单支网片尿道悬吊联合阴道成形术治疗伴Ⅰ~Ⅱ度前盆腔脱垂SUI的临床疗效  

Single branch mesh urethral suspension combined with vaginoplasty in the treatment of stress urinary incontinence in women with degree Ⅰ~Ⅱ anterior pelvic prolapse

作　　者：田道明 高振华[1] 王星棋 李玲[1] 杨勋国 文雨彬 李圆 张铨 申吉泓[1] Tian Daoming;Gao Zhenhua;Wang Xingqi;Li Ling;Yang Xunguo;Wen Yubin;Li Yuan;Zhang Quan;Shen Jihong(Department of Urology,The First Affiliated Hospital of Kunming Medical University,Kunming 650032,China)

机构地区：[1]昆明医科大学第一附属医院泌尿外科,昆明650032

出　　处：《中华泌尿外科杂志》2024年第2期122-126,共5页Chinese Journal of Urology

基　　金：国家自然科学基金(82260297);云南省高校女性盆底功能障碍性疾病研究与应用科技创新团队(K1322142)。

摘　　要：目的探讨单支网片尿道悬吊联合阴道成形术治疗伴Ⅰ~Ⅱ度前盆腔脱垂压力性尿失禁(SUI)患者的效果。方法回顾性分析2021年4-11月昆明医科大学第一附属医院收治的80例女性SUI合并Ⅰ~Ⅱ度前盆腔脱垂患者的病例资料。年龄(53.6±11.7)岁。孕次(3.1±1.4)次。5例有子宫切除术史。所有患者均有SUI症状,压力诱发试验阳性,指压试验阳性。超声检查提示膀胱颈移动度增大,膀胱轻度膨出声像,肛提肌裂孔面积增宽。根据简化盆腔器官脱垂分期系统分度,合并Ⅰ度前盆腔脱垂7例,Ⅱ度前盆腔脱垂73例。本组80例均全麻下行单支网片悬吊联合阴道成形术。患者取截石位。以盆底修复网片为原型裁剪为单支网片,网片由左右两侧臂和中间主体部分构成,为倒“T”形,左右对称。与传统吊带和网片相比,单支网片左右两侧悬吊臂增宽,以保证悬吊臂在耻骨降支有较大的受力面,防止吊带移动;中间主体部分增宽,使受力面从尿道中段延续至膀胱颈。选择双侧耻骨下支下缘外侧0.5cm处穿刺,引导单支网片双臂从内向外穿出,完成单支网片悬吊。采用阴道成形术修复撕裂的肛提肌,成形会阴体,分层重建肛门外括约肌,缩窄阴道呈“双喇叭口状”。术后1、3、6个月随访,采用盆腔器官脱垂术后患者全身状况改善问卷(PGI-Ⅰ)评价前盆腔脱垂治疗效果。SUI疗效评判标准:在术后无其他治疗的情况下,SUI症状完全消失,可自主控尿为治愈;SUI症状较术前减轻,剧烈活动时有少量漏尿,日常活动时无漏尿为改善;SUI症状较术前无改善或进一步加重,仍无法控制漏尿为无效。结果本组80例手术均顺利完成,术中无特殊情况。手术时间(90±8)min,术中出血量(20±10)ml。80例术后48h拔除尿管后均能自行排尿,超声检查测量残余尿量<50ml,术后72h出院。80例PGI-Ⅰ问卷评价结果显示,76例(95.0%)主观治愈,4例(5.0%)主观缓解。80�Objectives To investigate the results of single-branch mesh urethral suspension combined with vaginoplasty in the treatment of female patients with stress urinary incontinence combined with degree I-II anterior pelvic prolapse.Methods Data of 80 female patients with SUI combined with degree I-anterior pelvic prolapse admitted to the First Affiliated Hospital of Kunming Medical University from April to November 2021 were retrospectively analyzed.Patients'age were(53.6±11.7)years old.The number of pregnancies were(3.1±1.4).Five cases had a history of hysterectomy.All patients had SUI symptoms,positive pressure evoked test and positive finger pressure test.Ultrasonography suggested increased bladder neck mobility,mild bladder bulging image,and widening of the area of the fissure of the anal muscle.According to the simplified pelvic organ prolapse staging system,there were 7 cases combined with degree Ⅰ anterior pelvic prolapse and 73 cases with degree Ⅱ anterior pelvic prolapse.All 80 cases in our group underwent single branch mesh suspension combined with vaginoplasty under general anesthesia.The patients underwent the truncated position.The pelvic floor repair mesh was cut as a prototype of singlebranch mesh,consisting of the left and right arms and the main part in the middle,which was inverted"T"-shaped with symmetrical left and right arm.Compared with the traditional sling and mesh,the left and right arms of the single mesh were widened to ensure that the arms had a larger force surface in the pubic descending branch to prevent the sling from moving.The middle body part was widened so that the force surface was continued from the mid-urethra to the bladder neck.A puncture of 0.5 cm lateral to the lower edge of the bilateral pubic descending branch was selected to guide the double arms of the single mesh to penetrate from the inside to the outside to complete the suspension of the single mesh.Vaginoplasty was used to repair the torn anorectalis muscle,shape the perineal body,reconstruct the external anal s

关 键 词：尿失禁 压力性 全尿道悬吊 后盆底重建 随访研究 

分 类 号：R699.7[医药卫生—泌尿科学]