2种无张力尿道悬吊术对女性压力性尿失禁疗效比较

目的经耻骨后阴道无张力尿道悬吊术((tension-free vaginal tape,TVT)和经闭孔阴道无张力尿道悬吊术(ten-sion-free vaginal tape-obturator,TVT-O)是目前临床上常用的2种治疗女性压力性尿失禁(female stress urinary incontinence,FSUI)的手术方法,其疗效有差异,文中旨在探讨2种方法治疗FSUI的有效性、安全性及并发症的处理。方法 210例FSUI患者中行TVT 98例(TVT组)、行TVT-O 112例(TVT-O组),术后随访6～48个月,平均(32.0±4.5)个月,比较2种手术方式的疗效和术中、术后并发症,评估两者的安全性和有效性。结果 2组患者治愈率比较差异无统计学意义(P>0.05);TVT-O组较TVT组手术时间短,差异有统计学意义(P<0.05)。TVT-O组术后有17例患者主诉大腿根部疼痛,TVT组有10例患者主诉耻骨上不适,口服维生素B1,局部热敷及微波治疗,1月后症状消失。TVT-O组有8例患者出现剧烈咳嗽时仍有少量尿液漏出;TVT组出现8例,嘱其进行盆底肌肉锻炼,3个月后症状好转。TVT组患者术中出现6例膀胱损伤,术后出现3例吊带侵蚀,4例排尿困难,TVT-O组出现5例吊带侵蚀。2组患者均未出现严重膀胱穿孔、阴道穿孔、吊带排异反应及伤口感染等并发症。结论 TVT和TVT-O均是治疗FSUI的有效手段,治愈率高,且TVT-O较TVT手术时间短,发生严重并发症的概率更小,操作简单、术后恢复快。

Tension-free vaginal tape versus tension-free vaginal tape-obturator for female stress urinary incontinence

Objective Tension-free vaginal tape(TVT) and tension-free vaginal tape-obturator(TVT-O) are two common methods for the clinical treatment of female stress urinary incontinence(FSUI),but differ in prognosis.This study is to investigate the efficacy,safety and complications of the two methods.Methods A total of 210 patients with FSUI were included in this study,98 treated by TVT and the other 112 by TVT-O.We followed up the patients for 6 to 48(32.0±4.5) months,and compared the two procedures in safety,efficacy and intra-and post-operative complications.Results The cure rate showed no significant differences between the TVT and TVT-O groups(91.8% vs 92.9%,P>0.05).The mean operation time was significantly shorter in the TVT-O than that in the TVT group(P<0.05).Seventeen patients in the TVT-O group complained about pain in the upper inner thighs,while 10 in the TVT group about discomfort in the suprapubis.The symptoms disappeared after a month of oral administration of vitamin B1,local application of hot packs and microwave therapy.Violent cough-induced mild urine leakage occurred in 8 cases of the TVT-O and another 8 of the TVT group,all relieved after 3 months of pelvic floor muscle exercise.Six cases of intra-operative bladder injury,3 cases of postoperative tape erosion and 4 cases of postoperative dysuria were found in the TVT group,and another 5 cases of tape erosion in the TVT-O group,but neither group showed serious bladder perforation,vaginal perforation,tape rejection and wound infection.Conclusion Both TVT and TVT-O are effective for the treatment of FSUI,and the latter is even more advantageous its shorter surgical time,simpler operation,quicker recovery and fewer serious complications.