TVT与TVT-O不同位置治疗老年女性压力性尿失禁的有限元分析  

Finite element analysis of different positions of TVT and TVT-O in the treatment of stress urinary incontinence in elderly women

作　　者：李伟君 周沂 吴建辉[2] 陈丽华[3] 刘海英[4] 翟丽东[1] Li Weijun;Zhou Yi;Wu Jianhui;Chen Lihua;Liu Haiying;Zhai Lidong(Department of Anatomy,School of Basic Medical Sciences,Tianjin Medical University,Tianjin 300070,China;Department of Urology,Tianjin First Central Hospital,Tianjin 300192,China;Department of Radiology,Tianjin First Central Hospital,Tianjin 300192,China;School of Mechanical Engineering,Tianjin University of Technology,Tianjin 300384,China)

机构地区：[1]天津医科大学基础医学院人体解剖学系,天津300070 [2]天津市第一中心医院泌尿外科,天津300192 [3]天津市第一中心医院放射科,天津300192 [4]天津理工大学机械工程学院,天津300384

出　　处：《中国临床解剖学杂志》2025年第1期76-81,89,共7页Chinese Journal of Clinical Anatomy

基　　金：国家自然科学基金资助项目(31871212)。

摘　　要：目的用有限元分析的方法模拟老年女性压力性尿失禁(Stress urinary incontience,SUI)常见吊带手术:经耻骨后无张力尿道吊带(Tension-free vaginal tape,TVT)和经闭孔无张力尿道吊带(Tension-free vaginal tape-obturator,TVT-O),评估它们在尿道不同位置的治疗效果。方法根据一名无盆底疾病女性的磁共振(MRI)图像构建盆腔几何模型。将老年阴道组织薄弱认定为组织刚度降低,施加腹压模拟valsalva运动并分别在尿道近端、中远端、远端放置TVT与TVT-O,得出力学数据。结果尿道近端的吊带会导致α角与膀胱颈位移小于正常值。“漏斗”现象在吊带位于尿道近端与中远端时消失,位于尿道远端时依然存在;不同位置吊带与尿道之间的压强大小关系为:近端>中远端>远端。结论尿道近端(30%)的吊带容易导致尿道过紧,引起术后并发症;尿道远端(80%)的吊带治疗效果不佳;尿道中远端(60%)的吊带治疗效果好、术后并发症发生率低。尿道中远端放置TVT应该作为老年女性SUI手术的首选方法。Objective To simulate common sling surgeries for stress urinary incontinence(SUI)in elderly women using finite element analysis methods:tension-free vaginal tape(TVT)and tension-free vaginal tape-obturator(TVT-O),and to evaluate their therapeutic effects at different positions of urethra.Methods A pelvic geometry model was constructed based on magnetic resonance imaging(MRI)images of a woman without pelvic floor diseases.The thinning of elderly vaginal tissue was considered as a reduction in tissue stiffness.Abdominal pressure was applied to simulate valsalva maneuver,and TVT and TVT-O were placed at the proximal,mid-distal,and distal parts of urethra,respectively,to obtain mechanical data.Results The sling at the proximal part of urethra would lead to theα-angle and bladder neck displacement less than normal values.The"funnel"phenomenon disappeared when the sling was located at the proximal and middistal parts of urethra,but still existed when located at the distal part;the pressure magnitude between the sling and urethra at different positions was:proximal>mid-distal>distal.Conclusions The sling at the proximal part of urethra(30%)is prone to cause excessive tightness of urethra,leading to postoperative complications,the sling at the distal part of urethra(80%)has poor therapeutic effect,the sling at the mid-distal part of urethra(60%)has a good therapeutic effect and a low incidence of postoperative complications.The placement of TVT at the mid-distal part of urethra should be the preferred surgical method for elderly women with SUI.

关 键 词：压力性尿失禁 TVT TVT-O 有限元分析 生物力学 

分 类 号：R318.01[医药卫生—生物医学工程]