TVT与TVT-O治疗女性压力性尿失禁的疗效和并发症比较

目的 比较经阴道无张力尿道中段吊带术(TVT)和经闭孔无张力尿道中段吊带术(TVT-O)治疗女性压力性尿失禁(SUI)的临床疗效和并发症.方法 将2009年2月-2010年2月205例女性SUI患者按随机分配表随机分组,102例采用TVT术式,103例采用TVT-O术式,比较临床疗效和并发症.结果 TVT组手术时间25～45 min,平均为(27.5±13.3) min；TVT-O组手术时间11～25 min,平均为(18.5±7.4)min,两组平均手术时间比较差异有统计学意义(P＜0.05)；两组术中出血量、平均留置尿管时间、平均住院时间和术后残余尿量比较,差异无统计学意义(P＞0.05).两组共195例(95.1％)患者术后尿失禁得到控制,术后随访12 ～24个月无再次尿失禁发生.TVT组术中发生膀胱损伤者5例(4.9％),拔除导尿管后尿潴留2例(2.0％)；TVT-O组拔除导尿管后尿潴留2例(2％),未发生膀胱损伤,术后大腿内侧疼痛3例(2.9％).4例(3.8％)患者术后6个月内无尿失禁症状,12个月后出现中度的尿失禁症状,4例均较术前症状有所好转.结论 TVT与TVT-O两种术式治疗女性SUI疗效可靠,两种术式各有优缺点,TVT长期疗效优于TVT-O,但膀胱损伤概率较TVT-O高；TVT-O较TVT操作简单,手术创伤小,并发症少,但偶有大腿内侧疼痛,且重度SUI患者中期临床疗效略差于TVT.

Efficacy and complications of TVT procedure and TVT-O procedure in treatment of female stress urinary incontinence

Objective To compare the clinical efficacy and complications of tension-free vaginal tape(TVT) procedure(TVT group) and transobturator vaginal tape inside out(TVT-O) procedure(TVT-O group) in treatment of female stress urinary incontinence(SUI).Methods Two hundred and five female patients with SUI were randomized to receive TVT procedure(n=102) or TVT-O procedure(n=103) from February 2009 to February 2010,and the clinical efficacy and complications were compared.Results The mean time of operation in TVT group was(27.5±13.3) min(25 to 45 min),the mean time of operation in TVT-O group was(18.5±7.4) min(11 to 25 min),and there were significant differences between two groups(P<0.05).There was no significant difference in the volume of blood loss during operation,mean duration of indwelling catheter,average length of hospital stay and volume of postoperative residual urine between two groups(P>0.05).The symptoms of urinary incontinence in 195 patients(95.1%) in two groups were controlled after operation,and no incidence of urinary incontinence occurred during the follow-up for 12 to 24 months.There were 5 patients(4.9%) with intraoperative bladder injury and 2 patients(2.0%) with urinary retention after catheter removal in TVT group.There were 2 patients(2%) with urinary retention after catheter removal,3 patietns(2.9%) with postoperative thigh pain and no case of bladder injury in TVT-O group.There was no symptom of urinary incontinence within 6 months after operation in 4 patients(3.8%),moderate urinary incontinence emerged 12 months after operation,and the symptoms improved in all the 4 patients.Conclusion TVT procedure and TVT-O procedure are effective and reliable in treatment of female SUI.TVT procedure has better long-term effect and higher possibility of bladder injury than TVT-O procedure.TVT-O procedure is simpler than TVT procedure,with less surgical trauma,less complications and occasionally-occurred thigh pain.The mid-term clinical efficacy of TVT-O procedure is slightly worse than that of TVT procedure.