【摘要】 目的探究单切口可调节微吊带悬吊术(Ajust)与经阴道闭孔尿道中段无张力悬吊术(TVT-O)对女性压力性尿失禁(stress urinary incontinence, SUI)患者膀胱尿道功能及生活质量的影响。方法选取2016年4月—2019年3月收治的行手术治疗的82例女性SUI,根据手术治疗方式的不同,分为观察组(n=39)与对照组(n=43)。观察组行Ajust治疗,对照组行TVT-O治疗。比较术前及术后1个月尿道结构相关指标[膀胱颈移动度(BND)、膀胱尿道后角(PUVA)、尿道旋转角(URA)]、尿道功能相关指标[功能尿道长度(FUL)、最大尿道闭合压(MUCP)、Valsalva漏尿点压(VLPP)]变化,分析围术期相关指标(手术时间、术中出血量、尿管留置时间及住院时间),采用盆腔脏器脱垂/尿失禁性功能问卷(PISQ-12)评估术后1个月性生活质量,采用尿失禁生活质量问卷(I-QOL)评估术后1个月日常生活质量,观察术后并发症发生情况。结果与本组术前比较,两组术后1个月BND、PUVA、URA水平下降,FUL、MUCP、VLPP水平升高,差异有统计学意义(P<0.01)。两组手术时间、尿管留置时间比较差异无统计学意义(P>0.05);与对照组比较,观察组术中出血量减少,住院时间缩短,差异有统计学意义(P<0.05或P<0.01)。术后1个月,与对照组比较,观察组PISQ-12评分及I-QOL评分中的心理影响评分、社交尴尬评分、标准化总分升高,差异有统计学意义(P<0.05)。术后,与对照组比较,观察组腹股沟和(或)大腿根部疼痛的发生率明显降低,差异有统计学意义(P<0.05)。结论不同术式治疗女性SUI均可取得良好效果且安全性高,但Ajust创伤较小,有利于患者术后身心健康的恢复。更多还原

【Abstract】 Objective To explore the effects of adjustable single-incision micro-sling(Ajust) and transobturator tension-free vaginal tape-obturator(TVT-O) on bladder and urethral function and quality of life of female patients with stress urinary incontinence(SUI). Methods Eighty-two SUI female patients who underwent surgery from April 2016 to March 2019 were selected and divided into observation group group(n=39) and control group(n=43) according to different surgical methods. Observation group was given Ajust treatment, and control group was given TVT-O treatment. The urethral ultrasound structure-related parameters [bladder neck descent(BND), posterior urethrovesical angle(PUVA), urethral rotation angle(URA)] and urinary tract function-related parameters [functional urethral length(FUL), maximal urethral closure pressure(MUCP), Valsalva leakage point pressure(VLPP)] were compared between the two groups before operation and at 1 month after operation. The perioperative related indicators(duration of operation, intraoperative blood loss, urethral indwelling time, length of hospital stay) were analyzed. Sexual life quality at 1 month after operation was evaluated by pelvic organ prolapse/urinary incontinence sexual questionnaire(PISQ-12), and daily life quality at 1 month after operation was assessed by incontinence quality of life instrument(I-QOL). The occurrence of postoperative complications was observed. Results Compared with those before operation in the same group, the levels of BND, PUVA and URA in the two groups at 1 month after operation were decreased while the levels of FUL, MUCP and VLPP were increased(P<0.01). There were no significant differences between the two groups in duration of operation and urethral indwelling time(P>0.05). Compared with control group, the intraoperative blood loss was reduced and length of hospital stay was shortened in observation group(P<0.05 or P<0.01). Compared with control group, the PjustQ-12 score and psychological impact score, social awkwardness score and standardized total score of I-QOL in observation group were increased at 1 month after operation(P<0.05). Compared with control group, the incidence rate of pain in groin and/or thigh root was significantly decreased in observation group after operation(P<0.05). Conclusion Different surgical procedures for female SUI can achieve good efficacy and high safety. However, Ajust surgery has fewer traumas, and is more conducive to the recovery of physical and mental health of patients after operation.更多还原