压力性尿失禁吊带术后排尿困难的诊疗分析  

Management of the acquired voiding dysfunction after mid-urethral sling surgery

作　　者：张忠云[1] 张正望[1] 郑吉琼[1] 方伟林[1] 叶茂飞 钱伟庆[1] 孙忠全[1] 

机构地区：[1]复旦大学附属华东医院泌尿外科,上海200040

出　　处：《临床泌尿外科杂志》2016年第2期154-156,共3页Journal of Clinical Urology

摘　　要：目的：分析压力性尿失禁患者行吊带手术后出现排尿困难的原因及处理。方法：2013年6月~2015年5月,我科共收治女性压力性尿失禁患者吊带术后排尿困难9例,7例TVT,2例TVT-O术后,患者年龄50~72岁,病程为吊带术后0.5~12个月,最大尿流率8~14ml/s,剩余尿30~100ml。均先行尿道扩张4次,如效果不佳,行吊带松解手术（距离吊带手术至少3个月）。术后1个月复查尿流率及超声剩余尿。结果：4例患者尿道扩张后排尿顺畅,无进一步治疗。其余5例患者行吊带松解术,均排尿顺畅。9例患者经治疗后均无尿失禁复发,1个月后复查,最大尿流率16~23ml/s,剩余尿0~30ml。处理前后最大尿流率及剩余尿行配对t检验,P〈0.05。治疗后随访1~24个月,患者仍无尿失禁复发,自觉排尿顺畅。结论：压力性尿失禁患者吊带术后排尿困难的主要原因为吊带过紧及吊带位置不佳（近膀胱颈）,治疗上可先行尿道扩张治疗,如效果不佳,可行吊带松解术。经此处理,患者排尿困难可缓解,暂未发现尿失禁复发。Objective： To analyse the cause and treatment of voiding dysfunction after mid-urethral sling sur- gery. Method： We retrospectively studied clinical profiles of nine patients who suffered from voiding dysfunction after mid-urethral sling surgery （seven TVT, two TVT-O）. Patients age was 50-72 years old. The occurrence time of postoperative voiding dysfunction was 0.5-12 months. Peak flow was 8-14 ml/s, and residual urine was 30-100 ml. All patients received urethral dilatation for four times firstly. If urination did not improve, they subsequently received sling lysis three months after mid-urethral sling surgery. Peak flow and residual urine were fol- lowed up one month later. Result： Four patients got obvious improvement after urethral dilatation, the other five patients did not get improvement. So they received sling lysis and got obstructive symptoms relieved. After treatment, peak flow raised to 16-23 ml/s, and residual urine reduced to 0-30 ml one month after patients felt urination improved. Stress urinary incontinence did not recur in all nine patients. The median follow-up period was 12 （range, 1-24） months. Conclusion： The main causes of voiding dysfunction after mid-urethral sling surgery are that the sling is pulled too tightly and placed too close to bladder neck. Urethral dilatation can be the first-line therapy, and sling lysis is able to relieve voiding dysfunction if urethral dilatation does not work.

关 键 词：压力性尿失禁 吊带 排尿困难 尿道扩张 吊带松解术 

分 类 号：R699[医药卫生—泌尿科学]