不同路径手术治疗老年女性压力性尿失禁的对比研究  

A comparative study on two surgical procedures in treatment of stress urinary incontinence in old women

作　　者：陈信良[1] 姜敏 冯丽[1] 李怀芳[1] 童晓文[1] 

机构地区：[1]上海同济大学附属同济医院妇产科,200065 [2]上海市临床检验中心

出　　处：《中华老年医学杂志》2010年第8期648-651,共4页Chinese Journal of Geriatrics

基　　金：国家自然科学基金（30471815）

摘　　要：目的 评价经耻骨后间隙、经闭孔的2种路径尿道中段悬吊术在治疗老年女性压力性尿失禁（SUI）的安全性和临床效果.方法 选择2003年6月至2005年6月单纯性SUI患者52例,采用经耻骨后间隙的阴道尿道中段网片悬吊术（IVS）;2005年10月至2008年10月单纯性SUI患者112例,采用自制聚丙烯网片及穿刺锥行改良闭孔尿道中段悬吊术（改良TVT-O）;对2组患者治疗效果进行回顾性分析.结果 IVS组手术治愈率80.8%（42/52）,好转率13.5%（7/52）;改良TVT-O组手术治愈率84.8%（95/112）,好转率11.6%（13/112）,2组患者术后1个月随访均有无效病例,其中IVS组3例,改良TVT-O组4例.对7例无效病例,均再次行前路悬吊术.术后6个月、12个月随访结果提示患者均恢复良好.2组患者各有1例术后控制排尿效果良好,但出现了网片侵蚀,予拆除网片后重新行前路悬吊术,疗效良好.仅在IVS组有3例术中常规行膀胱镜检查时发现有膀胱损伤.2组患者手术治疗后控制排尿效果比较,差异无统计学意义（P＞0.05）.改良TVT-O组在手术时间、出血量、治疗费用均少于对照组,差异有统计学意义（P＜0.01）.结论 改良TVT-O、IVS 2种手术方法简单、操作安全,均为高效、微创的控尿手术,但改良TVT-O手术时间短、价格更低廉,易为患者接受.Objective To evaluate the safety and efficacy of two surgical procedures including retropubic space pathway and obturator foramen pathway in treatment of the old women with stress urinary incontinence （SUI）. Methods Intravaginal Slingplasty （IVS） procedure by retropubic space pathway was performed in 52 cases with simple SUI from June 2003 to June 2005. And the modified Transobturator Vaginal Tape Inside-Out （TVT-O） procedure was carried out in 112 cases with simple SUI from October 2005 to October 2008, using self-tailed polypropylene mesh and helical needles. The comparative retrospective study was performed between these two groups. Results The cure rate was 80.8% （42/52） and the improvement rate was 13.5% （7/52） in IVS group. And the corresponding data were 84.8% （95/112） and 11.6% （13/112） in modified TVT-O group. The 3 （5.8%） cases failed in IVS procedure and 4 （3.6%） cases failed in modified TVT-O procedure at 1 month＇s follow-up. All of the 7 patients received the ＇Tong＇s hammock procedure＇ and no cases failed at 6 and 12 month＇s follow-up. One case of vaginal erosion was found in each group although good effect of continence was observed. Meshes were removed in these two patients and then the ＇Tong＇s hommock procedure＇ was performed which turned out to be good outcome. Bladder injuries were found in 3 cases when route cystoscopy was performed. No significant difference in efficacy was found between these two groups（P〉0. 05）. In modified TVT-O group, operative duration, blood loss and medical cost were significantly reduced as compared with IVS group （P〈0. 01）. Conclusions Both of the two surgical procedures of modified TVT-O versus IVS are simple, safe and mini-invasive procedures with high efficacy. However, the modified TVT-O procedure is more easy to be adopted by patients due to short operative time and lower medical cost.

关 键 词：尿失禁 压力性 尿道下悬吊术 

分 类 号：R699[医药卫生—泌尿科学]