腹腔镜Burch悬吊和尿道中段悬吊带术治疗女性压力性尿失禁临床分析  

Laparoscopic retropubic bladder neck suspension(Burch) vs mid-urethral suspension in treatment of female stress urinary incontinence

作　　者：曹莉莉[1] 徐惠成[1] 王延洲[1] 

机构地区：[1]第三军医大学西南医院妇产科,重庆400038

出　　处：《第三军医大学学报》2011年第24期2607-2610,共4页Journal of Third Military Medical University

摘　　要：目的分析腹腔镜Burch术和尿道中段悬吊带(mid-urethral suspension,MUS)术治疗女性压力性尿失禁(stress urinary incontinence,SUI)的临床资料,探讨2种手术的疗效及安全性。方法回顾性分析114例SUI患者行2种手术治疗的围手术期情况和疗效,其中腹腔镜Burch术59例,MUS术55例。结果腹腔镜Burch术、MUS术患者术后平均随访33(12～77)个月,总有效率分别为93%(40/43)、100%(51/51),差异无统计学意义(P>0.05);治愈率分别为53.5%(23/43)、84.3%(43/51),差异有统计学意义(P<0.05)。腹腔镜Burch术组并发膀胱阴道瘘1例,术后缝线侵蚀膀胱2例,排尿困难1例,单侧输尿管不完全梗阻1例,MUS术没有并发症发生。对单独实施两种手术的资料进行比较,腹腔镜Burch术除手术时间长于MUS术外,其余比较差异均无统计学意义(P>0.05)。结论腹腔镜Burch术适应证较宽,总手术时间、出血量、术后恢复时间均多于MUS术组,住院费用较低;MUS术疗效好,手术简单、安全、术后患者康复快、留置尿管和住院时间短,术后并发症及排尿功能异常少,但住院费用较高。Objective To compare the efficacy and safety of laparoscopic retropubic bladder neck suspension（Burch） and mid-urethral suspension（MUS） in the treatment of female stress urinary incontinence（SUI） so as to clarify the clinical value of two kinds of suspender surgery.Methods Clinical data of 114 SUI cases who were operated in our department during January 2005 to June 2010 were retrospective analyzed.Among them,59 patients received laparoscopic Burch,and the other 55 cases mid-urethral suspension.Their perioperative situation and surgery efficiency were compared.Results In the mean follow-up time of 33 months（ranging from 12 to 77 months）,the overall response rate were 93%（40/43） and 100%（51/51） respectively in laparoscopic Burch and MUS surgery,with no significant difference（P0.05）.The cure rates were 53.5%（23/43） and 84.3%（43/51） respectively,with significant difference between them（P0.05）.In laparoscopic Burch group,bladder vaginal fistula occurred in 1 case,suture erosion into the bladder in 2 cases,dysuria in 1 case,and incomplete unilateral ureteral obstruction in 1 case.While no severe complication was found in MUS group.Among the 42 cases which were independently performed for suspender surgery,besides the operating time longer in the laparoscopic Burch group than in MUS group,there was no significant difference in other surgical parameters（P0.05）.Conclusion Laparoscopic Burch surgery has wild range of indications,but longer operative time,more blood loss,slower postoperative recovery times,but lower cost of hospitalization when compared with MUS.MUS is a simple,safe surgery with high efficacy,quick recovery,shorter indwelling catheter and hospital stay,less postoperative complications and voiding dysfunction,but has higher hospital charges.

关 键 词：压力性尿失禁 腹腔镜 膀胱颈悬吊术 尿道中段悬吊术 

分 类 号：R615[医药卫生—外科学] R694.54[医药卫生—临床医学]