transvaginal anterior wall sling release in the treatment of voiding dysfunction after the anterior vaginal wall sling procedure

目的分析经阴道前壁吊带松解术治疗阴道前壁吊带手术(MUS)术后排尿困难的临床疗效及安全性。方法回顾性分析2016年1月至2021年6月MUS术后出现排尿困难患者12例,患者年龄47~73(61.3±8.2)岁。随访患者术前及术后尿流率及残余尿量,并对患者进行国际尿失禁咨询委员会尿失禁问卷简表(ICI-Q-SF)调查,进行统计学分析。结果首次吊带手术发展至出现排尿困难时间最短为术后2个月,最长为术后7个月,平均(3.8±1.8)个月,术后吊带松解时间最短为术后5个月,最长为术后24个月,平均(12.3±6.6)个月。12例患者中11例吊带松解手术后排尿困难症状均较术前有显著改善,尿流率术前:9.3(3.7,13.2)ml/s,术后:21.5(15.7,34.2)ml/s,P=0.004;残余尿量术前:315(200,377)ml,术后:0(0,80)ml,P<0.001,统计学评价均有显著改善;ICI-Q-SF术前:0(0,5)分,术后:4(0,8)分,手术前后比较差异无统计学意义(P=0.348)。结论吊带松解术治疗MUS术后排尿困难患者安全、有效。

Objective To analyze the clinical efficacy and safety of surgical excision of slings in the treatment of voiding dysfunction after the midurethral sling(MUS)procedure.Methods A retrospective analysis was conducted on postoperative patients with voiding dysfunction after MUS from January 2016 to June 2021.The ages of the patients ranged from 47 to 73 years,with an average of(61.3±8.2)years.The patients were followed up for preoperative and postoperative urinary flow rates and PVR,and results from the ICI-Q-SF were collected from patients for statistical analysis.Results The shortest time from the first sling procedure to the occurrence of voiding dysfunction was 2 months and the longest was 7 months,with an average of(3.8±1.8)months.The earliest surgical excision was performed 5 months after MUS and the latest was done 24 months after MUS,with an average of(12.3±6.6)months.Among the 12 patients,symptoms of 11 patients after surgical excision of slings were significantly improved,compared with pre-surgery data.The urinary flow rate was 9.3(3.7,13.2)ml/s before surgery and 21.5(15.7,34.2)ml/s after surgery,P=0.004;The residual urine volume before surgery:315(200,377)ml,after surgery:0(0,80)points,P<0.001,both with statistical significance;preoperative ICI-Q-SF:0(0,5)points,postoperative:4(0,8)points,There was no significant difference between before and after operation(P=0.348).Conclusions Surgical excision of slings is safe and effective in the treatment of voiding dysfunction after MUS.