经耻骨后尿道中段悬吊带术治疗女性复发性压力性尿失禁的中长期疗效

Medium to long-term efficacy of tension-free vaginal tape procedure in the treatment of female recurrent stress urinary incontinence

目的:探讨经耻骨后尿道中段悬吊带术(tension-free vaginal tape,TVT)治疗女性复发性压力性尿失禁(recurrent stress urinary incontinence,rSUI)的效果及临床疗效。方法:回顾性分析2016年1月至2020年6月于北京朝阳医院采用TVT治疗rSUI的患者,收集患者基本信息。使用国际尿失禁咨询委员会尿失禁问卷表简表(International Consultation on Incontinence questionnaire-short form,ICI-Q-SF)记录患者术前、术后1年、术后3年以上的尿失禁症状评分,比较ICI-Q-SF各项评分及总分变化,同时记录并比较患者术前、术后3年以上的尿失禁临床症状严重程度。结果:共纳入24例患者,其中1例在术后1年因脑血管意外死亡,余23例随访时间3.9~7.3年,平均随访时间(5.2±1.1)年。ICI-Q-SF总分中位数术前为20.0(16.0,21.0),术后1年及平均5年随访时为5.0(1.5,7.8)和6.0(3.0,9.0),与术前比较差异均有统计学意义(P<0.001);ICI-Q-SF各分项评分在术后1年及平均5年的随访中均较术前减低,差异具有统计学意义(P<0.001)。从尿失禁严重程度来看,术前所有患者表现为中-重度尿失禁;术后平均5年,87.0%(20/23)的患者无尿失禁或仅有轻度尿失禁,13.0%(3/23)的患者再次出现中-重度尿失禁(P<0.001)。结论:TVT对女性rSUI治疗有效,平均5年治愈和有效改善率达到87.0%。

Objective:To investigate the effectiveness and clinical efficacy of tension-free vaginal tape(TVT)surgery in treating female recurrent stress urinary incontinence(rSUI).Methods:A retrospective analysis was conducted on 24 patients who experienced recurrence of mid-urethral sling failure and were treated with TVT surgery at Beijing Chao-Yang Hospital from January 2016 to June 2020.Basic patient information was collected.The International Consultation on Incontinence questionnaire-short form(ICI-Q-SF)was used to record urinary incontinence symptom scores preoperatively,1-year postoperatively,and more than three years postoperatively.The changes in various ICI-Q-SF scores and total scores were compared.Additionally,clinical symptom severity of urinary incontinence was recorded and compared preoperatively and more than three years postoperatively.Results:Among the 24 patients included in the follow-up,one patient was lost to follow-up due to death from a cerebrovascular accident one year postoperatively,leaving 23 patients with a follow-up period ranging from 3.9 to 7.3 years,with an ave-rage follow-up time of(5.2±1.1)years.Preoperatively,the median ICI-Q-SF total score was 20.0(16.0,21.0);at the 1-year follow-up,the median ICI-Q-SF total score was 5.0(1.5,7.8)(P<0.001);at an average follow-up of five years,the median ICI-Q-SF total score was 6.0(3.0,9.0),still showing a statistically significant difference compared with preoperative scores(P<0.001).The individual ICI-Q-SF scores were significantly lower at the 1-year and average five-year follow-ups compared with preoperative scores(P<0.001).Regarding the severity of urinary incontinence,all the patients had moderate to severe urinary incontinence preoperatively;Five years postoperatively,87.0%(20/23)of the patients had no or only mild urinary incontinence,and 13.0%(3/23)had recurrent moderate to severe urinary incontinence(P<0.001).Conclusion:TVT surgery is effective in treating female recurrent stress urinary incontinence,with an average 5-year cure and improvement rate of 87.0%.