单切口经闭孔免皮肤隧道穿刺尿道球部悬吊术在男性尿失禁患者中的临床应用  

The clinical application of single-incision transobturator bulbourethral sling suspension without skin tunnel puncture in male patients with urinary incontinence

作　　者：孟令峰[1] 王继鹏 敬吉波 王淼 侯惠民[1] 周云鹤 张耀光[1] 王建业[1] Meng Lingfeng;Wang Jipeng;Jing Jibo;Wang Miao;Hou Huimin;Zhou Yunhe;Zhang Yaoguang;Wang Jianye(Department of Urology,Bejing Hospital,National Center of Gerontology,Institute of Geriatric Medicine,Chinese Academy of Medical Sciences,Beijing 100730,China)

机构地区：[1]北京医院泌尿外科、国家老年医学中心、中国医学科学院老年医学研究院,北京100730

出　　处：《中华泌尿外科杂志》2024年第9期681-685,共5页Chinese Journal of Urology

基　　金：中国医学科学院中央级公益性科研院所基本科研业务费专项资金资助(2023-JKCS-21)。

摘　　要：目的探讨单切口经闭孔免皮肤隧道穿刺尿道球部悬吊术在男性尿失禁患者中的有效性及安全性。方法回顾性分析2023年8月至2024年8月在北京医院接受单切口经闭孔免皮肤隧道穿刺尿道球部悬吊术的6例男性尿失禁患者的临床资料。年龄66~76岁,平均71.7岁。病程18~48个月,平均30个月。其中3例因前列腺增生接受经尿道前列腺电切术,3例因前列腺癌接受根治性前列腺切除术。尿失禁程度为轻度2例,中度4例。6例患者每日使用尿垫量为1~3片,平均2.3片;国际尿控协会尿失禁问卷表简表(ICI-Q-SF)评分为13~19分,平均15.8分;尿失禁生活质量问卷(1-Q0L)评分为5.3~~30.6分,平均18.8分。患者均采用单切口经闭孔免皮肤隧道穿刺尿道球部悬吊术,其技术要点为:穿刺方式由传统的由外向内,改为由内向外,穿刺针从切口内皮肤下穿出后引导吊带穿人,实现免皮肤隧道穿刺;穿刺完成后,将两侧吊带末端在保证一定张力的情况下打结系于切口中线,并逐层缝合关闭切口。记录患者术后1个月的每日尿垫使用数量、主观量表(ICI-Q-SF、I-QOL)评分、并发症发生情况等指标,评估手术疗效及安全性。将每日使用O~1个尿垫定义为社交控尿。达到社交控尿标准定义为治疗成功;未达到社交控尿,但症状较术前改善≥50%定义为治疗改善;其他情况则定义为治疗失败。结果6例手术均顺利完成。手术时间为114~190 min,平均142min。术后随访1~11个月,平均7.2个月。所有患者均获治疗成功,达到社交控尿标准。患者术后每日使用尿垫量为0~1块,平均0.5片;ICI-Q-SF评分为1~7分,平均3分;I-QOL评分为72.1~85.2分,平均77.0分;均较术前显著改善。术后并发症方面,1例患者于拔除尿管后2d出现排尿困难、尿潴留,予以抗炎、消肿、留置尿管等对症治疗后好转。截至末次随访,无手术相关并发症发生。结论单切口经闭孔免皮肤隧道穿刺尿道�Objective To explore the efficacy and safety of single-incision transobturator bulbourethral sling suspension without skin tunnel puncture in male patients with urinary incontinence.Methods The clinical data of 6 male patients with urinary incontinence who underwent single-incision transobturator bulbourethral sling suspension without skin tunnel puncture in Beijing Hospital from August 2023 to August 2024 were retrospectively analyzed.The age of the patients ranged from 66 to 76 years old,with an average of 71.7 years old.The disease duration ranged from 18 to 48 months,with an average of 30 months.Six patients used 1 to 3 pads per day,with an average of 2.3 pads.The International Continence Incontinence Questionnaire Short Form(ICI-Q-SF)scored 13 to 19,with an average of 15.8.The Incontinence Quality of Life Questionnaire(1-Q0L)scored 5.3 to 30.6,with an average of 18.8.Three patients underwent transurethral resection of the prostate for benign prostatic hyperplasia and three patients underwent radical prostatectomy for prostate cancer.The degree of urinary incontinence was mild in 2 cases and moderate in 4 cases.The technical points are as follows:the puncture method has been changed from the traditional outside-in approach to an inside-out approach.After the puncture needle passes through from beneath the skin at the incision,the sling is guided in,avoiding the need for skin tunneling punctures.Upon completion of the puncture,the ends of the sling on both sides are tied with a certain tension at the midline of the incision,and the incision is then closed layer by layer.The efficacy and safety of surgery were evaluated by recording the number of daily pad use,subjective scoring scale[International Committee on Urinary Incontinence Questionnaire-Short Form(ICI-Q-SF),Incontinence Quality of Life(I-QOL)] and complications at 1 month after surgery.Social continence was defined as O to 1 pad use per day.Successful treatment was defined as social continence.Treatment improvement was defined as no social continence,b

关 键 词：尿失禁 男性 尿道球部悬吊术 单切口 经闭孔 免皮肤隧道穿刺 

分 类 号：R699.5[医药卫生—泌尿科学]