腹膜外入路腹腔镜下膀胱颈悬吊术治疗压力性尿失禁TVT-O术后失败或复发患者的初步经验

目的报道6例经腹膜外途径腹腔镜下膀胱颈Cooper韧带悬吊术(Burch手术)治疗女性压力性尿失禁行经阴道经闭孔尿道中段无张力悬吊术(TVT-O)术后失败或复发患者的初步经验。方法回顾分析2015年6月至2019年9月我们采用经腹腔镜下腹膜外途径Burch手术治疗的6例女性压力性尿失禁TVT-O术后失败或复发患者。自脐下2 cm处切开皮肤并制造腹膜外空间,用2#0薇荞线将尿道旁侧的阴道壁肌层“8字”缝合后再缝合到同侧Cooper韧带上。观察患者手术时间、出血量、住院时间等。结果所有手术均成功,手术时间(37±6)min,术中出血量(17±7)ml,术后住院时间(4.5±0.5)d。6例随访时间3~45个月,所有病例尿失禁症状均消失,均无感染、膀胱损伤、排尿困难、复发等并发症。结论女性压力性尿失禁患者行TVT-O术失败或复发后,选择腹腔镜下经腹膜外途径Burch术安全、有效,可以获得完全尿控,为临床可选方案。

Extraperitoneal laparoscopic burch colposuspension in the treatment of recurrent stress urinary incontinence after tension-free vaginal tape-obturator(TVT-O):Initial experiences

Objective To report our initial experiences of 6 successful extraperitoneal three-port laparoscopic burch colposuspensionin in the treatment of recurrent stress urinary incontinence after tensionfree vaginal tape-obturator(TVT-O).Methods six female patients with recurrent stress incontinence after TVT-O were treated by extraperioneal three-port laparoscopic burch colposuspension from Jun 2015 to september 2019.Extraperitoneal space was created with CO2 through a 10 mm midline port 2-cm below the umbilicus.A pair of figure-of-eight sutures was inserted at the level of midurethral and urethrovesical junction,fixing them to Cooper's ligament on each side with proper tension.The operation duration,bleeding volume and hospital stay were observed.Results The average surgery time was(37±6)min,blood loss(17±7)ml,postoperation hospitalization time(4.5±0.5)d.These 6 cases were then followed up in the next 3-45 months.All cases were cured.No complication occurred.Conclusion The extraperioneal laparoscopic Burch operation is a satisfactory procedure with the advantages of minimal invasion,quick recovery and short hospitalization in the treatment of recurrent stress urinary incontinence after TVT-O.