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。

Clinical study of Avaulta soloTM repair system combined TVT-O in treating anterior vaginal wall prolapse with concomitant SUI

Objective：To assess the clinical effect of Avaulta repair system combined tension free vaginal tapeobturator（TVT-O）in treating anterior vaginal wall prolapse with concomitant stress urinary incontinence（SUI）.Method：From January 2011 to February 2012,28 women suffered from anterior vaginal wall prolapse were assigned to undergo Avaulta repair system with concomitant TVT-O in Wuhan Tongji Hospital.All patients were followed up periodically after the operation.The success criteria included the Pelvic Organ Prolapse Quantification（POP-Q）less thanⅡ,no SUI and absence of subjective symptom.The failure was defined as POP-Q ≥Ⅱ or recurrence of SUI or subjective symptom within one year.The Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire（PISQ-12）,the Pelvic Floor Impact Questionnaire 7（PFIQ-7）,and the Pelvic Floor Distress Inventory（PFDI-20）were all used as subjective cure index.Result：The average operating time was（116.1±23.6）minutes and estimated blood loss was（83.9±54.4）ml.The mean postoperative hospital stay and postoperative indwelling catheter duration were（6.6±3.1）and（5.2±3.1）days,respectively.Of the 28 women,26 were cured,with a cure rate of 92.9%.The mean follow-up period was 25.7（range,24-36）months.Compared with baseline,all subjective indexes improved significantly（P〈0.05）.Two patients（7.1%）failed after the operation.One of them suffered from obvious SUI postoperatively and another one was found anterior vaginal wall prolapse at one week after the operation.No recurrence of SUI was found except one case（3.6%）.Conclusion：The Avaulta repair system combined TVT-O is an effective,easy and minimally invasive method to treat anterior vaginal wall prolapse with concomitant SUI.