【摘要】 目的探讨经阴道无张力吊带术(TVT)治疗女性压力性尿失禁(SUI)的疗效及安全性。方法对2002年5月至2004年12月施行TVT的114例女性SUI患者资料进行回顾性研究。根据Stamey尿失禁分级系统评价TVT手术的有效性。术后较术前尿失禁等级评分改善2级或2级以上为显著改善,1级为改善,无改善甚至加重为无效。术后尿失禁等级为0~1级为完全控尿,2级为有效控尿,3~4级为无效。评估术前、术后的24h尿垫试验及尿动力学检查结果。并对并发症进行统计和分析。结果随访110例(96.5%),随访时间6~30个月。24h尿垫试验术前(38.3±10.4)g,术后(8.8±7.4)g;尿失禁症状评分从术前42.3±11.4,术后20.4±9.2;尿失禁等级评分显著改善者94例(85.5%),改善者12例(10.9%),无效者4例(3.6%)。术后完全控尿者89例(80.9%),有效控尿者14例(12.7%),无效者7例(6.4%)。术中发生膀胱穿孔2例(1.8%),出血14例(12.7%)。术后1个月内有排尿不畅者9例(8.2%),尿频、尿急者12例(10.9%),尿潴留者1例(0.9%);术后6个月后有耻骨上不适者8例(7.3%),排尿不尽者2例(1.8%),尿频、尿急者3例(2.7%)。1例反复尿潴留患者经保守治疗无效,最终将吊带切断。术后未出现吊带处阴道黏膜糜烂和明显盆腔血肿。结论TVT术是目前治疗女性SUI的一种有效、安全的微创手术。更多还原

【Abstract】 Objective To evaluate the efficacy and safety of tension-free vaginal tape (TVT) pro-cedure,a minimally invasive management for women with stress urinary incontinence (SUI). Methods Atotal of 114 women who were diagnosed with SUI and underwent TVTtreatment from May 2002 to December2004 were retrospectively studied.By comparing the preoperative and postoperative outcomes of Pad test,In-continent Syndrome Questionnaire and Stamey grade of SUI,the effect and safety of TVTprocedure were eval-uated.Remission≥2 grades was regarded as significant improvement, remission of 1 grade as improvement,and no remission or worsening as failure.Complications of the procedure were also statistically analyzed. Results Follow-up was available in 110(96.5%) of the 114 patients.The results of 24-h Pad test beforeand after TVTwere (38.3±10.4)g and (8.8±7.4)g,respectively.The scores of the Incontinent SyndromeQuestionnaire before and after the surgery were 42.3±11.4 and 20.4±9.2, respectively.The grade of SUIwas improved remarkably in 94 patients (85.5%), moderately in 12(10.9%), and was considered a fail-ure in 4 (3.6%).According to the Stamey standards, 89 cases (80.9%) were regarded as achieving com-plete continence;14 cases (12.7%),partial continence;and 7 cases (6.4%), failure. Intraoperative com-plications included bladder perforation in 2 cases (1.8%),hemorrhage ( >100 ml) in 14 cases (12.7%).Postoperative short-term (within 1 month) complications included dysuria in 9 cases (8.2%),urinary reten-tion in 1(0.9%), de novo urgency and frequency in 12(10.9%).Long-term (after 6 months) complica-tions consisted of suprapubic discomfort in 8 cases (7.3%),urinary difficulty in 2(1.8%), frequency andurgency in 3(2.7%).No tape erosion or pelvic hematoma was found. Only 1 patient underwent the secondprocedure to cut off the tape due to repeated urinary retention. Conclusions TVTprocedure is effective,safe, minimally invasive for the management of female stress urinary incontinence.更多还原