经闭孔阴道无张力吊带术治疗老年女性压力性尿失禁的近期疗效观察

摘要

Objective To evaluate the short-term effectiveness of tension-free vaginal tapeobturator system(TVT-O) on the type Ⅰ,Ⅱ stress urinary incontinence(SUI) in the elderly female patients. Methods Elderly female patients (73 cases) with SUI type Ⅰ and Ⅱ were selected in 0.5-3.0 years after TVT-O surgical treatment,and they reached the age over 60 years before TVT-O.Difference of daily life and lower urinary tract symptoms before and after surgery were compared by the incontinence impact questionnaire ( Ⅱ Q-7) and the urogenital distress inventory (UDI-6) through telephone survey.Results Totally 73 patients were followed up successfully,aged 60 to 72 years (mean 64.0±4.5).Preoperative patients' daily life quality such as making housework,activities,entertainment,go-out,social contact and emotion had obviously been affected with a score of 9 to 25 by their own scoring (mean 17.0±6.7).Lower urinary tract symptoms including urgency,frequent urination,movement,leakage of urine volume,odynuria and dysuria were from 8 to 21 (mean 14.0±4.7) scores.Mild urinary frequency was 8.2％ (6 cases).Urinal pad usage was in 71 cases (97.3％)After TVT-O,patients' symptoms improved by their own scoring.The Ⅱ Q-7 scores were ranging from 2 to 13 (mean 6.4±3.2),and lower urinary tract symptoms scores from 1 to 9 (mean 5.4±3.2).Mild urinary frequency after surgery was 1.4 ％ (1 case).The urinary incontinence in 39 cases completely disappeared (53.4 ％ ),urinal pad usage were in 34 cases (46.6 ％ ).18 cases (24.7 ％ ) had suprapubic area pain or discomfort postoperatively.Conclusions TVT-O is an ideal choice for type Ⅰ and Ⅱ SUI in elderly female patients.%目的 观察经闭孔阴道无张力吊带术(TVT-O)治疗老年女性Ⅰ、Ⅱ型压力性尿失禁患者近期疗效.方法 选取已行TVT-O手术治疗半年至3年的老年女性Ⅰ、Ⅱ型压力性尿失禁患者73例,术前年龄60～72岁,平均(64.0±6.5)岁,采用尿失禁相关生活质量问卷(ⅡQ-7)、生活质量和尿生殖系统症状总表(UDI-6)进行电话问卷调查,比较患者术前、术后日常生活与下尿路症状的差异.结果 73例患者随访资料完整,术前患者做家务、活动、娱乐、外出、社交及情绪明显受到尿失禁症状影响,ⅡQ-7评分为9～25分,平均(17.0±6.7)分；下尿路症状尿急、尿频、运动、漏尿量、排尿困难及尿痛评分为8～21分,平均(14.0±4.7)分.轻度尿频8.2％(6例),尿垫使用率为97.3％(71例).11例患者诉排尿有耻骨上区不适.术后患者自评生活质量明显改善,ⅡQ-7评分2～13分,平均(6.4±3.2)分,下尿路症状评分1～9分,平均(5.4±3.2)分.轻度尿频1.4％(1例).39例(53.4％)患者尿失禁症状完全消失,尿垫使用率46.6％(34例).18例(24.7％)患者诉术后排尿有轻度耻骨上区不适.结论 TVT-O术是治疗老年女性Ⅰ、Ⅱ型压力性尿失禁患者较理想的选择.