手术治疗女性压力性尿失禁及盆底器官脱垂对患者生活质量的影响

目的：研究手术治疗女性压力性尿失禁（SUI）及盆底器官脱垂（POP）对健康相关生活质量的影响。方法：选择自2001年1月~2007年1月接受TVT、经闭孔无张力吊带术（TVT-O）、前路植入网带及整体植入网带的患者共142例．109例人选并同意参加本研究。采用改良PFDI-20量表评估术前3个月、术后6～12个月及术后12个月以后患者生活质量,采用方差分析对不同性功能变化情况的PFDI-20评分进行比较。结果：PFDI-20总分及POP评分术后较术前显著降低（P〈0．0167）,但术后12个月以后与术后6～12个月相比差异元统计学意义（P〉0．0167）。术后6～12个月时肛直肠症状评分较术前降低,但差异无统计学意义（P;0．0169）。术后12个月以后以术前及术后6～12个月相比均显著改善（P〈0．01671。术后6～12个月及术后12个月以后泌尿系症状较术前显著降低（P〈0．0167）,并且12个月以后较术后6～12个月亦显著改善（P=0．003）．61例术前术后均有性生活。术后6～12个月,20例（37．0％〉术后性功能受损,11例（20．4％）改善．23例（42．6％）无变化;术后12个月以后,21例（34．4％）术后性功能受损,12例（19．7％）改善,28例（45．9％）无变化;术后12个月以后性功能与术后6～12个月相比,无进一步变化;未发现生活质量与性功能之间存在关系。105例（96．3％）患者对手术疗效满意。结论：TVT、TVT-O及经阴道网带治疗SUI及POP疗效显著,术后患者生活质量显著提高。     

经闭孔无张力尿道中段吊带术联合阴道前壁修补术治疗女性压力性尿失禁

目的 评价经闭孔无张力尿道中段吊带术(TVT-O)联合阴道前壁修补术治疗合并阴道前壁脱垂的女性压力性尿失禁(stress urinary incontinence,SUI)的效果.方法 行TVT-O联合阴道前壁修补术治疗合并阴道前壁脱垂的女性压力性尿失禁18例.术后随访12个月,进行主观治疗结果及术后远期并发症的调查.术后12个月时,复查盆腔器官脱垂定量分度法(POP-Q)分期、尿流率、性生活质量评分(PISQ-12).结果 尿失禁主观治愈率为88.9%(16/18),主观改善率为11.1%(2/18).4例阴道前壁脱垂复发(术前Ⅲ期3例,Ⅱ期1例,术后均为Ⅰ期),11名有规律性生活的患者PISQ-12评分术前术后分别为27.5±4.4和31.2±6.1(P＜0.05).结论 TVT-O联合阴道前壁修补术治疗合并中度阴道前壁脱垂的女性压力性尿失禁简便易行,疗效可靠,对患者性功能无不利影响.     

富血小板血浆联合自体脂肪颗粒移植在治疗阴道松弛中的应用

目的：探讨富血小板血浆（Plateletrichplasma,PRP）联合自体脂肪颗粒移植在治疗阴道松弛中的临床应用效果。方法：选择2016年6月-2019年9月于笔者医院治疗的18例阴道松弛症患者，采用PRP联合自体脂肪颗粒移植治疗（获取患者自体脂肪颗粒约30 ml以及对应比例的PRP，将两者混合液注射于阴道后壁黏膜下层），术后给予抗感染治疗，禁止性生活2个月。观察术后并发症、阴道松弛改善情况及患者性功能。结果：本组18例患者，术后随访6～12个月，未发现感染、结节、脂肪液化、凹凸不平及感觉迟钝等并发症，阴道松弛程度明显改善，阴道内可容纳2指至2指半。其中14例（77.78%）患者自觉性生活明显改善，非常满意；3例（16.67%）患者自觉改善不明显；1例（5.56%）患者自觉无改善。18例患者术后6个月女性性功能量表（Female sexual function index,FSFI）评分为（25.09±2.68）分，明显高于术前的（20.23±2.18）分（P<0.05）。结论：PRP联合自体脂肪颗粒移植治疗阴道松弛操作简单，组织损伤小，恢复快，效果良好。     

TVT及TVT-O治疗老年女性压力性尿失禁的疗效及患者术后生活质量影响

目的:探讨经耻骨后无张力阴道吊带术(TVT)及经闭孔无张力阴道吊带术(TVT-O)治疗老年女性压力性尿失禁(SUI)的临床疗效及患者术后生活质量影响.方法:对167例60岁以上的女性压力性尿失禁患者分别行TVT术(74例)及TVT-O术(93例)治疗,术后分别使用Grouts-Blaivas评分法评价两种方法治疗尿失禁的效果.术后随访24个月,参考尿失禁生活质量问卷了解两种术式对患者术后生活质量影响.结果:手术均成功.结论:两种方法均为治疗老年女性suI的有效方法,在性生活方面改善均不明显.相比之下,TVT-O具备手术方法简单、并发症少等优点.     

两种经阴道无张力吊带术治疗女性压力性尿失禁疗效比较

目的比较两种植入人工合成耻骨阴道吊带手术治疗女性压力性尿失禁疗效。方法28例已育妇女,16例行阴道无张力吊带术(tension-free vaginal tape,TVT),12例行耻骨途径无张力吊带术(suprapubic Archsling,SPARC),随访3-36个月。结果TVT组与SPARC组比较,手术时间(30±15/25±10分)、手术出血量(110±20/100±30mL)、手术成功率(87.5%/83.3%)以及患者满意率(62.5%/75%)方面,差异无显著性;两组分别出现12.5%和8%的尿潴留;两组混合性尿失禁患者尿频、尿急症状均无明显缓解。结论经阴道无张力吊带术是治疗女性压力性尿失禁的较为理想手术,创伤小,出血少,远期效果好。无论是采用TVT法还是采用SPARC法,只有病例选择得好,方法得当,均能取得满意效果。     

两种经闭孔无张力尿道悬吊术治疗女性压力性尿失禁的对比研究

目的 比较由外向内经闭孔无张力尿道悬吊术(TOT)及由内向外经闭孔无张力尿道悬吊术(TVT-O)治疗女性压力性尿失禁(SUI)的安全性和有效性.方法 回顾性分析我院68 例女性SUI患者,30 例行TOT 术,38 例行TVT-O 术的临床资料.SUI 诊断主要根据患者症状、妇科检查、压力试验及尿动力学检查.术前及术后6 个月按照国际尿失禁问卷调查表进行评分,评价其主观治愈率.记录手术时间、术中及术后并发症、术中失血量、术后尿管留置时间、住院天数及术后6~24 个月随访结果.结果 TVT-O 组术后出现2 例大腿内侧疼痛(5.3%)和1 例急迫性尿失禁,TOT 组出现2 例短暂性尿潴留.两组手术时间、术中出血量及住院天数无明显差异(P>0.05).两组手术方式均无膀胱穿孔、排尿困难及阴道腐蚀现象.随访6~24 个月,TOT 组治愈率为97.2%,TVT-O 组治愈率为96.3%.两组术后尿失禁生活质量量表(I-QOL)评分明显高于术前,盆腔器官脱垂尿失禁患者性功能问卷(P-ISQ)性生活质量评分术前术后无明显改变.结论 TOT 与TVT-O 均可作为治疗女性SUI 的安全、有效的方法.     

经闭孔无张力阴道吊带术治疗女性压力性尿失禁的手术配合

目的:探讨经闭孔无张力阴道吊带术(TVT-O)治疗女性压力性尿失禁(SUI)的术中最佳配合方案方法:对女性压力性尿失禁(SUI)患者接受经闭孔无张力阴道吊带术(TVT-0),术前准备充分,术中密切配合结果:手术均顺利完成,医生满意,患者恢复良好结论:经团孔无张力阴道吊带术(TVT-O)是治疗性压力性尿失禁的一种安全有效的术式,充分的术前准备和术中的密切配合是保证手术顺利完成的关键.     

经尿道前列腺汽化术对性功能的影响

目的 :观察经尿道前列腺汽化术 (TUVP)对良性前列腺增生 (BPH)病人性功能的影响。　方法 :对 139例BPH病人TUVP后进行随访研究 ,每例病人在TUVP前均填表回答目前性生活满意程度、凌晨勃起情况、性交频率等相关问题 ,病人在术后 3、6、12个月时回答同样的问题。　结果 :术前 5 9%的病人对性生活满意 ,术后 3、6、12个月分别为 5 2 %、5 7%、6 1% ,术前 ,术后无明显变化。术前凌晨勃起 6 2 % ,术后 3、6、12个月分别为 6 9%、72 %、82 %。术前 ,术后有明显差异 (P <0 .0 1)。　结论 :BPH病人行TUVP术后除逆行射精外不引起病人性功能的明显改变 ,而凌晨勃起功能反而有改善。     

经尿道前列腺等离子切割术治疗良性前列腺增生对性功能的影响

目的探讨经尿道前列腺等离子切割术(PRP)治疗良性前列腺增生(BPH)对性功能的影响。方法对398例BPH患者行PRP,对其中297例术前性功能正常者术后随访6个月,观察阴茎勃起功能指数(IIEF-5)、性生活满意度以及射精功能。结果297例患者术后6个月IIEF-5为(24.6±4.9)分。射精异常232例(78.1%),其中逆行射精196例(65.9%)。237例(79.8%)术后对性生活满意。结论 PRP治疗BPH,对性功能的影响主要为射精功能异常,表现为逆向射精。术中只要操作规范,手术本身对阴茎勃起功能及性生活满意度均无明显影响。     

无张力阴道吊带和经闭孔阴道吊带术治疗女性压力性尿失禁的前瞻性比较：1年随访结果

作者前瞻性比较无张力阴道吊带和经闭孔阴道吊带术（入-出式）治疗女性压力性尿失禁的有效性和安全性。120例女性压力性尿失禁患者交替分配至无张力阴道吊带组（60例）和经闭孔阴道吊带组（60例）。无张力阴道吊带组有10例患者伴急迫性尿失禁，经闭孔阴道吊带组有4例。术前评价包括尿动力学检查、韩国尿失禁生活质量问卷等。     

Sexual function and health-related quality of life following anterior vaginal wall surgery for stress urinary incontinence and pelvic organ prolapse

To assess female sexual function (FSF) and health-related quality of life (HRQOL) following anterior vaginal wall surgeries for stress urinary incontinence (SUI) and pelvic organ prolapse (POP). The retrospective study consisted of 116 patients. Chinese translations of the modified Lemack Questionnaire (not validated) and Pelvic Floor Distress Inventory-Short Form 20 were used to assess FSF and HRQOL, 3 months pre-operatively and 12-24 months (mean 16.8 months) post-operatively. Sixty-one (52.6%, 29 in SUI group and 32 in POP group) of patients were sexually active before and after the operation. Overall, 12 (19.7%, six in SUI group and six in POP group) reported an improvement in overall intercourse satisfaction, 21 (34.4%, 8 in the SUI and 13 in the POP group) were decreased and 28 (45.9%, 15 in SUI group and 13 in POP group) were unchanged. Incidence of coital incontinence decreased significantly in SUI group. Frequency of intercourse decreased, vaginal dryness and pain due to it and asymptomatic vaginal narrowing increased significantly, following the surgery in POP group. There were no statistically significant differences in the frequency of intercourse in SUI group, patients' perception of intercourse, frequency of orgasm and the importance of sex life in both groups. Partner discomfort remained unchanged. HRQOL improved significantly after the operation in both groups. There was no association between HRQOL and FSF in the post-operative period. In most patients, overall FSF did not impaired. All trans-anterior vaginal wall surgery positively impacted on the patients' HRQOL. A prospective study with validated questionnaire is necessary in future.     

阴道前壁“斜拉桥”式修补术与传统阴道前壁修补术治疗阴道前壁膨出的临床效果比较

目的比较阴道前壁“斜拉桥”式修补术与传统阴道前壁修补术治疗阴道前壁膨出的临床效果。方法2006年1月～2009年10月对30例（斜拉桥式组）阴道前壁膨出施行阴道前壁“斜拉桥”式修补术（将阴道前壁两侧膀胱筋膜分别缝于对侧耻骨降支骨膜上）,与2002年1月-2006年1月35例（传统术式组）阴道前壁膨出行传统阴道前壁修补术（将膀胱筋膜荷包缝合以使膨出的膀胱回缩）进行比较,比较2组手术时间、术中出血量、手术并发症、术后复发率、术后阴道深度、术后性生活满意情况及保持率。结果2组手术时间、术中出血量、术后1周内新发尿潴留无统计学差异（P〉0．05）。术后12个月阴道深度传统术式组为（5．6±1．1）cm显著短于斜拉桥式组（7．5±0．6）em（t=-8．440,P=0．000）。传统术式组术后2年复发率20．0％（7／35）,显著高于斜拉桥式组0（P=0．010）。术后12个月内性生活保持率传统术式组5．7％（2／35）与斜拉桥式组13．3％（4／30）无统计学差异（,=0．395,P=0．530）。结论阴道前壁“斜拉桥”式修补术不用额外材料而将脱垂的组织交叉固定在坚韧有力的骨膜上,借鉴了斜拉桥的构造原理,既加固盆底又经济,且骨膜标志易辨识,手术简单易操作,增加了安全性,临床效果优于传统修复术。     

Anatomical outcome and quality of life following posterior vaginal wall prolapse repair using collagen xenograft

The aim of this study was to evaluate quality of life, sexual function, and anatomical outcome after posterior vaginal wall prolapse repair using a collagen xenograft. Thirty-three patients were evaluated preoperatively and at 6 and 12 months follow-up (FU). Quality of life and sexual function were assessed using a self-reported questionnaire. Prolapse staging was performed using the pelvic organ prolapse quantification system (POPQ). Preoperatively 3 patients had stage I, 26 patients stage II, and 4 patients stage III prolapse of the posterior vaginal wall. Prolapse of the posterior vaginal wall stage II was observed in 7 patients (21%) at the 6-month FU and in 13 patients (39%) at the 12-month FU. Mean point Bp was reduced from –1.1 preoperatively to –2.5 at 6 months FU (p<0.01) and –1.8 at 12 months FU (p<0.01). Previous abdominal surgery was associated with a less favorable anatomical outcome (odds ratio: 2.0, 95% confidence interval: 1.5–3.8). There were no significant changes in sexual function or dyspareunia during the 1-year FU. Preoperatively 76% of the patients reported a negative impact on quality of life as a result of genital prolapse. There was a significant improvement in several variables associated with quality of life at 6 and 12 months FU. Posterior vaginal wall prolapse repair using a collagen xenograft was associated with an unsatisfying anatomical outcome at 1-year FU although several quality of life-associated variables affecting psychosocial function were improved. Improvement was not restricted to postoperative restoration of vaginal topography, and previous surgery had a negative effect on anatomical outcome.     

阴道前壁的自体组织Kelly术联合腹腔镜高位宫骶韧带悬吊术治疗重度前盆腔缺陷的疗效

目的探讨阴道前壁的自体组织Kelly术联合腹腔镜高位宫骶韧带悬吊术治疗重度前盆腔缺陷的疗效。方法2013年4月~2018年11月我院采用阴道前壁的自体组织Kelly术联合腹腔镜高位宫骶韧带悬吊术治疗178例重度前盆腔缺陷为主的盆腔脏器脱垂(pelvic organ prolapse,POP)并完成系统随访,即术后1、3、6、12个月及之后每年1次进行随访。客观疗效评价采用POP-Q定量分度法,主观疗效评价采用患者整体印象改善评分量表(Patient Global Impression of Improvement,PGI-I)、盆底不适调查表简表(Pelvic Floor Distress Inventory Short Form 20,PFDI-20)和盆底功能影响问卷简表(Pelvic Floor Impact Questionnaire Short Form 7,PFIQ-7)。手术成功的标准:术后POP-Q分度≤1度。性生活质量评价采用盆腔脏器脱垂/尿失禁性功能问卷(Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire,PISQ-12),术后新发神经痛患者的疼痛评估采用改良手术疼痛量表(Surgical Pain Scale,SPS)和视觉模拟量表(Visual Analogue Scale,VAS)。结果总手术时间(192.9±52.0)min,出血量(99.0±56.1)ml,留置尿管时间平均4.4 d(3~15 d),术后住院时间(7.1±3.6)d。无一例术后病率或输尿管、膀胱及直肠的损伤,无一例需要输血。178例中位随访时间34个月(8~75个月),手术成功率为99.4%(177/178),主观满意率为98.3%(175/178)。术前后POP-Q指示点Aa、Ba、C、Ap、Bp、gh、pb、TVL点差异均有显著性(P<0.05),术前后PFDI-20、PFIQ-7、PISQ-12评分差异均有显著性(P<0.05)。术后神经痛发生率为0.6%(1/178)。结论阴道前壁的自体组织Kelly术联合腹腔镜高位宫骶韧带悬吊术治疗重度前盆腔缺陷中期疗效满意。     

Sexual function after tension-free vaginal tape (TVT) for stress incontinence: results of a mailed questionnaire

In a retrospective study we evaluated sexual function after tension-free vaginal tape (TVT) placement for urinary stress incontinence based on responses to a mailed questionnaire at least 3 months after the operation, to a maximum of 1 year. From 1999 to 2002, a sexual function questionnaire was mailed to 128 women (and their partners) who had undergone a TVT procedure for genuine urinary stress incontinence, without pelvic organ prolapse or detrusor instability. The questionnaire was returned by 96 women (75%), 69 (72%) of whom reported being sexually active. Mean frequency of intercourse did not change. Overall, 26% described improved intercourse compared to before the operation. Only one patient described worsening of intercourse after the TVT operation because of an increase in her incontinence. Overall, in this study the technique of tension-free vaginal tape as such seems to have no negative impact on sexual function. However, because of its successful outcome on incontinence, it has a positive overall effect on sexual function. The possible causes of postoperative partner discomfort require further investigation.Abbreviations AVWS Anterior vaginal wall suspension - SUI Stress urinary incontinence - TVT Tension-free vaginal tape This study was supported by the Pelvic Floor & Sexuality research group Leiden. Editorial Comment: The impact of urogynecologic surgery on sexual function is unclear. For those who are incontinent with intercourse, cure of incontinence may improve sexual activity at the price of potential damage to the vaginal anatomy. In this study sexual function following the TVT procedure was evaluated. The authors report that sexual frequency was overall unchanged, and many patients felt that intercourse improved. It appears that much of this improvement is probably related to cure of the incontinence rather than any specific features of the TVT. Although the study is flawed by its retrospective design and a long interval between the procedure and the questionnaire, the results overall are reassuring.     

阴道前后壁修补术联合阴式子宫全切术治疗中重度子宫脱垂的疗效

目的探究阴道前后壁修补术联合阴式子宫全切术治疗中重度子宫脱垂的疗效及其对性功能的影响。 方法选择芜湖市第五人民医院妇产科自2014年8月至2018年8月收治的中重度子宫脱垂患者60例,随机分为观察组与对照组,每组各30例。观察组行阴式全子宫切除术加阴道前后壁修补术治疗,对照组行单纯阴道前后壁修补术治疗,对比2组围手术期临床指标、术后并发症发生率及复发情况,采用盆腔器官脱垂/尿失禁性功能问卷（PISQ-12）对比2组术前、术后随访6个月的性功能变化情况。 结果观察组平均手术时间、肛门排气时间、住院天数明显短于对照组,观察组术中出血量少于对照组,差异有统计学意义（P<0.05）;观察组术后并发症发生率与对照组差异无统计学意义（P>0.05）;观察组的治愈率为90.00%,好转率为10.00%,高于对照组的80.00%、3.33%,观察组无复发者,对照组复发率为16.67%,差异均有统计学意义（P<0.05）;术后随访6个月后观察组PISQ-12评分为（35.12±3.37）分,低于对照组（38.83±5.62）分,差异有统计学意义（P<0.05）。 结论阴式全子宫切除术联合阴道前后壁修补术治疗中重度子宫脱垂的临床效果较理想,与单纯阴式子宫切除术相比可显著缩短手术时间较短,减少术中出血,提高手术疗效,降低术后复发率,但在改善术后性功能方面并不具有优势。     

Impact of tension-free vaginal tape on sexual function: results of a prospective study

The purpose of this study was to prospectively assess the impact of a TVT insertion for the treatment of stress urinary incontinence (SUI) on coital incontinence and overall sexual life. Sexually active women with pure SUI and without concomitant pelvic organ prolapse scheduled for TVT procedure completed a sexual function questionnaire at baseline and 6 months after surgery. Fifty-three patients were enrolled. Preoperatively 23 (43.4%) women experienced urine leakage during intercourse, 21 (91%) during penetration and 2 (9%) on orgasm. The objective cure rate for SUI was 98%. Coital incontinence was cured in 20 of 23 patients (87%). Thirty-three (62.2%) women reported no change in sexual function after surgery and 18 (34%) reported an improvement. Of the latter, 17 (94%) were of those cured from coital incontinence. No significant difference in the incidence of dyspareunia was found postoperatively. Two patients (3.8%) reported intercourse to be worse following surgery, one because of a vaginal erosion and one cited de novo anorgasmia as the main reason.     

无张力性吊带术治疗女性压力性尿失禁

目的探讨无张力阴道吊带术(tension-free vaginal tape，TVT)治疗女性压力性尿失禁的疗效。方法13例经尿动力学检查证实为压力性尿失禁在连续硬膜外麻醉下经阴道前壁行无张力阴道吊带术，低平截石位，经阴道前壁向上穿刺尿道两侧间隙，从耻骨上腹壁引出TVT吊带，调整张力，关闭切口。结果手术时间15～45min，平均35min。13例随访6～24个月，平均13个月，12例治愈，1例改善，无尿失禁复发或排尿困难。结论TVT操作简单，创伤小，手术时间短，术后恢复快，治疗压力性尿失禁疗效好。