TVT与TVT-O治疗女性压力性尿失禁对比研究

目的比较无张力性尿道中段悬吊术（tension-free vaginal tape,TVT）和经闭孔无张力尿道中段悬吊术（tension-free vaginal tape-obturator,TVT-O）治疗女性压力性尿失禁（stress urinary incontinence.SUI）的有效性及并发症。方法 31例女性SUI患者,16例行经阴道TVT,15例行TVT-O。SUI诊断主要根据患者症状、妇科检查、压力试验及尿动力学检查。术前及术后3、6、12、24月按照自制尿失禁问卷调查表进行评分,评价其主观治愈率。记录手术时间、术中及术后并发症、术中失血量、术后尿管留置时间、住院天数、术后2年随访结果。结果 TVT-O组手术平均时间比TVT组明显缩短（P〈0.05）。TVT-O组无膀胱穿孔及排尿困难,TVT术中2例出现膀胱穿孔（12.5%）,术后1例出现短暂性尿潴留（6.2%）,1例出现急迫性尿失禁（6.2%）,TVT-O组2例术后出现大腿内侧疼痛（13.3%）。两组手术出血量、尿管留置天数及住院天数均无明显差异。两组均未出现吊带腐蚀现象。随访2年结果：TVT治愈率为93.7%,TVT-O治愈率为93.3%。两组术后尿失禁生活质量量表（incontinence quality of life,I-QOL）评分明显高于术前,盆腔器官脱垂-尿失禁患者性功能问卷（organ prolapse/urinary incontinence sexual function questionnaire,P-ISQ）性生活质量评分术前术后无明显改变。结论 TVT与TVT-O手术效果相当,均是治疗女性SUI有效的方法,但TVT-O手术时间较短,并发症相对较少。

Tension-free Vaginal Tape and Tension-free Vaginal Tape-obturator for Treatment of Female Stress Urinary Incontinence

Objective To compare the effectivity and complications of tension-free vaginal tape （TVT） and tension-free vaginal tape-obturator （TVT-O） for treatment of stress urinary incontinence （SUI）.Methods Thirty-one female patients with SUI were randomly allocated for TVT （n=16） and TVT-O （n=15） treatment.SUI was diagnosed according to the symptoms,gynecological examination,stress test and urodynamics.The subjective cure rates were evaluated by a self-made questionnaire of urine incontinence before surgeries and 3,6,12,24 months after surgeries.The mean operation time,intra-and post-operation complications,intra-operation blood loss,postoperation time with urinary catheter,hospitalization days,and two-year＇s follow-up result were respectively recorded.Results The mean operation time was significantly shorter in the TVT-O group than in the TVT group （P0.05）.In the TVT group,bladder perforation occurred in two patients （12.5%）,and transient urine retention occurred in one patient （6.2%）.In the TVT-O group,the ache in the medial thigh occurred in two patients （13.3%）.There was no significant difference in the mean operation time,intra-operation blood loss,hospitalization days and postoperation time with urinary catheter between the two groups.None tape erosion occurred in the two groups.Two-year＇s follow-up indicated that the recovery rate was 93.7% and 93.3% for TVT and TVT-0 groups respectively.Both groups had an improvement in the incontinence quality of life （I-QOL） after the surgery,but the scores of organ prolapse/urinary incontinence sexual function questionnaire （P-ISQ） was not significantly different before and after the surgeries.Conclusion TVT and TVT-O have equal efficacy for the treatment of female SUI.But the operation time is shorter and the complications are less of the TVT-O surgery.