自体阔筋膜吊带尿道中段悬吊带术治疗压力性尿失禁的短期疗效观察  

Short-term efficacy of mid-urethral sling with autologous fascia lata sling in the treatment of stress urinary incontinence

作　　者：管祎祺[1] 杨俊芳[1] 韩劲松[1] 王一婷[1] 张坤[1] 姚颖[1] 于博 Guan Yiqi;Yang Junfang;Han Jinsong;Wang Yiting;Zhang Kun;Yao Ying;Yu Bo(Department of Obstetrics and Gynecology,Peking University Third Hospital,National Clinical Research Center for Obstetric and Gynecologic Diseases,Beijing 100191,China)

机构地区：[1]北京大学第三医院妇产科,国家妇产疾病临床医学研究中心,北京100191

出　　处：《中华妇产科杂志》2025年第3期177-182,共6页Chinese Journal of Obstetrics and Gynecology

摘　　要：目的观察使用自体阔筋膜吊带(AFLS)行无张力尿道中段悬吊带(MUS)治疗压力性尿失禁(SUI)的安全性及短期疗效。方法2022年2月至2023年12月期间,对11例SUI患者行使用AFLS的无张力MUS,术前记录患者基本信息,完善排尿不适调查表(UDI-6)。术中应用取腱器小切口采集AFLS并作为吊带行经闭孔或经耻骨后MUS。记录患者围手术期相关指标:手术方式、手术时间、术中出血量、术后住院时间、留置尿管时间、围手术期并发症(Clavien-Dindo分级)及手术费用。术后2个月门诊随访,术后半年、1年及此后每年进行电话随访,随访内容包括有无漏尿症状、排尿不适调查表(UDI-6)、满意度、患者整体印象改善评分表(PGI-I)及并发症。结果11例患者的年龄为(54.8±10.9)岁(范围:41~72岁),体重指数为(23.9±1.8)kg/m 2(范围:21.4~27.3 kg/m 2),均有咳嗽、喷嚏和活动后漏尿,SUI诱发试验均阳性。术前UDI-6评分为(50.0±21.6)分(范围:16.7~79.2分),1 h尿垫试验结果为(18.9±12.0)g(范围:2.5~71.2 g)。4例患者仅行MUS,手术时间为(98.0±13.3)min(范围:86~117 min),其中取腱时间为(21.6±2.4)min,术中总出血量为(17.5±5.0)ml(范围:10~20 ml);7例同时行盆腔器官脱垂修复手术。术后住院时间为(3.5±2.0)d(范围:2~9 d),留置尿管时间为(4.5±3.8)d(范围:2~11 d)。取腱+MUS的手术费用为(2762±293)元。术后尿潴留3例(3/11),其中1例因排尿困难症状重于术后1周行吊带松解术;围手术期无其他Clavien-Dindo 2级及以上并发症。术后2个月门诊随访,患者均无漏尿症状,UDI-6评分为(2.3±1.9)分(范围:0~8.3分),满意度10例为“非常满意”、1例为“比较满意”,PGI-I均为“明显改善”,妇科检查均无异常。电话随访时有1例失访,其余10例患者的随访时间为(18.6±4.9)个月(范围:7~29个月),均无漏尿,UDI-6评分为(2.7±2.6)分,满意度均为“非常满意”,PGI-I均为“明显改善”。结论小切口采集AFLS并行MUS�ObjectiveTo observe the safety and short-term efficacy of using an autologous fascia lata sling(AFLS)for tension-free mid-urethral sling(MUS)in the treatment of stress urinary incontinence(SUI).MethodsBetween February 2022 and December 2023,11 patients with SUI underwent AFLS-MUS.Preoperative data were recorded,including basic patient information and completion of urinary distress inventory 6(UDI-6).During surgery,AFLS was harvested through a small incision using a tendon extractor,and used as a sling for transobturator or retropubic MUS.Perioperative indicators were recorded,including surgical approach,operation time,intraoperative blood loss,postoperative hospital stay,duration of catheterization,perioperative complications(Clavien-Dindo classification),and surgical costs.Follow-ups included outpatient physical examination at 2 months postoperatively,and telephone follow-up at 6 months,1 year,and annually thereafter.Follow-up content included the presence or absence of urinary leakage symptoms,UDI-6,satisfaction,patient global impression of improvement(PGI-I),and complications.ResultsThe age of the 11 patients was(54.8±10.9)years(range:41-72 years),with body mass index of(23.9±1.8)kg/m²(range:21.4-27.3 kg/m²).All patients experienced urinary leakage after coughing,sneezing and physical activity,with positive SUI provocation tests.The preoperative UDI-6 was 50.0±21.6(range:16.7-79.2),the result of 1-hour pad test was(18.9±12.0)g(range:2.5-71.2 g).Four cases underwent MUS only,with operation time of(98.0±13.3)minutes(range:86-117 minutes),and intraoperative blood loss of(17.5±5.0)ml(range:10-20 ml);7 cases also underwent pelvic floor repair simultaneously.The postoperative hospital stay was(3.5±2.0)days(range:2-9 days).The duration of catheterization was(4.5±3.8)days(range:2-11 days),with postoperative urinary retention in three cases,one of which underwent sling release surgery due to severe postoperative voiding difficulty 1 week after MUS,with no other complications of Clavien-Dindo grade 2 or above.

关 键 词：尿失禁 压力性 阔筋膜 尿道下悬吊术 治疗结果 

分 类 号：R699.7[医药卫生—泌尿科学]