全盆底重建术联合尿道中段悬吊术在盆腔器官脱垂合并压力性尿失禁的作用  

Significance of total pelvic floor reconstruction and tension-free vaginal tape-obtu- rato in the pelvic organ prolapse combined with stress urinary incontinence

作　　者：陶勇[1] 余刚[1] 彭玉兰[1] 

机构地区：[1]湛江中心人民医院泌尿外科,广东湛江524037

出　　处：《现代泌尿外科杂志》2014年第1期29-32,共4页Journal of Modern Urology

摘　　要：目的探讨全盆底重建术联合经闭孔阴道无张力尿道中段悬吊术(TVT-O)在盆腔器官脱垂(POP)合并压力性尿失禁(SUI)的作用。方法将78例POP合并SUI患者按照患者家属充分知情自愿原则分为对照组(n=35)与治疗组(n=43),对照组患者采用无张力尿道中段悬吊术(TVT-O)进行保守治疗,治疗组患者采用Prolift全盆底重建术联合(TVT-O)进行治疗,对比两组患者的手术时间、术中出血量、并发症、尿管滞留时间、住院天数及尿动力学、生活质量(I-QOL)评分情况。结果对照组患者的手术时间(112.8±17.9)min、术中出血量(204.8±65.7)mL、尿管滞留时间(2.4±0.5)d、住院天数(5.4±0.6)d这4个指标均优于观察组[手术时间(152.4±20.9)min、术中出血量(262.5±80.4)mL、尿管滞留时间(2.6±0.5)d、住院天数(5.8±0.7)d](P均<0.05),但并发症显著高于治疗组(χ2=3.864,P=0.049)。治疗组患者的初尿膀胱容量(303.4±26.8)mL、最大膀胱容量(403.1±30.4)mL这2个指标均优于对照组初尿膀胱容量(275.4±19.7)mL、最大膀胱容量(349.8±28.7)mL](P<0.05)。术后随访半年的I-QOL评分,治疗组与对照组分别为(81.1±12.7)分、(72.9±9.8)分,差异有显著统计学意义(t=4.454,P<0.01)。结论全盆底重建术联合TVT-O对POP合并SUI患者疗效确切,拥有更好的近远期疗效,可有效提升患者的生活质量。Objective To investigate the significance of total pelvic floor reconstruction and tension free vaginal tape obturator （TVT O） in pelvic organ prolapse （POP） complicated with stress urinary incontinence （SUI）. Methods A total of 78 patients with POP complicated with SUI were divided into the control group （n=35） and the treatment group （n=43）. The control group was treated with TVT O, and the treatment group was treated with total pelvic floor reconstruction combined with TVT O. The operative time, blood loss, complications, urinary retention time, length of hospital stay, urodynamic situation, and I QOL scores in incontinence patients were compared. Results The operative time （112.8±17.9）min, blood loss （204.8±65.7）mL, urinary retention time （2.4±0.5）d and length of hospital stay （5.4±0.6）d of the control group were shorter than those of the treatment group, namely （152.4±20.9）min, （262.5±80.4）mL, （2.6±0.5）d and （5.8±0.7）d. Complications were significantly higher in the control group than in the treatment group （χ2 = 3.864, P=0.049）. The urodynamic situation and I QOL scores in the treatment group （81.1±12.7） were better than those in the control group （72.9±9.8, P〈0.05）. Conclusions The total pelvic floor reconstruction surgery combined with TVT O is effective in patients with POP complicated with SUI, which can improve the short term and long term quality of life.

关 键 词：全盆底重建术 经闭孔阴道无张力尿道中段悬吊术 盆腔器官脱垂 压力性尿失禁 尿动力参数 I-QOL 

分 类 号：R692.2[医药卫生—泌尿科学]