人工尿道括约肌植入术治疗压力性尿失禁长期随访结果  

Long term follow up outcome of artificial urinary sphincter implantation to treat stress urinary incontinence

作　　者：张帆[1] 廖利民[1,2] 付光[1] 熊宗胜[1] 鞠彦合[1] 陈国庆[1] 李兴 查丽华[1] 丛惠伶[1] 王祎明 吴娟[2] 李东[2] 韩春生[2] 靖华芳[2] 高轶[2] Zhang Fan;Liao Limin;Fu Guang;Xiong Zongsheng;Ju Yanhe;Chen Guoqing;Li Xing;Zha Lihua;Cong Huiling;Wang Yiming;Wu Juan;Li Dong;Han Chunsheng;Jing Huafang;Gao Yi(Department of Urology,China Rehabilitation Research Center,Bejing Bo ai Hospital,Beijing 100068,China;Department of Neurourology,China Rehabilitation Research Center,Bejing Bo ai Hospital,Bejing 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,北京100068 [2]中国康复研究中心,北京博爱医院神经泌尿科,北京100068

出　　处：《中华泌尿外科杂志》2022年第9期659-664,共6页Chinese Journal of Urology

摘　　要：目的探讨人工尿道括约肌植入术治疗压力性尿失禁的长期疗效。方法回顾性分析中国康复研究中心2002年4月至2022年4月行人工尿道括约肌植入术治疗46例压力性尿失禁患者的临床资料。男45例,女1例;年龄19~80岁,平均45.6岁;患者病程8个月至33年。其中尿道外伤术后尿失禁24例,神经源性尿失禁9例,前列腺术后尿失禁13例。术前每日尿垫使用量(3.5±1.0)片,尿失禁对生活质量影响的视觉模拟症状(VAS)评分(7.1±1.2)分。46例均行人工尿道括约肌植入术,其中20例植入术前行药物治疗或尿路相关手术(口服抗胆碱能药物5例,尿道狭窄切开术2例,括约肌切开术3例,尿道扩张术5例,尿道结石碎石术1例,肠道膀胱扩大术4例)。45例男性中25例经会阴入路,20例经阴囊入路;1例女性采用经腹入路。根据术中测量球部尿道周径选择袖套,其中男性16例袖套周径为4.5 cm,29例为4.0 cm;1例女性患者袖套周径为8 cm。随访手术长期疗效,观察患者术后控尿情况(社交控尿定义为每日使用尿垫≤1片,完全干燥定义为无需使用尿垫),装置使用状态及并发症。对比不同病因、手术入路及袖套周径患者手术效果的差异。结果术后随访6个月至19年,平均7.1年。截至末次随访,32例(69.6%)仍正常使用初次安装的括约肌装置,3例(6.5%)行1次修复手术植入新装置后可维持控尿,11例(23.9%)因术后并发症取出装置。术后35例(76.1%)达到社交控尿,其中16例(34.8%)达到完全干燥。术后患者尿垫使用量为(1.2±0.6)片/日,较术前显著下降(P<0.001);尿失禁对生活质量影响的VAS评分为(2.6±1.9)分,较术前显著下降(P<0.001)。术后并发症发生率为32.6%(15/46),其中感染4例,局部侵蚀5例,机械故障3例,排尿困难2例,尿道萎缩1例。尿道外伤术后尿失禁、神经源性尿失禁、前列腺术后尿失禁患者术后社交控尿率[75.0%(18/24)与66.7%(6/9)与84.6%(11/13)]、并发症发生率[3Objective To investigate the long term outcome of artificial urinary sphincter implantation for patients with stress urinary incontinence.Methods The data of 46 patients who underwent artificial urethral sphincter implantation in China Rehabilitation Research Center from April 2002 to April 2022 were retrospectively analyzed.The patients'age ranged from 19-80 years old(median 45.6 years).There were 45 males and 1 female.The history of llness was 8 months to 33 years.The patients category were urethral injuries associated urinary incontinence(n=24),neurogenic urinary incontinence(n=9)and post-prostatectomy incontinence(n=13).Preoperative daily pad usage was 3.5±1.0.The impact of incontinence on the quality of life(QOL)measured by the visual analogue scale(VAS)was 7.1±1.2.All 46 patients underwent artificial urethral sphincter implantation,of which 20 patients were treated with anticholinergic drugs(5 cases)or urinary tract related surgery(urethral stenosis incision in 2 cases,sphincterectomy in 3 cases,urethral dilation in 5 cases,urethral calculus lithotripsy in 1 case,and augmentation cystoplasty in 4 cases)before artificial urethral sphincter implantation.Of the 45 male patients,25 patients had the transperineal approach and 20 had the trans-scrotal approach.The female case had a trans-retropubic approach.Different cuffs size was used based on individual circumference of bulbar urethra(45 male cases:4.5cm in 16 cases,4.0cm in 29 cases;one female case:8.Ocm).Long-term surgical efficacy was evaluated.Assessments included postoperative urinary continence(socially continent:one pad per day or less;complete dry:wearing no pads),artificial urinary sphincter status and complications.The influences of patients of different etiologies,surgical approaches and cuff size on surgical results were compared.ResultsThe mean follow-up time was 7.1 years ranged from 6 months to 19 years.At the latest visit,32 patients(69.6%)maintained the primary functional artificial urinary sphincter.Three patients(6.5%)had artificial urinar

关 键 词：尿失禁 压力性 人工尿道括约肌 控尿率 并发症 疗效 

分 类 号：R699.6[医药卫生—泌尿科学]