经闭孔无张力尿道中段悬吊术后复发性压力性尿失禁的临床分析  

Clinical and Therapeutic Features of Recurrent Female Stress Urinary Incontinence after Failure of the Transobturator Tension-Free Vaginal Tape Mid-Urethral Sling

作　　者：乔鹏[1] 关星[1] 曾嵩[1] 王飚[1] QIAO Peng;GUAN Xing;ZENG Song(Department of Urology,Capital Medical University,Beijing Chaoyang Hospital,Institute of Urology,Capital Medical University,Beijing 100020,China)

机构地区：[1]首都医科大学附属北京朝阳医院泌尿外科首都医科大学泌尿外科研究所,北京100020

出　　处：《实用妇产科杂志》2022年第6期436-439,共4页Journal of Practical Obstetrics and Gynecology

摘　　要：目的:分析经闭孔无张力尿道中段悬吊术(TVT-O)后复发性压力性尿失禁(SUI)女性患者的临床特点和治疗。方法:回顾性分析2013年1月至2019年6月于首都医科大学附属北京朝阳医院住院的TVT-O术后复发性SUI女性患者16例的临床资料,患者复发后均采用耻骨后无张力尿道中段悬吊术(TVT)治疗。分析患者的临床特点、手术疗效和安全性,并采用尿失禁问卷简表(ICI-Q-SF)、生活质量问卷(I-QOL)及尿动力学检查对术前与术后的情况进行比较。结果:16例患者年龄60.6±9.3岁,TVT-O术后2.5±1.3年SUI复发,复发后10例患者体质量指数(BMI)≥28.0 kg/m^(2),14例患者有尿道括约肌关闭功能受损。12例患者的既往吊带位于尿道中段,其中3例位于阴道肌层,无术中并发症。与术前相比,术后ICI-Q-SF评分显著降低,I-QOL评分则显著提高,差异均有统计学意义(P<0.05)。TVT术后主、客观治愈率均为93.8%(15/16)。随访8~46个月,所有患者均未出现SUI复发及中远期并发症,1例患者术后出现排尿困难,2例患者出现单侧会阴区疼痛,均予对症处理及时缓解。术后2个月复查各项尿动力学指标,与术前相比差异均无统计学意义(P>0.05)。结论:TVT-O术后SUI的复发可能与肥胖、吊带位置不正确和术式选择不当有关,二次行TVT术可有效和安全地治疗TVT-O术后复发性SUI。Objective:To analyze the clinical and therapeutic features of recurrent female stress urinary incontinence(SUI)after failure of transobturator tension-free vaginal tape mid-urethral sling(TVT-O).Methods:Retrospectivly analyzed the data of 16 cases of females with recurrent SUI after failure of TVT-O in Beijing Chaoyang Hospital between January 2013 and June 2019.All patients received the repeat retropubic tension-free vaginal tape mid urethral sling(TVT).The clinical characteristics,curative effect and safety of the operation were analyzed,and the preoperative and postoperative conditions were compared using ICI-Q-SF,I-QOL and urodynamic examination.Results:The mean age was 60.6±9.3 years old and the mean recurrence time following TVT-O was 2.5±1.3 years.Among the 16 patients,10 had body mass index greater than 28.0 kg/m^(2) and 14 had the urethral sphincter dysfunction.12 patients were located at the middle of urethra during surgery,among which 3 slings were located at the vaginal muscle layer.The ICI-Q-SF score was decreased significantly after the repeat TVT compared with preoperative conditions(P<0.001),while the I-QOL score was increased significantly after the repeat TVT compared with preoperative conditions(P<0.001).93.8%(15/16)were both objectively and subjectively cured by repeat TVT,while I patient had postoperative dysuria,and 2 patients had unilateral perineal pain.During the follow-up period,no patients experienced recurrence,intraoperative complications and long-term complications.No significant difference was found between preoperative and postoperative conditions in urinary flow rate and residual urine volume.Conclusions:Recurrent SUI after failure of TVT-O was potentially associated with obesity,incorrect sling position and inappropriate surgical procedure.Repeat TVT procedure demonstrates its effect and safety in the treatment of recurrent SUI after failure of TVT-O.

关 键 词：压力性尿失禁 复发 尿道中段悬吊术 治疗 

分 类 号：R694.54[医药卫生—泌尿科学]