不同路径阴道无张力尿道中段悬吊术治疗重度压力性尿失禁  

Clinical study on tension-free vaginal tape and tension-free vaginal tape obturator for surgical treatment of severe stress urinary incontinence

作　　者：王文艳[1] 朱兰[1] 郎景和[1] 孙智晶[1] 海宁[1] 

机构地区：[1]中国医学科学院中国协和医科大学北京协和医院妇产科,100730

出　　处：《中华妇产科杂志》2008年第3期180-184,共5页Chinese Journal of Obstetrics and Gynecology

基　　金：“十一五”国家科技支撑计划（2007BAI04B05）

摘　　要：目的探讨经耻骨后路径阴道无张力尿道中段悬吊（TVT）术及经闭孔路径阴道无张力尿道中段悬吊（TVT—O）术治疗女性重度压力性尿失禁的临床效果。方法前瞻性随机对照单盲方法选取重度压力性尿失禁患者69例（其中35例行TVT，34例行TVT—O），部分患者合并Ⅰ～Ⅱ度子宫脱垂及阴道前壁膨出。分别记录两种路径手术的手术时间、术中出血量、术后住院时间、住院费用，以及术中、术后并发症的类型和发生率。运用尿道疾病程度分类问卷（UDI-6）和尿失禁相关生活质量问卷（IIQ-7）对两组患者组内及组间手术前后生活质量的变化进行评估。结果TVT-O组平均手术时间为（18±5）min，明显短于TVT组的（27±5）min，差异有统计学意义（P〈0．01）。两组术中出血量、术后第1天B超测量残余尿量的合格率、并发症发生率、术后住院时间和住院费用均相似，差异均无统计学意义（P均〉0．05）。术后随访率100％，平均随访时间14．5个月。TVT组治愈率88．6％（31／35），略高于TVT—O组[85．3％（29／34）]，但两组间比较，差异无统计学意义（P〉0．05）。吊带侵蚀发生率TVT组为5．7％（2／35），高于TVT—O组[2．9％（1／34）]；耻骨上、腹股沟或大腿内侧酸痛发生率TVT组为5．7％（2／35），低于TVT—O组[14．7％（5／34）]，但差异均无统计学意义（P均〉0．05）。两组间手术前后UDI-6和IIQ-7问卷各项目评分及总体评分分别比较，差异均无统计学意义（P均〉0．05）。两组内手术后UDI-6问卷（除梗阻项目）和IIQ-7问卷各项目评分及总体评分较手术前均明显降低，差异均有统计学意义（P均〈0．01），UDI-6问卷中梗阻项目评分，两组内手术前后比较，差异无统计学意义（P〉0．05）。结论TVT—O路径较TVT路径手术时间短，术后短期随访结果显示，两种手术路径均可有效治疗�Objective To investigate the clinical efficacy and improvement of patients＇ quality of life in tension-free vaginal tape （TVT） and tension-free vaginal tape obturator （TVT-O） for surgical treatment of severe female stress urinary incontinence. Methods This study was a randomized, singleblinded, controlled trial. Patients were randomized by a computer-generated randomization schedule with allocation to either TVT or TVT-O procedure. TVT procedure was performed in 35 cases and TVT-O in 34 cases. None had received surgery for urinary incontinence or was in pregnancy. Transvaginal hysterectomy and prolapse reparation were done simultaneously in some of the patients. All patients were requested to complete the Urinary Distress Inventory （UDI-6） and Incontinence Impact Questionnaire （ IIQ-7 ） as part of their pre- and postoperative assessment. Results All patients were evaluable and the mean follow-up was 14. 5 months. The mean operative time was （18 ± 5 ）min in the TVT-O group, significantly shorter than in the TVT group （27 ±5）min（ P 〈 0. 01 ）. The two groups did not differ significantly in perioperative blood loss, postoperative complications （including tape erosion, pain in thigh or behind pubis ）, postvoid residual volume, hospital stays or expenses（ all P 〉 0. 05）. Sixty patients were successfully treated for stress urinaryincontinence （88.6% and 85. 3% for TVT and TVT-O groups, respectively）. There were significant improvements in postoperative scores for both the IIQ-7 and the UDI-6 （ P 〈 0. 01 ）, except in subscale measuring symptoms of voiding dysfunction （P 〉 0. 05）. Conclusions Both techniques appear to be equally effective in the surgical treatment of severe stress urinary incontinence in a short term review. Significant improvements could also be seen in patients＇ quality of life. However, TVT-O has a shorter operative time. No evidence of increasing risk of urethral obstruction after the operation could be found. Long term followups are necess

关 键 词：尿失禁 压力性 尿道 泌尿外科手术 随机对照试验 治疗结果 

分 类 号：R686[医药卫生—骨科学]