四种中段尿道吊带术治疗女性压力性尿失禁的比较

目的比较4种中段尿道吊带术治疗女性压力性尿失禁（stress urinary incontinence,SUI）的疗效。方法回顾分析80例行中段尿道吊带术的女性SUI患者的临床资料,其中改良Stamey法14例、In-fast法12例、TVT法42例及TVT-O法12例。结果组间比较,手术时间有显著性差异（P〈0.05）,其中TVT-O组时间最短,为（18.8±4.3）min,改良Stamey组时间最长,达（52.1±5.4）min。80例患者随访3~100个月,70例（87.5%）治愈,尿失禁症状完全消失;7例（8.75%）改善;3例（3.75%）失败。改良Stamey组、In-fast组、TVT组及TVT-O组治愈率分别为78.6%、75.0%、92.9%及91.7%,无统计学差异（P〉0.05）。改良Stamey组2例患者术后出现排尿困难,经多次下压式尿道扩张无效而剪断悬吊线;In-fast吊带组1例患者因阴道吊带外露而拆除,TVT组及TVT-O组术后各有1例患者出现排尿困难,经下压式尿道扩张后解除梗阻。结论4种尿道吊带术疗效相似,均为治疗女性压力性尿失禁安全、有效的方法;其中TVT-O因操作简单手术时间最短。

Comparison of Four Kinds of Mid-urethral Slings in the Treatment of Female Stress Urinary Incontinence

Objective To compare the efficacy of four kinds of mid-urethral slings in the treatment of female stress urinary incontinence （SUI）. Method Eighty women with SUI underwent four kinds of mid-urethral slings were reviewed, in which 14 of modified transvaginal Stamey sling, 12 of In-fast, 42 of tension-free vaginal tape （TVT）, and 12 of transobturator vaginal tape inside-out （TVT-O）. Results There were significant differences in operative time among the 4 groups（P 〈0.05 ）. TVT-O group was the fastest one with（ 18.8 ± 4.3）minutes, and the modified Stamey transvaginal sling group was the longest with （52.1 ±5.4）minutes in operative duration. Within 3 to 100 months follow-up, 70 cases （87.5%） were cured, 7（8.75% ） improved and 3 failed （ 3.75% ）. The cure rate of modified Stamey, In-fast, TVT and TVT-O was 78.6%, 75.0%, 92.9% and 91.7% respectively, and there was no statistical difference among the four procedures. Dysuresia was occurred in 4 cases. Of them, 2 cases （TVT and TVT-O for each） were cured by urethral dilation, and 2 cases of modified Stamey sling were sheared the suspension suture after invalid urethral dilation. 1 sling of In-fast group was removed because of vaginal erosion. Conclusions The 4 techniques have similar efficacy, all of them are s＇afe and effective procedures for female SUI. TVT-O is a simple technique with the shortest operative duration. However, longer follow-up is necessary to determine the outcomes and complications.