自体股外侧肌髂胫束筋膜尿道中段耻骨上悬吊术治疗女性压力性尿失禁的疗效观察  

The efficacy of autogenous femoral lateral iliotibial fascia in the treatment of female stress incontinence

作　　者：王颂[1] 王伟刚[1] 董宁[1] 朱德淳[1] 王金国[1] 李玉强 李坤 崔杨[1] 姚友生[2] Wang Song;Wang Weigang;Dong Ning;Zhu Dechun;Wang Jingou;Li Yuqiang;Li Kun;Cui Yang;Yao Yousheng(Department of Urology,The First Hospital of Jilin University,Changehun 130021,China)

机构地区：[1]吉林大学第一医院泌尿外二科,长春130021 [2]中山大学附属孙逸仙纪念医院泌尿外科

出　　处：《中华泌尿外科杂志》2018年第11期809-813,共5页Chinese Journal of Urology

基　　金：吉林省发展与改革委员会基金项目（2015y031-2）;吉林省科技厅国际合作处项目（20170414031GH）

摘　　要：目的探讨采用自体股外侧肌髂胫束筋膜行尿道中段耻骨上悬吊术治疗女性压力性尿失禁的安全性及疗效。方法回顾性分析2016年1月至2017年6月收治的7例女性压力性尿失禁患者的临床资料。年龄45-72岁，平均58．2岁。病程5-21年，平均10．7年。体重指数20．3-31．4kg／ITI。，平均24．1kg／m^2。7例根据临床症状主观分度均为重度。7例术前国际尿失禁咨询委员会尿失禁问卷表简表（ICIQ-SF）评分为（14．3±1．1）分，尿失禁生活质量问卷（I-QOL）评分为（24．3±4．8）分。手术采用全麻，患者先取半侧卧位，右腿伸直在下，左腿屈膝在上，于体表标记髌骨及股外侧肌髂胫束走行。取垂直于股外侧肌髂胫束的横行切口4-6em，显露股外侧肌髂胫束筋膜，沿筋膜充分游离。切取宽1．5-2．0cm，长12-14cm的股外侧肌髂胫束筋膜。将取出的筋膜用生理盐水浸泡，使用两根24）CTlPDS可吸收线或24）血管缝线于筋膜两端分别连续缝合3针，形成吊带。然后改截石位，留置尿管，经两侧阴道旁沟切口行自体筋膜尿道中段耻骨上悬吊术。记录手术时间、术中出血量、术中并发症、术后留置导尿管时间、住院时间、术后并发症等，比较患者手术前后尿失禁及生活质量改善情况。结果本组7例手术均顺利完成。手术时间95-140min，平均117．6min。术中出血量50-90ml，平均70．3ml。术中无并发症。术后留置导尿管5-7d，平均5．8d。术后住院时间5-8d，平均6．3d。7例术后均治愈，其中2例拔除尿管后出现尿潴留，予口服盐酸坦索罗辛及溴吡斯的明，并再次留置尿管3周后治愈。随访13-24个月，平均18．2个月，所有患者术后均无尿失禁，未发生并发症。患者术后1年ICIQ-SF评分为（0．6±0．5）分，I-QOL评分为（96．1±4．3）分，与术前比较明显改善（P〈0．01）。结论应用自体股外侧肌髂胫束筋膜Objective To analyze the safety and efficacy of autogenous femoral lateral iliotibial fascia（ autologous fascia lata） in the treatment of female stress incontinence. Methods The clinical data of 7 female patients with stress incontinence admitted from January 2016 to June 2017 were retrospectively analyzed. The mean age was 58.2 years （range 45 -72 years）. The mean disease duration was 10.7 years （ range 5 - 21 years）. The mean Body mass index （BMI） was 24.1 kg/m^2 （ range 20.3 ± 31.4 kg/m^2 ）. 7 patients had severe subjective scores according to clinical symptoms. The average score of urinary incontinence questionnaire-simple form （ICIQ-SF） of international urinary incontinence advisory committee was 14.3 ± 1. 1, the score of incontinence-quality of life （I-QOL） was 24.3 ±4.8, respectively. During general anesthesia, the patient was placed in a half-recumbent position with the right leg straight down and the left leg bent over. The position of patella as well as the iliotibial band of the lateral femoral muscles were marked on the body surface. The iliotibial fascia of the lateral femoral muscle was exposed through a transverse incision 4 ± 6 cm perpendicular to the iliotibial fascia of the lateral femoral muscle. The fascia of the lateral iliac tibia] fascia of the lateral vastus with a width of 1.5 to 2.0 cm and a length of 12 to 14 em was cut. The fascia was immersed in physiological saline and sutured with two 2-0 CT1PDS absorbable sutures or 2-0 vascular sutures at both ends of the fascia for 3 consecutive needles to form a sling. Then the urethral catheter was placed in the position of lithotomy, and then urethral suprapubic suspension was performed using autologous fascia through bilateral paravaginal incisions. The duration of surgery, intraoperative blood loss, intraoperative complications, postoperative catheter indwelling time, the length of hospital stay and postoperative complications were recorded. The situation of urinary incontinence as well as life quality before

关 键 词：自体筋膜 悬吊术 压力性尿失禁 

分 类 号：R699.7[医药卫生—泌尿科学]