经闭孔无张力尿道中段悬吊术治疗女性压力性尿失禁

目的探讨经闭孔无张力尿道中段悬吊术(transobturator inside-out tension-free urethral suspension,TVT-O)治疗女性压力性尿失禁(stress urinary incontinence,SUI)的效果。方法2005年8月～2006年2月采用经闭孔无张力尿道中段悬吊术治疗女性SUI18例,螺旋穿刺针自阴道前壁尿道旁间隙经闭孔穿刺至大阴唇外侧皮肤后放置网片,调整张力,关闭切口。结果手术时间10～25min,(15±3)min;术中出血量10～20ml,(15±2)ml。1例术后排尿困难,保留尿管3d后自行排尿。18例治愈,随访6个月均无复发。结论TVT-O操作简单,疗效确切,是治疗女性SUI安全有效的方法之一。     

经闭孔无张力阴道吊带术治疗女性压力性尿失禁(附16例报告)

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)的疗效.方法 经临床和尿动力学检查确诊16例女性SUI患者,手术自尿道外口与阴道外口之间的切口向耻骨和耻骨降支的联合处钝性分离间隙并穿过闭孔,将聚丙烯网吊带无张力置于尿道中段.结果 手术时间平均20分钟,术中出血量平均18ml,术后平均留置导尿...     

改良经阴道闭孔无张力尿道中段悬吊术治疗女性压力性尿失禁30例

目的探讨改良经阴道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(female stress urinary incontinence,FSUI)的临床效果。方法 2015年11月~2016年6月对30例FSUI实施改良TVT-O,利用聚丙烯网片根据患者骨盆大小术中自制成相应的吊带,10号丝线固定于两端;尿道中段宽约1.2 cm切开阴道黏膜及黏膜下层为入口,向耻骨降支方向钝性分离阴道黏膜下层与尿道、膀胱的间隙,经耻骨降支的后缘达闭孔膜所形成的隧道为路径,阴蒂的水平与大腿内侧皮肤皱褶交界处为出口;利用螺旋穿刺针及其头部"L"形的卡槽,以及10号丝线牵引、放置、调整吊带。结果 30例手术成功,1例术后出现尿潴留后经吊带松解术治愈。手术时间25~130 min,(43.9±17.8)min;术中出血5~100 ml,(28.3±20.8)ml;术后住院3~10 d,(4.0±1.7)d。术中未发生膀胱、输尿管、神经等损伤,术后无尿失禁复发,也无慢性腿部疼痛、吊带侵蚀及网片排异反应等。29例随访3~10个月,手术治愈率90.0%(27/30),改善率6.7%(2/30)。结论改良TVT-O治疗FSUI疗效确切,安全可靠,操作简便、微创,值得临床应用。     

TVT-O治疗女性压力性尿失禁17例报告

目的：对经闭孔入路经阴道尿道中段无张力悬吊术（Transobturator vaginal tape,TVT-O）治疗女性压力性尿失禁（SUI）的疗效进行评价。方法：对17例SUI患者进行TVT-O治疗。结果：手术时间20～45min,平均30min,术中出血30～80ml,平均50ml。拔管后尿失禁消失14例,咳嗽增加腹压后偶有尿液溢出2例。随访1～13个月,平均7个月,无一例复发。结论：TVT-O治疗SUI操作简单,效果可靠,并发症少,是一种较为理想的方法。     

经耻骨后和经闭孔尿道中段无张力悬吊术治疗女性压力性尿失禁的疗效观察

目的:观察经耻骨后和经闭孔尿道无张力悬吊术治疗女性压力性尿失禁(Stress urinary incontinence,SUI)的疗效。方法:选择女性SUI患者198例,病程2~25年,平均7.3年;年龄41~78岁,平均58.3岁。采用经耻骨后无张力阴道吊带术(tension-free vaginal tape,TVT,57例为TVT组)或经闭孔尿道下无张力吊带术(transobturator vaginal tape inside-out,TVT-O,141例为TVT-O组)进行治疗。结果:本文患者随访6~120个月,179例(90.4%)治愈,其中TVT组平均随访86个月,治愈51例(89.5%),改善4例(7%);TVT-O组平均随访38个月,治愈128例(90.7%),改善6例(4.3%);疗效不佳9例(3.5%)。TVT组2例发生膀胱穿孔(3.5%),TVT-O组3例出现腹股沟血肿伴下肢大腿根部疼痛,2例出现短期单下肢活动障碍,但经保守治疗均好转;术后拔除尿管后排尿困难5例,其中TVT组2例,TVT-O组3例,经多次下压式尿道扩张及延长保留尿管后解除梗阻、恢复正常排尿4例;TVT组中1例采用尿道扩张无效而剪断悬吊带。结论:经阴道中段无张力悬吊术(尤其是TVT-O)操作简便,疗效佳,并发症少,是治疗女性SUI的有效方法。     

TVT-O治疗女性压力性尿失禁的疗效观察

目的 探讨评价经闭孔无张力尿道中段悬吊术(TVT-O)治疗女性压力性尿失禁(SUI)的临床疗效.方法 回顾性分析2008年9月至2011年9月采用TVT-O治疗SUI18例进行疗效观察.结果 手术时间15 ～45min,平均25 min,术中出血20 ～ 60ml,平均40ml.拔管后尿失禁消失15例,增加腹压后偶有尿液溢出3例.随访3～l2个月,平均6个月,无一例复发.结论 TVT-O治疗SUI操作简单安全,创伤小,并发症少,疗效可靠,是一种理想治疗方法.     

TVT-O治疗女性压力性尿失禁21例报告

目的对经闭孔入路经阴道尿道中段无张力悬吊术（transobturator vaginal tape,TVT-O）治疗女性压力性尿失禁（stress urinary incontinence,SUI）的疗效进行评价。方法回顾性分析2007年3月-2009年2月采用TVT-O术式治疗女性SUI的临床资料21例。结果手术时间20-40min,平均30min,术中出血20-60mL,平均40mL。1例术后排尿困难,保留尿管5d后自行排尿。21例治愈,随访3-12个月,平均6个月,无1例复发。结论TVT-O治疗女性SUI操作简单,效果可靠,并发症少,是一种较为理想的方法。     

经闭孔阴道无张力尿道中段悬吊术治疗女性压力性尿失禁的临床观察

目的探讨经闭孔阴道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 2006年1月至2011年11月本院收治的女性SUI患者80例,其中中度50例,重度30例,35例合并子宫脱垂。均采用TVT-O术进行治疗,对伴有子宫脱垂或膀胱直肠膨出的患者,同时行阴式全子宫切除术(TVH)+阴道壁修补。结果手术时长为30~80min,术中出血量40~100ml,术后2~24h去除导尿管后自行排尿,80例术后均获得满意效果,术后合并短时轻度排尿困难5例,无膀胱、尿道损伤,无盆腔血肿。随访3个月至5年,复发1例,无尿路感染及排尿障碍。结论 TVT-O术是治疗SUI的有效方法之一,是目前SUI手术治疗的发展方向之一。     

经闭孔尿道中段无张力悬吊术 TVT-O 和 TOT 的对比研究

经闭孔尿道中段无张力悬吊术治疗女性SUI分为由内向外经闭孔无张力悬吊术(“inside-outside”tension-free vaginal tape obturator,TVT-O)和由外向内经闭孔无张力悬吊术(“outside-inside”transobturator suburethral tape,TOT)两种术式.我院自2005年8月至2009年-6月,分别采用TVT-O和TOT术式治疗女性SUI患者共40例,比较两种术式的安全性和随访1年的疗效.     

经闭孔及经耻骨后无张力阴道吊带术治疗女性压力性尿失禁的疗效比较

目的探讨经闭孔无张力阴道吊带术(TVT-O)及经耻骨后无张力阴道吊带术(TVT)治疗女性压力性尿失禁(SUI)的临床疗效。方法回顾性分析40例经过临床和尿动力学检查诊断为SUI的女性患者不同手术方法治疗的疗效,其中TVT-O术18例,TVT术22例。2组患者的年龄、病程、术前腹腔漏尿点压力间比较差异均无统计学意义(P值均>0.05)。结果TVT-O组手术时间11~20min,平均(14±3)min,术中出血量(10±3)ml,术后平均住院时间1.5d;TVT组手术时间25~50min,平均(32±7)min,术中出血量(40±15)ml,术后平均住院时间3.5d;2组比较差异均有统计学意义(P值均<0.01)。TVT-O无需膀胱镜观察。2组患者于术后24~36h拔除尿管后尿失禁症状均消失。TVT-O组无严重手术并发症,TVT组出现1例术后排尿困难。随访1~6个月,2组均无尿失禁复发。结论TVT-O和TVT术均为微创手术,二者疗效相似,而TVT-O术更安全,手术操作更简便,创伤小,患者康复快,并发症少。     

Transobturator vaginal tape inside out procedure for stress urinary incontinence: results of 102 patients

Multiple behavioral and surgical treatments exist for the treatment of stress urinary incontinence (SUI). We report herein on the safety and efficacy of the transobturator vaginal tape inside out (TVT-O) procedure for patients with SUI. A retrospective study of 102 consecutive patients with SUI who underwent the TVT-O procedure was conducted. Pre and postoperative evaluations included urodynamic studies and a 60-min pad test. Based on the 4th and 8th week postoperative evaluations, 97 of 102 (95%) patients had a complete cure. Of 88 patients who were followed for 12 months, 84 (95%) achieved a complete cure. Two instances of intraoperative lateral vaginal sulcus perforation occurred. Pain over the inner thigh was noted in 17 (17%) patients. Mesh erosion was noted in one case. TVT-O procedure is a safe, effective, and minimally invasive procedure for SUI with a low rate of complications.     

TVT-O治疗压力性尿失禁89例的中期随访报告

目的探讨经闭孔无张力尿道中段悬吊术（transobturator vaginal tape inside-out,TVT-O）治疗压力性尿失禁（stress urinary incontinence,SUI）的疗效。方法 2006年3月～2009年6月对89例轻、中、重度压力性尿失禁行TVT-O。采用特制的穿刺器械由阴道内经闭孔穿出,将吊带平铺于尿道中段形成＂吊床＂达到治疗SUI的目的。结果 89例手术顺利,72例行单纯TVT-O,5例合并子宫脱垂行阴式子宫全切术,6例合并阴道前后壁脱垂行阴道前后壁修补术,6例（合并阴道前壁脱垂1例,阴道后壁脱垂5例）行网片悬吊术。未出现膀胱损伤或穿孔、血管、神经损伤,无血肿、尿瘘,无吊带侵蚀,术后出现排尿困难2例。89例随访36个月,完全治愈85例,显著好转3例,无效1例,完全治愈率95.5%（85/89）,显著好转率3.4%（3/89）,联合手术者未见SUI复发或阴道前后壁脱垂复发,72例单纯行TVT-O者性生活未觉明显异常。结论 TVT-O治疗轻、中、重度压力性尿失禁,安全有效。     

One-year follow-up of tension-free vaginal tape (TVT) and trans-obturator suburethral tape from inside to outside (TVT-O) for surgical treatment of female stress urinary incontinence: a prospective randomised trial

OBJECTIVES: To compare tension-free vaginal tape (TVT) and trans-obturator suburethral tape from inside to outside (TVT-O) for surgical treatment of stress urinary incontinence (SUI) for complications (primary end point) and success rate (secondary end point). METHODS: Seventy-two consecutive patients, with a mean age of 53.2 yr (range: 38-69 yr) and affected by SUI, were included in this randomised controlled trial. After preoperative assessment, patients were randomly allocated to the TVT or TVT-O procedure. Operative time, perioperative complications, and hospital stay were prospectively recorded. Cure of SUI was defined as no leakage of urine during the stress test at urodynamic testing at the 12-mo evaluation. The Wilcoxon signed rank sum test, Mann-Whitney U test, McNemar test, and Fisher exact test were used to verify statistical significance, set at p<0.05. RESULTS: All patients were evaluable at the 12-mo follow-up. The characteristics of patients were well balanced between groups after randomisation. The mean operative time was significantly shorter in the TVT-O group. Perioperative complications were significantly more common after the retropubic approach (5% and 27% in TVT-O and TVT groups, respectively, p<0.04). The groups did not differ significantly in intraoperative blood loss, hospital stays, and time to return to normal activities. Sixty-five patients (90%) were successfully treated for SUI 12 mo after the operation (89% and 91% for TVT-O and TVT groups, respectively). CONCLUSIONS: Both techniques appear to be equally effective in the surgical treatment of SUI. However, TVT-O had a shorter operative time and lower overall perioperative complication rate.     

由内向外经闭孔尿道中段悬吊术治疗女性压力性尿失禁的并发症

目的：探讨由内向外经闭孔尿道中段悬吊术（TVTO）治疗女性压力性尿失禁（SUI）的并发症及其处理办法。方法：对经TVT-O治疗的100例SUI患者的临床资料进行分析,了解术中、术后出现的并发症及处理措施。结果：SUI治愈80例,治愈率80％,改善18例（18％）。发生阴道损伤3例,新发尿急6例．排尿困难3例。术后腹股沟区发生疼痛21例,出现网带腐蚀2例,经相关处理后均缓解。2例手术失败,术后拔出尿管尿失禁改善,但分别在术后2周、4周时症状复发,改行其他方法治愈。结论：TVT-O治疗SUU疗效较好．但手术并发症时有发生并需及时作相应处理;术后腹股沟痛可能与神经损伤有关。     

中段尿道吊带术治疗女性压力性尿失禁的手术并发症防治

目的探讨中段尿道吊带术的并发症及其防治措施。方法采用中段尿道吊带术治疗女性压力性尿失禁48例,其中,TVT术26例,TVT-O术19例,Sparc术3例。结果手术并发症包括:1例(TVT)术中膀胱镜检发现穿刺针穿入膀胱,经重新调整穿刺纠正。2例(Sparc术和TVT-O术各1例)分别于术后1、3个月发现阴道前壁吊带外露,经再次手术修补阴道前壁治愈。4例出现尿急症状,给予黄酮哌酯对症治疗2周后症状明显改善。2例出现股内侧轻度疼痛,未经特殊治疗,1周内症状自行缓解。结论中段尿道吊带术治疗女性压力性尿失禁方法简便、疗效可靠,但其手术并发症的发生应引起重视。     

四种中段尿道吊带术治疗女性压力性尿失禁的比较

目的比较4种中段尿道吊带术治疗女性压力性尿失禁（stress urinary incontinence,SUI）的疗效。方法回顾分析80例行中段尿道吊带术的女性SUI患者的临床资料,其中改良Stamey法14例、In-fast法12例、TVT法42例及TVT-O法12例。结果组间比较,手术时间有显著性差异（P〈0.05）,其中TVT-O组时间最短,为（18.8±4.3）min,改良Stamey组时间最长,达（52.1±5.4）min。80例患者随访3~100个月,70例（87.5%）治愈,尿失禁症状完全消失;7例（8.75%）改善;3例（3.75%）失败。改良Stamey组、In-fast组、TVT组及TVT-O组治愈率分别为78.6%、75.0%、92.9%及91.7%,无统计学差异（P〉0.05）。改良Stamey组2例患者术后出现排尿困难,经多次下压式尿道扩张无效而剪断悬吊线;In-fast吊带组1例患者因阴道吊带外露而拆除,TVT组及TVT-O组术后各有1例患者出现排尿困难,经下压式尿道扩张后解除梗阻。结论4种尿道吊带术疗效相似,均为治疗女性压力性尿失禁安全、有效的方法;其中TVT-O因操作简单手术时间最短。     

TVT-O vs TVT: a randomized trial in patients with different degrees of urinary stress incontinence

TVT-O and TVT were compared in patients stratified according the severity of Stress Urinary Incontinence (SUI). Those patients with intrinsic sphincter deficiencies, overactive bladders, associated prolapses, neurovegetative disorders and recurrent SUI or under rehabilitative/medical therapies were all excluded. There were 208 women included. Operating times were longer, and postoperative pain greater for TVT (p < 0.001). TVT produced longer hospitalizations in severe SUI patients (p < 0.001). After 1 year of follow-up, incontinence was cured in all mild SUI patients with both techniques, in all severe SUI patients when treated with TVT and in 66% of them when treated with TVT-O (p < 0.001). Vaginal perforations occurred during the TVT-O (p = 0.01), bladder perforations during TVT (p = NS), bladder obstructions in mild SUI patients after TVT (p < 0.001). The severity of SUI is an important parameter that influences results after TVT-O and TVT, and could be used to guide surgeons in selecting the most effective intervention.     

Avaulta solo~(TM)骨盆底修复系统联合TVT-O治疗阴道前壁脱垂合并压力性尿失禁的临床研究

目的:观察Avaulta soloTM骨盆底修复系统联合经闭孔经阴道无张力尿道中段悬吊术(TVT-O)治疗盆腔器官脱垂(POP)合并压力性尿失禁(SUI)的临床效果。方法:2011年1月~2012年2月我院收治阴道前壁脱垂合并SUI患者28例,同期行Avaulta骨盆底修复和TVT-O。术后定期随访,以盆腔脏器定量分度法(POP-Q)作为客观疗效评价指标,以盆腔器官脱垂/尿失禁性功能问卷(PISQ-12),盆底功能障碍影响问卷简版(PFIQ-7),盆底困扰量表简表(PFDI-20)作为主观治愈指标。结果:28例患者手术均顺利完成,手术时间(116.1±23.6)min,估计手术出血量为(83.9±54.4)ml,术后平均住院时间为(6.6±3.1)d。客观治愈率92.9%。随访24~36个月,平均25.7个月,术后2年主观评价量表各项与术前比较,差异有统计学意义(P0.05)。2例(7.1%)手术失败患者中1例术后仍有明显压力性尿失禁,另1例术后1周左右出现阴道前壁脱垂。另外有1例(3.6%)复发SUI。结论:Avaulta骨盆底修复系统同期联合TVT-O治疗阴道前壁脱垂合并SUI短期疗效确切,简便微创。     

Patient-reported outcomes for tension-free vaginal tape-obturator in women treated with a previous anti-incontinence procedure

Our purpose was to evaluate the outcome of a subset of patients that had a tension-free vaginal tape-obturator (TVT-O) placed following a previous anti-incontinence procedure. We performed a retrospective analysis of 27 consecutive women who had a TVT-O placed from January 2004 to December 2007. Patients were given the Patient Global Impression of Improvement (PGI-I) questionnaire starting at the 3-month follow-up. Of 174 women who had a TVT-O placed, 27 (15.5%) had a prior failed anti-incontinence procedure or surgery performed. The mean age was 63.8 years (range 43–87). Mean follow-up was 25.7 months (range 12–47 months). Based on the PGI-I, the overall success rate was 80% (20/25). In the properly selected patients with prior intervention for stress urinary incontinence (SUI), the success rate for TVT-O of 80% appears to be comparable to that of patients who never had a previous surgical or minimally invasive treatment for SUI.