自体阴道前壁黏膜瓣尿道悬吊术治疗女性压力性尿失禁的临床疗效研究

Clinical efficacy study of autologous anterior vaginal wall mucosal flap urethral suspension for the treatment of female stress urinary incontinence

目的探讨自体阴道前壁黏膜瓣尿道悬吊术(AVMFUS)和经闭孔无张力尿道中段悬吊术(TVT-O)治疗压力性尿失禁的临床疗效。方法2021年1月至2023年9月在佛山市妇幼保健院,根据患者选择手术方式不同,将纳入患者分成AVMFUS组(34例)与TVT-O组(35例),回顾性分析两组手术疗效。结果(1)两组手术时间、术后留置尿管天数及术后残余尿合格率差异无统计学意义(P>0.05)。(2)AVMFUS组住院时间及术中总出血量多于TVT-O组住院时间:[(8.53±3.88)d vs.(5.14±1.75)d];出血量(mL):[50.00(30.00,70.00)vs.20.00(5.00,30.00)];而医疗费用低于TVT-O组[(16711.20±6477.33)元vs.(22436.87±3000.56)元],P<0.05,差异有统计学意义。(3)在术前及随访的4个时间段内,两组间压力性尿失禁程度(ICIQ-SF)评分及客观治愈率比较差异均无统计学意义(P>0.05),且两组患者术后ICIQ-SF较术前均显著降低,差异有统计学意义(P<0.05)。结论自体阴道前壁黏膜瓣尿道悬吊术和TVT-O均是治疗SUI的有效术式,可显著改善尿失禁症状。自体阴道前壁黏膜瓣尿道悬吊术更具经济的优势和减少术后网片侵蚀暴露风险,值得临床推广。

Objective To explore the clinical efficacy of autologous anterior vaginal wall mucosal flap urethral suspension(AVMFUS)and tension-free vaginal tape-obturator(TVT-O)for the treatment of female stress urinary incontinence.Methods From January 2021 to September 2023 at Foshan Maternal and Child Health Care Hospital,the included patients were divided into AVMFUS group(34 cases)and TVT-O group(35 cases)according to the patients'choice of surgical procedures,and the surgical efficacy of the two groups was retrospectively analyzed.Results(1)The differences in the operation time,catheter retention time and qualified rate of residual urine after operation between the two groups were not statistically significant(P>0.05).(2)The AVMFUS group had a longer hospital stay[(8.53±3.88)d vs.(5.14±1.75)d]and higher total blood loss during surgery[50.00(30.00,70.00)mL vs.20.00(5.00,30.00)mL]than the TVT-O group,while the medical expenses were lower in the AVMFUS group than in the TVT-O group[(16711.20+6477.33)CNY vs.(22436.87±3000.56)CNY,P<0.05],there being statistically significant differences.(3)The differences in ICIQ-SF scores and objective cure rates were not statistically significant between the two groups during the preoperative period and the four time periods of follow-up;both groups showed a significant decrease in ICIQ-SF after surgery compared with the preoperative period(P<0.05),and there were statistically significant dfferences.Conclusions AVMFUS and TVT-O are both effective procedures for SUI and can significantly improve the symptoms of urinary incontinence.AVMFUS has more economical advantages and reduces the risk of postoperative mesh invasion and exposure,and is worthy of clinical promotion.