TVT-O 治疗女性压力性尿失禁远期疗效分析

摘要

目的：分析经闭孔阴道无张力尿道中段悬吊带术（ TVT-O）治疗女性压力性尿失禁（ SUI）的远期临床疗效。方法确诊为重度压力性尿失禁的女性患者50例（其中2例为混合性尿失禁）均进行TVT-O治疗，术后随访至少3年，评估TVT-O的远期疗效。随访内容为患者主观症状改善情况、膀胱容量标准化后护垫试验评分，并采用改良的布里斯托问卷（ ICIQ-FLUTS）评分判断术后性生活改善情况；安全性指标包括吊带侵蚀和排异情况、手术部位疼痛、泌尿感染等并发症的发生情况。结果随访45例患者，主观总治愈率为75-．6％（34／45），好转率为20．0％（9／45），无效率为4．4％（2／45）；客观治愈率为75．6％（34／45），好转率22．2％（10／45），无效率为2．2％（1／45）。45例患者经TVT-O手术治疗后，S评分均较术前明显降低有统计学意义（ P ＜0．05），提示术后性生活质量改善。随访中出现排尿困难1例，出现吊带阴道侵蚀2例，并发症发生率为6．67％。结论 TVT-O在保证较低的远期并发症的同时，实现了较为满意的远期效果，是治疗重度女性压力性尿失禁的理想手术方式。%Objective To analyze the long term clinical curative effect of transobturator tension-free vaginal tape sur-gery ( TVT-O) in the treatment of female stress urinary incontinence ( SUI). Methods Female patients diagnosed as severe stress urinary incontinence of 50 cases ( including 2 cases of mixed urinary incontinence ) were received TVT-O treatment;Which were followed up for at least 3 years after surgery to evaluate the long-term efficacy of TVT-O.The contents of the follow up including subjective symptoms improvement , the bladder capacity after standardization pad test score , and using modified Bristol questionnaire ( ICIQ /FLUTS) score to judge the situation of improvement of sexual life after surgery;safety indicators include tape erosion and rejection , the operative site pain , urinary tract infection and other complications. Results The fol-low-up was completed in 45 patients, the subjective cure rate was 75.6%(34/45), improvement rate was 20.0%(9/45), no effect in 4.4%(2/45);the objective cure rate was 75.6%(34/45), improvement rate was 22.2%(10/45), no effect in 2.2%(1/45).45 cases of patients after surgical treatment of TVT-O, the S scores were significant decreased with statisti-cal significance ( P <0.05), suggesting that the improvement of the postoperative quality of sexual life. In the follow-up, dysuria was found in 1 case, 2 cases occurred with vaginal tape erosion; the complication rate was 6.67%.Conclusion It demonstrated that the TVT-O could ensure the long term lower incident of complications and reach the long -term satisfied effect;it is an ideal surgical method for the treatment of severe female stress urinary incontinence.