TVT-S治疗女性压力性尿失禁的疗效和安全性分析

目的 探讨经阴道无张力尿道中段吊带术(TVT-S)治疗女性压力性尿失禁(SUI)的有效性及安全性.方法 回顾性分析2008年10月至2010年5月诊治的27例SUI患者的资料.年龄35～77(56.1±10.7)岁;单纯型20例,混合型7例;产次1～6(2.8±1.4)次;体质指数22.0～31.9(25.6±2.5);病程1～30(6.8±7.2)年.有盆腔手术史2例,均无抗尿失禁手术史,膀胱颈抬举试验均阳性;腹压漏尿点压(ALPP)27～120(60.9±27.5)cm H2O;术前ICI-Q-SF评分7～14(11.2±1.8)分.结果 27例均行TVT-S,其中行"U"术式19例,行"H"术式8例.手术时间13～19(15.3±1.4)min.术中无膀胱、尿道损伤,无闭孔血管、神经损伤,术中出血10～50 ml;术后测量最大尿流率4～50(25.4±13.1)ml,残余尿0～95(23.2±7.6)ml.术后发生轻度排尿困难3例(11.1%),出现阴道创口渗液3例(11.1%);术后随访3～21(12.6±6.7)个月,出现尿频、尿急或急迫性尿失禁10例(37.0%),无阴道侵蚀.疗效判定:治愈15例(56%),好转8例(30%),无效4例(1 5%).结论 TVT-S治疗SUI简单易行,操作安全,并发症轻微易治,但手术治愈率较低,长期疗效仍需大量临床和随访资料证明.

Abstract：

Objective To evaluate the efficacy and safety of the TVT-Secur procedure for female stress urinary incontinence (SUI). Methods Analyze retrospectively the preoperative, intraoperative and postoperative complications and follow-up data of 27 SUI patients from October 2008 to May 2010. 20 cases were simple SUI, and 7 cases were mixed SUI. The average age was 56.1 ± 10.7 years (range, 35-77), the average parity was 2.8-±- 1.4 (range, 1-6), the average body mass index was 25.6±2.5, and the average course of the disease was 6.8±7.2 yeas (range, 1-30). Two cases had past history of pelvic surgery without any anti-incontinence surgery. Mashall-marchett test was positive in all patients, with an average abdominal leak point pressure (ALPP) of 60.9±27.5 cm H2O (range, 27- 120 cm H2O). The mean International Consultation on Incontinence-Short Form (ICIQ-SF) score was 11.2 ± 1.8 (range, 7- 14) before surgery. Results 27 patients underwent TVT-Secur procedure, of which 19 cases underwent "U" procedure, and 8 cases underwent "H" procedure. The mean operation time was 15.3±1.4min (range, 13- 19 min). There were no intraoperative bladder or urethral injury, and no obturator vessel or nerve damage. The blood loss was 10 to 50 ml, and the maximum urinary flow rate was 25. 4±13. 1 ml (range, 4-50 ml). Three eases had mild dysuria(11. 1%), and 3 cases had wound effusion(11. 1%). Followed up for 12. 6 ±6. 7 months (range, 3-21 months). 10 cases complained of bladder overactivity symptoms such as frequency, urgency, and urge incontinence, and no case had vaginal erosion. Therapeutic efficacy: 15 cases were cured (56%), 8 cases were improved (30%), and 4 cases were ineffective (15%). Conclusions TVT-Secur procedure is a simple, safe and minimally invasive surgery, while the cure rate is low. The long-term efficacy needs great amount of clinical data and long-term follow-up to prove.

Efficacy and safety of TVT-Secur procedure for treatment of female stress urinary incontinence

Objective To evaluate the efficacy and safety of the TVT-Secur procedure for female stress urinary incontinence (SUI). Methods Analyze retrospectively the preoperative, intraoperative and postoperative complications and follow-up data of 27 SUI patients from October 2008 to May 2010. 20 cases were simple SUI, and 7 cases were mixed SUI. The average age was 56.1 ± 10.7 years (range, 35-77), the average parity was 2.8-±- 1.4 (range, 1-6), the average body mass index was 25.6±2.5, and the average course of the disease was 6.8±7.2 yeas (range, 1-30). Two cases had past history of pelvic surgery without any anti-incontinence surgery. Mashall-marchett test was positive in all patients, with an average abdominal leak point pressure (ALPP) of 60.9±27.5 cm H2O (range, 27- 120 cm H2O). The mean International Consultation on Incontinence-Short Form (ICIQ-SF) score was 11.2 ± 1.8 (range, 7- 14) before surgery. Results 27 patients underwent TVT-Secur procedure, of which 19 cases underwent "U" procedure, and 8 cases underwent "H" procedure. The mean operation time was 15.3±1.4min (range, 13- 19 min). There were no intraoperative bladder or urethral injury, and no obturator vessel or nerve damage. The blood loss was 10 to 50 ml, and the maximum urinary flow rate was 25. 4±13. 1 ml (range, 4-50 ml). Three eases had mild dysuria(11. 1%), and 3 cases had wound effusion(11. 1%). Followed up for 12. 6 ±6. 7 months (range, 3-21 months). 10 cases complained of bladder overactivity symptoms such as frequency, urgency, and urge incontinence, and no case had vaginal erosion. Therapeutic efficacy: 15 cases were cured (56%), 8 cases were improved (30%), and 4 cases were ineffective (15%). Conclusions TVT-Secur procedure is a simple, safe and minimally invasive surgery, while the cure rate is low. The long-term efficacy needs great amount of clinical data and long-term follow-up to prove.