无张力尿道中段悬吊术后发生排尿障碍的危险因素分析  

Incidence and risk factors of voiding dysfunction after mid-urethral sling surgery for stress urinary incontinence

作　　者：周全[1] 李宝恒[2] 宋岩峰[2] 黄惠娟[2] 王凤玫[2] 杨巧妹[2] 罗建秀 

机构地区：[1] 三峡大学人民医院妇产科,443000 [2]南京军区福州总医院妇产科

出　　处：《中华泌尿外科杂志》2014年第5期354-358,共5页Chinese Journal of Urology

基　　金：福建省科技创新平台项目（2010Y2005）;福建省青年人才资助项目（2008F3087）

摘　　要：目的 探讨无张力尿道中段悬吊术（mid-urethral sling surgery,MUS）后发生排尿障碍的危险因素. 方法 回顾性分析2003年6月至2010年12月573例采用MUS治疗的压力性尿失禁患者的临床资料,对术后发生排尿障碍可能相关的危险因素进行单因素分析及多因素Logistic回归分析. 结果 MUS术后出现排尿障碍28例,发生率为4.9％.单因素分析结果显示,患者年龄、盆底手术史、术前残余尿量、平均尿流率、最大尿流率、漏尿点压、合并行前盆腔脱垂手术及术者手术经验是影响MUS术后排尿障碍发生的主要因素（P＜0.05）;多因素分析结果显示,术前最大尿流率≤15 ml/s（OR=3.782,P=0.003）是术后排尿障碍的独立危险因素,而术者经验（OR=0.295,P=0.016）是其保护因素. 结论 术前最大尿流率≤15 ml/s是MUS术后排尿障碍发生的独立危险因素,加强技术培训、提高手术技能可能有助于减少排尿障碍的发生.Objective To analyze the risk factors of voiding dysfunction after mid-urethral sling surgery for stress urinary incontinence.Methods Clinical data of 573 consecutive patients undergoing midurethral sling surgery from January 2003 to December 2010 were collected and analyzed retrospectively.All relative risk factors were evaluated by univariate and multivariate Logistic analysis to identify risk factors of voiding dysfunction.Results Voiding dysfunction occurred in 28 patients,with an incidence of 4.9% （28/573）.Univariate analysis showed that age,previous pelvic surgery,pre-operative postvoid residuals,maximum flow rate,average urine flow rate,Valsalva leak point pressure,concomitant anterior pelvic repair and operator performing〈50 procedures were the relative risk factors （P〈0.05） for voiding dysfunction.Multivariate logistic regression analysis revealed that the maximum flow rate （Qmax） ≤ 15 ml/s （OR=3.782,P=0.003） was an independent risk factor for voiding dysfunction and surgery experience was its protection factors （OR=0.295,P=0.016）.Conclusions Qmax ≤ 15 ml/s on preoperative urodynamic study is an independent risk factor for voiding dysfunction after mid-urethral sling procedure.Improving skill of surgery and strengthening technical training will help to reduce the incidence of this complication.

关 键 词：尿失禁 压力性 危险因素 排尿障碍 

分 类 号：R699.7[医药卫生—泌尿科学]