[1]吴　凯,赵立云.改良经闭孔尿道中段悬吊带术治疗女性压力性尿失禁疗效观察[J].新乡医学院学报,2020,37(1):075-78.[doi:10.7683/xxyxyxb.2020.01.018]
　WU Kai,ZHAO Liyun.Effect of revised tension-free vaginal tape obturator in treatment of female stress urinary incontinence[J].Journal of Xinxiang Medical University,2020,37(1):075-78.[doi:10.7683/xxyxyxb.2020.01.018]
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改良经闭孔尿道中段悬吊带术治疗女性压力性尿失禁疗效观察
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《新乡医学院学报》[ISSN:1004-7239/CN:41-1186/R]

卷:
37
期数:
2020年1
页码:
075-78
栏目:
临床研究
出版日期:
2020-01-05

文章信息/Info

Title:
Effect of revised tension-free vaginal tape obturator in treatment of female stress urinary incontinence
作者:
吴　凯; 赵立云
(洛阳新区人民医院泌尿外科，河南　洛阳　471023)
Author(s):
WU Kai; ZHAO Liyun
(Department of Urology，People′s Hospital of Luoyang New District， Luoyang 471023，Henan Province,China)
关键词:
女性压力性尿失禁; 改良经闭孔无张力吊带尿道中段悬吊术; 尿流动力学; 并发症
Keywords:
female stress urinary incontinence;  revised tension-free vaginal tape obturator;  urodynamic;  complications
分类号:
R473.71
DOI:
10.7683/xxyxyxb.2020.01.018
文献标志码:
A
摘要:
目的　探讨改良经闭孔尿道中段悬吊带术（TVT-O）治疗女性压力性尿失禁（SUI）的近远期效果及对患者尿流动力学的影响。方法　选择洛阳新区人民医院2016年6月至2018年6月收治的56例SUI患者为研究对象，根据手术方式将患者分为2组，观察组30例接受改良TVT-O治疗，对照组26例接受TVT-O治疗，比较2组患者手术时间、术中出血量、住院时间及术中、术后并发症情况，用Grouts-Blaivas评分测定患者术后12个月的治疗效果，比较2组患者术前、术后12个月尿动力学参数。结果　观察组患者手术时间显著短于对照组（P＜0.05），2组患者术中出血量、住院时间比较差异均无统计学意义（P＞0.05）。2组患者术后1、3、6、9、12个月时Grouts-Blaivas评分比较差异均无统计学意义（χ2=0.034、0.463、1.800、0.584、1.074，P＞0.05）。2组患者术前及术后12个月各项尿动力学参数比较差异无统计学意义（P＞0.05）。与术前比较，2组患者术后12个月的最大尿流率、平均尿流率、最大尿道闭合压均降低，功能尿道长度缩短，排尿时间延长，初始尿意、强烈尿意及腹压漏尿点压增高（P＜0.05）；急迫尿意、最大膀胱容量与术前比较差异无统计学意义（P＞0.05）。对照组患者术后发生腿部疼痛9例（34.62%），尿潴留3例（11.54%），排尿困难3例（11.54%）；观察组患者术后发生腿部疼痛1例（3.33%），尿潴留1例（3.33%），排尿困难4例（13.33%）；观察组患者术后腿部疼痛发生率显著低于对照组（χ2=9.292，P＜0.05），2组患者术后尿潴留、排尿困难发生率比较差异无统计学意义（χ2=1.414、0.063，P＞0.05）。结论　改良TVT-O和TVT-O治疗SUI对尿动力学参数的影响无明显差异，但改良TVT-O手术时间更短，术后腿部疼痛发生率更低，具有更好的临床应用价值。
Abstract:
Objective　To investigate the short and long-term efficacy of revised tension-free vaginal tape obturator (TVT-O) in the treatment of female stress urinary incontinence (SUI) and its effect on urodynamics. Methods　Fifty-six patients with SUI admitted to People′s Hospital of Luoyang New District from June 2016 to June 2018 were selected as the study subjects. Thirty patients in the observation group were treated with revised TVT-O，while 26 patients in the control group were treated with TVT-O. The operative time，intraoperative hemorrhage，hospitalization time，intraoperative and postoperative complications were compared between the two groups. The therapeutic effect at 12 months after operation was measured by Gross-Blaivas. And the urodynamic parameters of the two groups were compared before and at 12 months after operation. Results　The operation time of the observation group was shorter than that of the control group (P＜0.05)，and there were no difference in the intraoperative bleeding volume and hospital stay between the two groups (P＞0.05). There was no significant difference in the Grouts-Blaivas score between the two groups at 1，3，6，9 and 12 months after operation (χ2=0.034，0.463，1.800，0.584，1.074；P＞0.05). There was no significant difference in the urodynamic parameters between the two groups before and at 12 months after operation (P>0.05). Compared with that before operation，the maximum urine flow rate，mean urine flow rate，maximum urethral closure pressure were all decreased，the length of the functional urethra was shortened，the urination time was prolonged，the initial urine intention，the strong urine intention and the leakage point pressure of abdominal pressure were increased in the two groups（P＜0.05）；but there was no statistically significant difference in the urgent urine intention and maximum bladder capacity in the two groups(P>0.05). There were 9 cases of leg pain (34.62%)，3 cases of urinary retention (11.54%)，3 cases of dysuria (11.54%) in the control group. And there was 1 case of leg pain (3.33%)，1 case of urinary retention (3.33%)，and 3 cases of difficulty of urination (13.33%) in the observation group. The incidence of leg pain in the observation group was lower than that in the control group( χ2=9.292，P＜0.05),and there was no significant difference in the incidence of postoperative urinary retention and dysuria between the two groups(χ2=1.414，0.063；P＞0.05). Conclusions　There was no significant difference in the effect between revised TVT-O and TVT-O on urodynamic parameters in the treatment of SUI，but the revised TVT-O has shorter operation time and lower incidence of postoperative leg pain，which has better clinical application value.

参考文献/References:

［1］　CAPOBIANCO G，MADONIA M，MORELLI S，et al.Management of female stress urinary incontinence：a care pathway and update［J］.Maturitas，2018，109(6)：32-38.
［2］　DWYER P L，KARMAKAR D.Surgical management of urinary stress incontinence-where are we now［J］.Best Pract Res Clin Obstet Gynaecol，2019，54(6)：31-40.
［3］　SERATI M，BRAGA A，ATHANASIOU S，et al.Tension-free vaginal tape-obturator for treatment of pure urodynamic stress urinary incontinence：efficacy and adverse effects at 10-year follow-up［J］.Eur Urol，2017，71(4)：674-679.
［4］　中华医学会妇产科学分会妇科盆底学组.女性压力性尿失禁诊断和治疗指南(试行) ［J］.中华妇产科杂志，2011，46(10)：796-798.
［5］　于淼淼，张艳梅，杨露，等.改良盆底重建术对治疗女性压力性尿失禁的效果［J］.中国妇幼健康研究，2016，27(8)：1024-1026.
［6］　余昆，谢珍国，余志海，等.中国成年女性尿失禁患病率的 meta 分析［J］.中国循证医学杂志，2019，19(1)：36-43.
［7］　马琳，阚艳敏，李宁，等.不同程度压力性尿失禁患者的盆底超声观察及危险因素分析［J］.新疆医科大学学报，2019，42(6)：773-776.
［8］　SANDERS K.Treatment of stress urinary incontinence in women：a medical and surgical review［J］.Urol Nurs，2019，39(1)：29-35.
［9］　DUCKETT J，BODNER-ADLER B，RACHANENI S，et al.Management of complications arising from the use of mesh for stress urinary incontinence：international Urogynecology Association Research and Development Committee opinion［J］.Int Urogynecol J，2019，30（9）：1413-1417.
［10］　张晓薇，梁雪早.女性压力性尿失禁手术治疗及术中关键环节［J］.实用妇产科杂志，2018，34(3)：167-169.
［11］　姜帆，孙秀云，孟祥音.改良型TVT-O术式治疗女性压力性尿失禁的临床效果分析［J］.中国妇产科临床杂志，2019，20(2)：163-165.
［12］　SERATI M，BRAGA A，TORELLA M，et al.The role of urodynamics in the management of female stress urinary incontinence［J］.Neurourol Urodyn，2019，38(Suppl 4)：S42-S50.

更新日期/Last Update: 2020-01-05