治疗压力性尿失禁的两种手术方式临床分析

目的 探讨阴道无张力尿道中段悬吊术(TVT)与腹腔镜Butch手术治疗压力性尿失禁(SUI)的疗效与近远期并发症,评价压力性尿失禁两种手术方式的临床价值.方法 回顾性分析因尿道高活动性压力性尿失禁行TVT手术67例,腹腔镜Butch手术37例.入选标准为单纯尿道高活动型压力性尿失禁,无尿失禁手术史.对照比较两组患者临床特征、手术情况、手术疗效及近远期并发症.结果 (1)两组患者临床特征:年龄、年龄构成比、体重指数、产次、SUI分度构成比比较,差异无统计学意义(均P>0.05).(2)两组手术情况及并发症:手术时间、出血量、住院天数比较,差异均有统计学意义(均P<0.05),术后早期并发症两组发生率均很低且差异无统计学意义(P>0.05).(3)两组手术疗效及随访:术后平均随诊时间为(9±10)个月,两组手术主观治愈率差异无统计学意义(86.5%vs95.5%,P>0.05),两组改善率与无效率分别为8.1%,4.5%及5.4%,0%,均P>0.05;远期并发症仅出现于TVT组,为吊带侵蚀3例,发生率为4.48%.结论 腹腔镜Burch手术与TVT手术均为治疗SUI的有效手段,两者主观治愈率差异无统计学意义,但是TVT手术的主观治愈率高于Burch手术,无效率低于Burch手术,且后者手术时间及术中出血量、住院天数均显著高于前者,TVT手术更为微创,只是手术费用高于腹腔镜Burch术.

Effects of laparoscopic Burch colposuspension and tension-free vaginal tape in treatment of female stress urinary incontinence:a comparative study

Objective To evaluate the efficacy and complications of laparoseopic Butch colposuspension and tension-free vaginal tape (TVT) in treatment of female stress urinary incontinence (SUI). Methods Thirty patients underwent laparoscopic Burch colposuspension and 67 age,BMI,parity,and grading-matched patients underwent TVT because of moderate to severe hypermodility urodynamic SUI from 2002 to 2006. Follow-up was conducted for (9±10) months. The clinical characteristics,mean operation time,hospital stay,peri-operative complications,and late complications were compared. Results The mean operative time and the hospital stay of the TVT group was (29.57±8.23) min and (3.0±2.1) d,both significantly shorter than those of the Butch operation group [(87±23) min and (4.8±1.9) d respectively,P<0.001 and P<0.01]. The blood loss of the TVT group was (27±12) ml,significantly less than that of the Butch operation group [(59±30) ml,P<0.001]. The subjective cure rate of the Bureh operation group was 86.5%,not significantly different from that of the TVT group (95.5%,P>0.05). Short-term complications included 1 case of bladder injury and 1 case of circumflex iliac vein injuring,both occurring in the Burch colposuspension group. The postoperative urine retention rate of the Burch colposuspension group was 23.5% ,not significantly different from that of the TVT group (14.9%,P>0.05),and the postoperative fever rate of the Burch colposuspension group was 16.2%,significantly higher than that of the TVT group (4.5%,P<0.05). Three cases of erosion of sling were found in the TVT group as late complications. Conclusion Both Bureh colposuspension and TVT are effective in the treatment of female SUI. The mean operative time of Butch operation and the hospital stay thereafter are longer;however,the cost of TVT is much higher than that of the Burch operation.