无张力阴道吊带术与经闭孔无张力阴道吊带术治疗女性压力性尿失禁的临床对比

目的对比研究无张力阴道吊带术（TVT）和经闭孔无张力阴道吊带术（TVT-O）治疗女性压力性尿失禁（SUI）的临床效果。方法回顾分析2003年3月一2013年4月女性SUI患者61例，其中行TVT33例，TVT-028例，术后随访1～62个月，平均22个月。以术后咳嗽、增加腹压无尿液溢出，且B型超声检查无剩余尿为治愈；术后咳嗽、增加腹压少许尿液溢出但较术前改善者为改善；术后咳嗽、增加腹压仍不能控制尿液溢出者为无效。结果两组患者的年龄及病程等临床资料相似，差异均无统计学意义（P〉0．05）。61例手术均顺利完成。TVT组手术时间26～45min，平均（35．5±4．3）min；TVT-O组15～20min，平均（17．2±3．1）min；两组的手术时间差异有统计学意义（P〈0．05）。两组术中出血量差异无统计学意义（P〉0．05）。TVT-O组的并发症发生率比TVT组低。两组的治愈率、改善率差异均无统计学意义（P〉0．05）。结论TVT和TVT-O都是治疗SUI安全有效的方法。相比TVT，TVT-O具有无需膀胱镜、手术时间更短、创伤小、并发症发生率更低等优点，是治疗女性SUI更理想的手术方法。

Clinical Comparison between Tension-Free Vaginal Tape and Tension-Free Vaginal Tape-obturator for Female Stress Urinary Incontinence

Objective To compare the clinical outcome of tension-free vaginal tape （TVT） and TVT-obturator （TVT-O） for female stress urinary incontinence （SUI）. Methods Sixty-one female SUI patients were included in our study, in which 33 received TVT procedure and 28 received TVT-O procedure. The patients were followed up for 1 to 62 months post-operatively, averaging at 22 months. Cure was defined as no leakage during the stress test and no residual urine showed by B ultrasound, improvement as less leakage during the stress test after operation, and inefficacy as leakage during the stress test and no difference was detected after operation. Results Age and disease course were not significantly different between the two groups （P 〉 0.05）. All patients underwent TVT or TVT-O procedure successfully. Time of TVT ranged from 26 to 45 min averaging at （35.5 ± 4.3） minutes, and it was significantly different from the time of TVT-O which ranged from 15 to 20 min averaging at （7.2 ± 3.1） minutes （P 〈 0.05）. Bleeding during the surgery was not significantly different between the two groups （P 〉 0.05）. The rate of complications occurring during TVT-O procedure was significantly less and milder than that during the TVT procedure （P 〈 0.05）. The cure rate and improvement rate indicated no significant differences between the two groups （P 〉 0.05）. Conclusions The evidence available indicates that TVT and TVT-O procedure are both effective and safe for female SUI. Compared with TVT, TVT-O procedure has the advantages of being more convenient, shorter operation time, being less invasive, and fewer complications, and it may be more suitable for female SUI.