两种悬吊术治疗女性压力性尿失禁疗效比较

目的探讨经闭孔尿道中段无张力悬吊术和改良尿道中段无张力悬吊术在治疗女性压力性尿失禁中的疗效。方法 2008年5月至2009年5月在南京医科大学附属常州市第二人民医院将100例压力性尿失禁患者随机分成两组,一组进行经闭孔尿道中段无张力悬吊术,简称闭孔组,作为对照组;另一组行改良尿道中段无张力悬吊术,简称改良组;比较两组术中情况及术后疗效。结果分别对两种方法的手术时间,术中出血量,排气时间及住院时间等指标进行统计学分析(P<0.05),结果表明改良组较对照组手术时间短,术中出血少,住院时间短(P<0.05);而改良组在术后1年的复发率较对照组差异无统计学意义(P>0.05)。结论改良尿道中段无张力悬吊术手术更简单,短期疗效满意,对患者生存质量有很大改善,但对其长期疗效还有待进一步研究。     

经闭孔阴道无张力尿道中段悬吊带术治疗女性压力性尿失禁的远期结局及进展

压力性尿失禁(SUI)是影响女性身心健康的常见疾病,有多种治疗方法,其中阴道无张力尿道中段悬吊带术是一线手术治疗SUI的常用方法,目前临床上多选择闭孔路线。经闭孔从外向内穿刺的无张力尿道中段吊带术(TOT)及经闭孔从内向外穿刺的无张力尿道中段吊带术(TVT-O)安全性高、手术时间短、疗效好、并发症少,可显著提高SUI患者的生活质量、维持或改善性功能,且膀胱穿孔、肠管损伤及排尿功能障碍等围手术期并发症的发生率均较低。经闭孔路径悬吊带术(包括TVT-O和TOT)的特有并发症为下肢疼痛,可以通过药物治疗或随着时间推移减轻症状。     

Prolift网片联合尿道中段悬吊治疗POP或合并SUI患者的近期疗效

目的:探讨全阴道修复网片(total vaginal mesh,TVM)即Gynecare Prolift网片修复系统及联合经闭孔无张力阴道吊带(tensiongfree vaginal tape-obtutor,TVT-O)尿道中段悬吊手术治疗盆腔器官脱垂(pelvic organ prolapse,POP)或合并压力性尿失禁(stress urinary incontinence,SUI)的近期疗效。方法:选择Ⅱ度以上子宫和(或)阴道壁脱垂患者24例,其中本次手术前已切除子宫5例,术中同时切除子宫12例,保留子宫7例。16例用全盆底修复网片(total Prolift),8例用前盆修复网片(anterior Prolift);10例因合并压力性尿失禁同时行TVT-O尿道中段悬吊术。结果:24例患者术中均无严重并发症发生,3例(12.5%)出血量超过500ml;术后随访12～20个月,1例至术后10个月时发现阴道壁网片侵蚀(4.2%,1/24),经门诊4次修剪好转;24例患者均无复发。结论:用Prolift盆底修复网片系统进行盆底重建术,手术安全、易行、微创,近期疗效肯定;合并SUI者同时使用TVT-O不增加手术难度和并发症的发生率。     

压力性尿失禁4种不同手术方式治疗的临床效果分析

目的:分析应用尿道折叠术、耻骨后库柏韧带悬吊术(Burch)、阴道无张力尿道中段悬吊带术(TVT)以及经闭孔经阴道尿道中段悬吊带术(TVT-O)治疗压力性尿失禁(SUI)患者的临床效果.方法:回顾分析83例尿失禁合并子宫、阴道脱垂患者的临床资料,根据行不同手术治疗,将其分为行尿道折叠术组(32例)、Burch组(15例)、TVT组(22例)以及TVT-O组(14例),并对4组的术中、术后及并发症情况进行比较.结果:①TVT-O组患者手术时间最短77.6±4.0分钟,与其他3组比较,差异有统计学意义(P<0.05).TVT-O组和TVT组的患者在手术时间、留置尿管时间和住院天数上,与尿道折叠术组和Burch组比较,差异均有统计学意义(P<0.05).②TVT-O组吊带侵蚀1例,术后排尿困难1例;TVT组吊带侵蚀1例,术后排尿困难3例;Burch组排尿困难4例;尿道折叠术组外阴血肿2例,下肢静脉血栓形成1例,术后排尿困难7例.③TVT-O组手术治愈率最高100%,TVT-O组患者2年治愈率92.86%.结论:TVT-O操作简单、治愈率高,在保证较低手术并发症的同时,实现了2年随访期限内理想稳定的治疗效果.TVT-O术是目前治疗压力性尿失禁的比较理想的手术方法.     

压力性尿失禁不同手术方式治疗的临床效果分析

目的　分析应用阴道无张力尿道悬吊带(TVT)术、经闭孔尿道悬吊带(TOT)术、自体阔筋膜尿道悬吊(Lata)术,以及耻骨后库柏韧带悬吊(Burch)术治疗压力性尿失禁(SUI)术的临床效果。方法　回顾分析103例尿失禁并部分合并子宫、阴道脱垂患者行不同手术治疗的疗效,其中行TVT术53例,行TOT术16例,行Lata术19例,行Burch术15例。结果　术后3个月治愈率, 行TVT、TOT、Lata和Burch术的患者,分别为94% (50 /53)、94% (15 /16)、95% (18 /19)和87% (13 /15);手术时间分别为(28±7)、(16±5 )、( 125±13 )和( 43±6 )min;术后留置尿管时间分别为( 26±3 )、(3±1)、(120±6)和(72±5)h。手术并发症有膀胱穿孔,行TVT术患者2例;术后尿潴留,行TVT术患者1例,行Lata患者2例。结论　4种手术对治疗SUI均有相同的疗效;TVT术和TOT术为微创手术,术后患者康复快,住院和留置尿管时间短,可与子宫、阴道脱垂等手术同时进行;行Burch术可与经腹其他手术同时进行。     

阔筋膜悬吊术用于治疗女性压力性尿失禁

目的探讨自体阔筋膜吊带行尿道悬吊术治疗女性压力性尿失禁的疗效和安全性。方法对13例压力性尿失禁伴子宫脱垂及阴道前后壁膨出的患者,取自体大腿外侧阔筋膜条作为吊带,经下腹阴道联合切口,行尿道近端悬吊术,同时行阴式全子宫切除及阴道前后壁修补术,平均随访30个月。结果13例患者均获得治愈,无阴道出血、感染、排斥反应等并发症发生。5例患者在术后出现轻度、暂时性排尿困难,1个月内症状消失。结论自体阔筋膜吊带行尿道悬吊术是治疗女性压力性尿失禁的安全有效术式。     

经阴道无张力尿道悬吊术治疗女性压力性尿失禁40例分析

目的：观察经阴道无张力尿道悬吊术(TVT)治疗女性压力性尿失禁的临床疗效。方法：2001年10月至2003年1月采用经阴道无张力尿道悬吊术治疗40例女性压力性尿失禁。结果：40例手术后尿失禁均得到控制，经随访2—26个月无一例出现尿失禁现象。平均手术时间54min，平均出血量80mL。40例患者恢复正常排尿后到残余尿均＜50mL。结论：TVT手术治疗女性压力性尿失禁具有手术创伤小、在局麻下手术、吊带悬吊效果可靠、作用持久、手术悬吊适度、手术并发症发生率低等优点，适宜临床推广应用。     

自制网片经阴道无张力尿道中段悬吊治疗女性压力性尿失禁

<正>女性压力性尿失禁是中老年妇女的常见病,发病率为15%～30%,成年女性发生尿失禁达46.5%,其中,压力性尿失禁占59.6%。近年治疗压力性尿失禁的新方法不断出现,但疗效较好、并发症少、费用低的方法应推经阴道尿道中段补片悬吊术(童式前路悬吊术),此后童晓文教授对此术进行了改良,将原来网片缝于耻骨降支的骨膜改为经闭孔固定于耻骨降支。2005年12月至2006年12月我们应用此法治疗女性压力性尿失禁30例,现报道如下。     

TVT-A与TVT-O治疗女性压力性尿失禁术后发生腹股沟疼痛情况分析

目的:比较使用改良式经闭孔经阴道无张力尿道中段悬吊术(tension-free vaginal tape-abbrevotm,TVT-A)与传统经闭孔无张力尿道中段悬吊术(tension-free vaginal tape-obturator,TVT-O)治疗女性压力性尿失禁术后发生腹股沟疼痛情况。方法:回顾性分析2014年1月至2016年4月87例采用TVT-A治疗压力性尿失禁及33例采用TVT-O治疗压力性尿失禁患者的临床资料,比较分析两组患者的术后效果及术后腹股沟疼痛的发生情况。结果:TVT-A和TVT-O两组手术均顺利完成,平均手术时间、术中出血量及治愈率差异无统计学意义(P0.05);术后腹股沟疼痛发生率TVT-A组明显小于TVT-O组,差异有统计学意义(P0.05);疼痛VAS评分TVT-A组小于TVT-O组,差异有统计学意义(P0.05)。结论:TVT-A治疗女性压力性尿失禁,安全有效,TVT-A较TVT-O术后腹股沟疼痛的发生率明显降低。     

女性压力性尿失禁研究进展

压力性尿失禁(SUI)是影响女性健康的常见问题,给患者带来的社会心理压力及生活不便已经不容忽视。依靠病史、体格检查和其他辅助检查能诊断SUI。最新研究提出8~9例剖宫产能减少1例压力性尿失禁发生,对于无合并症的单纯SUI患者术前采取尿动力学评估并不优于简易评估。非手术治疗无并发症发生,但疗效不尽相同。干细胞治疗为一种新的治疗方案,已经在临床上取得一定疗效,但标准治疗方案尚需进一步探索。手术治疗首选吊带手术,经耻骨后尿道无张力悬吊术(TVT)与经闭孔尿道无张力悬吊术(TVT-O)治疗效果相近,疗效高于单切口经阴道无张力尿道中段悬吊术(TVT-Secur,TVT-S)。     

经闭孔无张力尿道中段悬吊术治疗女性压力性尿失禁22例临床分析

目的 评价经闲孔无张力尿道中段悬吊术（TVT-O）治疗女性压力性尿失禁（SUI）的疗效。方法 回顾性总结2004-07—2005-12采用TVT-O术式治疗女性SUl的临床资料22例。结果 22例病人均治愈，平均手术时间14min，术中无并发症，无膀胱损伤。术后短期尿潴留3例（13．6％）。术后平均随访9个月（1～15个月），至今无并发症发生。结论 TVT-O术式操作简便快捷、创伤小、并发症少、不易损伤膀胱，是治疗女性SUI的安全有效方法。     

经耻骨后与经闭孔无张力尿道悬吊术治疗女性压力性尿失禁并发症分析

目的比较经耻骨后无张力尿道悬吊术（TVT）和经闭孔无张力尿道悬吊术（TVT—O）治疗女性压力性尿失禁的手术并发症。方法回顾性分析我院2002年9月-2007年6月应用TVT和TVT—O治疗女性压力性尿失禁患者167例（TVT术74例,TVT-O术93例）的临床资料。结果术中膀胱穿孔：TVT组发生率为9．46％,TVT—O组为1．08％（P〈0．05）;术中出血〉100ml：TVT组发生率为16．22％,TVT—O组6．45％（P〈0．05）,其他术中、术后并发症发生率两种手术方法比较,差异无显著性（P〉0．05）。结论与TVT比较,TVT-O手术并发症的发生率低,且手术操作简便、手术时间短,是一种较理想的治疗女性压力性尿失禁的手术方法。     

Comparing vaginal tape and transobturator tape for the treatment of mild and moderate stress incontinence.

OBJECTIVE: To compare the efficacy and safety of the tension-free vaginal tape (TVT) and transobturator suburethral tape (TVT-O) procedures for the treatment of mild and moderate stress urinary incontinence (SUI). METHODS: A total of 56 women were randomly selected to undergo the TVT-O or the TVT procedure. In some patients, vaginal repair or vaginal hysterectomy was done simultaneously for associated indications. RESULTS: Mean blood loss and hospital stay duration were the same for the 2 groups, but mean +/- SD operative time was significantly shorter in the TVT-O than in the TVT group (16+/-4 min vs 27+/-6 min; P<0.001). On the second day following surgery a residual urine volume less than 100 mL was noted in 86% and 89% of the patients in the TVT-O and TVT groups, respectively; cure was achieved in 92.9% and 92.6% of the patients. No serious complications occurred in either group. Outcome was subjectively assessed, with the patients followed-up for a mean of 27.6 months. CONCLUSION: No significant differences in rates of cure, postoperative urine retention, or operative complications were found following the TVT-O or the TVT procedure.     

The comparison of an inexpensive-modified transobturator vaginal tape versus TVT-O procedure for the surgical treatment of female stress urinary incontinence

ObjectiveTo compare the safety and efficacy of an inexpensive–modified transobturator vaginal tape procedure with the transobturator tension-free vaginal tape (TVT-O) procedure for the surgical treatment of female stress urinary incontinence (SUI).Materials and MethodsPatients with SUI were randomly allocated to either the test group receiving the inexpensive–modified transobturator vaginal tape procedure or the control group receiving the GYNECARE TVT-O procedure. Treatment outcomes and Quality-of-life scores were recorded and analyzed between two groups.ResultsA total of 156 patients were enrolled in this trial. Eighty patients underwent the modified transobturator vaginal tape procedure. Among them 75(93.8%) were cured and 5(6.2%) were improved. The rest of the 76 patients underwent the GYNECARE TVT-O procedure with a 92% (70 of 76) cure rate and an 8% (6 of 76) improvement rate. No inefficient or aggravated cases occurred in both groups. The success rates between groups had no significant statistic difference (p > 0.05). The operative time, blood loss, hospital stay, and medical cost were significantly lower in the test group (p < 0.01); the increases in Quality-of-life scores were comparable between groups.ConclusionsThe modified transobturator vaginal tape procedure is an efficacious and economic surgical treatment for female SUI.     

Comparison of TVT and TVT-O in patients with stress urinary incontinence: Short-term cure rates and factors influencing the outcome. A prospective randomised study

Background: Recently, mid-urethral slings have been commonly used in treatment of patients with stress urinary incontinence (SUI).
Aims: To investigate tension-free vaginal tape (TVT) and tension-free obturator tape (TVT-O) for surgical treatment of SUI for cure rates (primary endpoint), complications and factors influencing cure rate (secondary endpoints).
Methods: One-hundred and sixty-four patients were included in the study ( n  = 81 for TVT, n  = 83 for TVT-O). The cure rates, complications, preoperative and postoperative urodynamic evaluation, Q-tip test, the Turkish version of Incontinence Impact Questionnaire (IIQ-7) and Urogenital Distress Inventory (UDI-6) scores were recorded. At three and 12 months, the patients were evaluated regarding outcome measures.
Results: The cure rates were similar in TVT and TVT-O groups, 88.9% versus 86.7% respectively. Mean operative time was significantly shorter in TVT-O group ( P  = 0.001). The cure rate was significantly higher in both groups in patients with urethral hypermobility when compared with those with no hypermobility ( P  = 0.001).
Conclusions: The TVT and TVT-O procedures appear to be equally effective for the treatment of SUI. Also, urethral hypermobility seems to be a factor influencing cure rate of mid-urethral slings.     

不同路径阴道无张力尿道中段悬吊术治疗重度压力性尿失禁

目的 探讨经耻骨后路径阴道无张力尿道中段悬吊(TVT)术及经闭孔路径阴道无张力尿道中段悬吊(TVT-O)术治疗女性重度压力性尿失禁的临床效果.方法 前瞻性随机对照单盲方法选取重度压力性尿失禁患者69例(其中35例行TVT,34例行TVT-O),部分患者合并Ⅰ～Ⅱ度子宫脱垂及阴道前壁膨出.分别记录两种路径手术的手术时间、术中出血量、术后住院时间、住院费用,以及术中、术后并发症的类型和发生率.运用尿道疾病程度分类问卷(UDI-6)和尿失禁相关生活质量问卷(ⅡQ-7)对两组患者组内及组间手术前后生活质量的变化进行评估.结果 TVT-O组平均手术时间为(18±5)min,明显短于TVT组的(27±5)min,差异有统计学意义(P＜0.01).两组术中出血量、术后第1天B超测量残余尿量的合格率、并发症发生率、术后住院时间和住院费用均相似,差异均无统计学意义(P均＞0.05).术后随访率100%,平均随访时间14.5个月.TVT组治愈率88.6%(31/35),略高于TVT-O组[85.3%(29/34)],但两组间比较,差异无统计学意义(P＞0.05).吊带侵蚀发生率TVT组为5.7%(2/35),高于TVT-O组[2.9%(1/34)];耻骨上、腹股沟或大腿内侧酸痛发生率TVT组为5.7%(2/35),低于TVT-O组[14.7%(5/34)],但差异均无统计学意义(P均＞0.05).两组间手术前后UDI-6和ⅡQ-7问卷各项目评分及总体评分分别比较,差异均无统计学意义(P均＞0.05).两组内手术后UDI-6问卷(除梗阻项目)和ⅡQ-7问卷各项目评分及总体评分较手术前均明显降低,差异均有统计学意义(P均＜0.01),UDI-6问卷中梗阻项目评分,两组内手术前后比较,差异无统计学意义(P＞0.05).结论 TVT-O路径较TVT路径手术时间短,术后短期随访结果显示,两种手术路径均可有效治疗重度压力性尿失禁、改善患者生活质量且不增加尿道梗阻风险,但长期疗效有待进一步随访观察.     

腹腔镜手术治疗巨大卵巢良性肿瘤25例分析

目的:探讨腹腔镜手术治疗巨大卵巢良性肿瘤的疗效。方法:回顾分析2003.01-2006.12期间腹腔镜手术治疗巨大卵巢良性肿瘤25例。结果:25例均在腹腔镜下完成手术,手术平均时间30.2±10.5min、术中平均出血量40.3±18.6ml、平均住院日4.3±2.1d,术后无严重并发症。结论:腹腔镜手术治疗巨大卵巢良性肿瘤疗效肯定,安全。     

TVT-O treatment of stress urinary incontinence: immediate and one-year results

OBJECTIVE: To compare one-year results between the classic retropupubic (TVT) and the in-out transobturator approaches (TVT-O) of tension-free vaginal tape for the treatment of stress urinary incontinence (SUI). PATIENTS AND METHODS: The first 82 patients operated for SUI by TVT-O in our institution were included in the analysis. Patients were evaluated at 1 and 12 months. The global satisfaction rate was assessed at 12 months by a self-reported questionnaire. Results were compared to those of the first 124 patients operated of SUI by TVT in the same institution and by the same surgeons between 1996 and 1999. RESULTS: Except a younger mean age in the TVT-O group (57 versus 60 years), no other preoperative parameter was significantly different between the TVT and the TVT-O groups. The mean operating time was shorter in the TVT-O group (15 versus 30 minutes, P<0.001). No intraoperative complication occurred. The rate of bladder perforation was significantly lower in the TVT-O group (0 versus 8.8%, P=0.004). The rate of post-voiding residual less than 100 ml was higher in the TVT-O group (88 versus 61%, P<0.001). In the TVT-O group, 40% of patients had postoperative inguinal pain (mean=9 days, range 2-15 days). After 12 months from TVT-O, 85% of patients were completely dry, 6% had de novo over bladder activity, and 93.5% of patients were satisfied with the treatment they received. The 12-month results were not significantly different between the TVT and the TVT-O groups. DISCUSSION AND CONCLUSION: With a follow-up of 12 months, TVT-O is as efficient as TVT and has a lower risk of bladder injury, a cut by half operating time, and less postoperative dysuria.     

改良经皮下无张力阴道悬吊术对女性盆底功能障碍性疾病的治疗效果

目的:评估改良经皮下无张力阴道悬吊术对女性盆底功能障碍性疾病(PFD)治疗的有效性和安全性。方法:对60例盆腔器官膨出患者采用改良经皮下无张力阴道悬吊术,尝试自行修剪聚丙烯网片,以自创的简便网片经皮下固定位点进行盆底修补和重建,分析术中情况,随访治疗效果。结果:60例患者平均年龄60.73岁(37～78岁);平均手术时间88min(55～130min);术中平均出血131ml(80～300ml),无一例术中输血;平均住院时间为11天(8～18天);术后随访时间平均23.3个月(4～52个月),发现7例术后网片侵蚀,发生率为11.67%,2例复发,治愈率为96.7%,无网片感染发生;其中15例压力性尿失禁,11例症状消失,治愈率为73.3%,4例症状改善,尿频尿急13例中9例症状消失,2例改善。结论:改良经皮下无张力阴道悬吊术用于PFD患者的手术治疗,操作简便,易于掌握,并发症少,近期疗效稳定,经济实用,对于我国基层PFD患者的治疗具有积极意义。