人工尿道括约肌植入术在复杂尿路重建中治疗尿失禁的应用  

Clinical outcome of artificial urinary sphincter implantation to treat complex urinary incontinence

作　　者：张帆[1] 廖利民[1] 付光[1] 陈国庆[1] 吴娟[1] 熊宗胜[1] 李东[1] 韩春生[1] 鞠彦合[1] 史文博[1] Zhang Fan Liao Limin Fu Guang Chen Guoqing Wu Juan Xiong Zongsheng Li Dong Han Chunsheng Ju Yanhe Shi Wenbo(Department of Urology, China Rehabilitation Research Center. Department of Urology of Capital Medical University, Beifing 100068, China)

机构地区：[1]中国康复研究中心北京博爱医院泌尿外科首都医科大学泌尿外科学系,100068

出　　处：《中华泌尿外科杂志》2016年第12期884-887,共4页Chinese Journal of Urology

摘　　要：目的 总结人工尿道括约肌植入术在复杂尿路重建中治疗尿失禁的经验.方法 回顾性分析我中心自2002年4月至2016年4月30例行人工尿道括约肌植入术患者的临床资料.男29例,女1例.年龄20～70岁,平均40.2岁.对围手术期的相关处理及患者尿失禁和生活质量改善情况进行观察评价.结果 术后随访25个月～13年,平均52.8个月.截至最近一次随访,23例患者仍使用初次安装的括约肌装置,4例行一次修复手术,3例因术后并发症取出装置.术后22例达到社会控尿,其中14例达到完全干燥,手术成功率73.3％（22/30）.术后患者尿垫使用量为（1.1±0.3）片,较术前（3.8±0.3）片显著下降（P＜0.001）;VAS评分提示术后患者尿失禁对生活影响指数为1.9±0.5,较术前6.9±0.3显著下降（P ＜0.001）.术后并发症发生率为26.7％,其中感染4例,局部侵蚀3例,机械故障1例.结论 复杂性尿失禁的治疗需根据患者个体情况计划一系列尿路重建手术.AUS植入作为重要步骤,其手术时机的选择及并发症的处理应比单纯根治性前列腺切除术后尿失禁的AUS植入更加谨慎.Objective To present the experience of artificial urinary sphincter implantation as a part of urinary tract reconstruction for patients with refractory urinary incontinence.Methods Between April 2002 and April 2016,a total of 30 patients （median age,40.2 years,29 males,1 female） with urinary incontinence had accepted artificial urinary sphincter placement during urinary tract reconstruction.Assessments included case selection,perioperative management,urinary continence,artificial urinary sphincter status,complications,quality of life and additional procedures.Results The mean follow-up time was 52.8 months ranged from 25 months to 13 years.At the latest visit,23 patients （76.7%） maintained the primary artificial urinary sphincter.Four patients （13.3%） had artificial urinary sphincter revisions.Explantations were performed in three patients.Twenty-two patients were socially continent,of which 14 patients were totally dry,leading to the overall success rate as 73.3%.There was a significant reduction in pad count from 3.8 ±0.3 to 1.1 ±0.3 diapers per day （P 〈0.001）.There was a significant reduction on the impact of urinary incontinence on quality of life,with a decrease from 6.9 ± 0.3 to 1.9 ± 0.5 （P 〈 0.001） on a visual analogue scale （VAS）.The complication rate was 26.7%;including infections （n =4）,erosions （n =3）,and mechanical failure （n =1）.Conclusions Artificial urinary sphincter implantation is an effective treatment as a key procedure for urinary tract reconstruction,especially in complicated urinary incontinence cases.Other than post-prostatectomy incontinence cases,the quality and choice of management modalities should be tailored to the unique needs of each individual with caution.

关 键 词：人工尿道括约肌 尿失禁 尿路重建 并发症 随访 

分 类 号：R699[医药卫生—泌尿科学]