无张力阴道吊带术治疗女性压力性尿失禁(附20例报告)

目的 评价无张力阴道吊带术(tension-free vaginal tape，TVT)治疗女性压力性尿失禁的疗效。方法 总结采用TVT术治疗女性压力性尿失禁20例的临床资料。结果 平均手术时间26.5min。拔除尿管后，19例病人控尿满意，1例仍有轻微尿失禁。术后平均随访12(3-24)个月，20例病人均无尿失禁。合并症有1例膀胱穿孔，1例术后轻度排尿不畅，2例尿频尿急。结论 TVT术操作简便快捷，创伤小，合并症少，术后康复快，是一种治疗女性压力性尿失禁的理想方法。     

Tension-free vaginal tape for the treatment of urodynamic stress incontinence with intrinsic sphincteric deficiency

The purpose of this study was to evaluate the outcome of tension-free vaginal tape (TVT) procedure in women with urodynamic stress incontinence diagnosed as having intrinsic sphincteric deficiency (ISD). The combination of a maximal urethral closure pressure <20 cm H₂O and a Valsalva leak point pressure <60 cm H₂O was considered as diagnostic of ISD. Subjects with detrusor overactivity on preoperative urodynamics were excluded. A total of 35 patients with both low closure pressure and leak point pressure were enrolled. Bladder perforation occurred in three (8.6%) cases. Postoperative urinary voiding difficulties occurred in nine (25.7%) women. Two patients underwent surgical detension of the tape, with complete resolution of urinary retention and no relapse of incontinence. Women with postoperative voiding dysfunction had a significantly lower detrusorial pressure at the peak flow on preoperative urodynamics compared to those who voided efficiently after TVT. The mean (range) follow-up time was 12.5 months (3–36). The objective cure rate for stress incontinence was 91.4%. Two of the three (66%) patients in whom the TVT procedure failed had a fixed urethra. De novo urge incontinence was found in five (14.3%) patients.     

经阴道无张力吊带术治疗女性压力性尿失禁的体会

目的探讨经阴道无张力吊带术(TVT)治疗女性压力性尿失禁(SUI)的疗效及安全性。方法对2002年5月至2004年12月施行TVT的114例女性SUI患者资料进行回顾性研究。根据Stamey尿失禁分级系统评价TVT手术的有效性。术后较术前尿失禁等级评分改善2级或2级以上为显著改善,1级为改善,无改善甚至加重为无效。术后尿失禁等级为0~1级为完全控尿,2级为有效控尿,3~4级为无效。评估术前、术后的24h尿垫试验及尿动力学检查结果。并对并发症进行统计和分析。结果随访110例(96.5%),随访时间6~30个月。24h尿垫试验术前(38.3±10.4)g,术后(8.8±7.4)g;尿失禁症状评分从术前42.3±11.4,术后20.4±9.2;尿失禁等级评分显著改善者94例(85.5%),改善者12例(10.9%),无效者4例(3.6%)。术后完全控尿者89例(80.9%),有效控尿者14例(12.7%),无效者7例(6.4%)。术中发生膀胱穿孔2例(1.8%),出血14例(12.7%)。术后1个月内有排尿不畅者9例(8.2%),尿频、尿急者12例(10.9%),尿潴留者1例(0.9%);术后6个月后有耻骨上不适者8例(7.3%),排尿不尽者2例(1.8%),尿频、尿急者3例(2.7%)。1例反复尿潴留患者经保守治疗无效,最终将吊带切断。术后未出现吊带处阴道黏膜糜烂和明显盆腔血肿。结论TVT术是目前治疗女性SUI的一种有效、安全的微创手术。     

压力性尿失禁的TVT术治疗

压力性尿失禁为腹内压突然增高时 (如咳嗽、打喷嚏、大笑或体力活动期间 )尿液的非随意性排出 ,常给患者尤其是女性患者带来一系列社会、精神、家庭、职业、体力和性生活方面的困扰 ,生活质量受到明显损害。本研究报告我院采用经阴道无张力尿道吊带 (tension free vaginal tape,TVT)术治疗压力性尿失禁的情况。1　资料和方法1.1　入选 TVT手术者条件　 (1)常规检查 :精神、神志正常 ;无严重贫血、白细胞低下症 ;肝肾功能正常或接近正常 ;无怀孕或期望再生育 ;未接受抗凝治疗 ;无急性泌尿道感染 ;无慢性咳嗽、咳痰 ;心电图检查无严重缺血…     

TVT系统经阴道尿道中段悬吊治疗压力性尿失禁8例

目的探讨无张力尿道中段悬吊（TVT）手术方法、疗效及并发症的预防。方法女性压力性尿失禁（sUI）患者8例。经阴道前壁尿道中段行无张力阴道吊带术。结果8例,SUI均得到较满意的控尿效果。1例患者术后剩余量60cm,但主观评价明显改善,随访1～24个月,基本无SUI症状复发者,无排尿困难及尿路感染等。结论TVT吊带系统是治疗压力性尿失禁的一种简便、快捷的治疗SUI方法,疗效满意,可以减少患者的痛苦和缩短住院周期。     

Ergebnisse und Komplikationen nach urethralen Bändern

Zusammenfassung Der Einsatz der urethralen Bänder entspricht dem Trend der Zeit und kann aufgrund der Datenlage bei entsprechender Indikationsstellung befürwortet werden. Der transobturatorische Zugang scheint gegenüber dem retropubischen Zugang im Hinblick auf die intraoperativen Komplikationen Vorteile zu bringen. Die häufigste postoperative Komplikation stellt bei beiden Verfahren die zu enge Bandlage dar. Daher ist auf diesen Umstand intraoperativ besondere Aufmerksamkeit zu lenken.     

Quality of life assessments in women operated on by tension-free vaginal tape (TVT)

The aim of the study was to evaluate quality of life (QOL) prospectively in women who undergo tension-free vaginal tape (TVT) operation for stress urinary incontinence. Sixty-six women who completed QOL questionnaires and a 2-year follow-up examination were included. Improvement of health-related QOL was assessed by the Incontinence Impact Questionnaire-7 (IIQ-7), the Urogenital Distress Inventory-6 (UDI-6), and two questions regarding patient satisfaction and de novo urge incontinence. Prior to surgery, patients complained most of stress symptoms followed by physical activities and emotional health. Postoperatively IIQ-7 and UDI-6 as a whole and all seven domains improved significantly (p<0.001). Scores of IIQ-7, UDI-6, and seven domains did not differ between the adult and the elderly groups. Of the patients 88% were much satisfied or satisfied with surgical outcomes. Incidence of de novo urge incontinence was 12%. It is concluded that the TVT procedure significantly improved health-related quality of life.The authors listed above wrote this contribution on behalf of the Tension-free Vaginal Tape Trial GroupEditorial Comment: This study adds to the body of literature on the efficacy of the TVT procedure. Using quality of life instruments 88% of the patients were much satisfied or satisfied with surgical outcomes. Incidence of de novo urge incontinence was 12%. The biggest deficiency of the study was that follow-up was only available on 66 of 161 women