Objective To observe clinical effects of the improved tension free vaginal tape-obturator ( improved TVT-O) in the treatment of female stress urinary incontinence (FSUI). Methods From November 2015 to June 2016, the improved TVT-O was performed in 30 women with FSUI in our hospital. According to patient ' s pelvic size, a corresponding tape was made by using polypropylene mesh intraoperatively and fixed at both ends with the 10# silk thread. The middle urethra was opened with a width of 1. 2 cm through the vaginal mucosa and submucosa as the entrance. Blunt separation to the pubic descending direction of vaginal and urethral submucosa and bladder gap to the rear of the pubic descending branch of the obturator membrane was performed to make the tunnel path. The exit was located at the level of the clitoris and thigh skin creases junction. By using spiral puncture needle and"L"shaped slot and silk thread, the tape was drawn, implanted and adjusted. Results The surgery was successfully completed in the 30 cases. Postoperative urinary retention appeared in 1 case and was cured after release treatment. The operating time was 25-130 min(mean,43.9±17.8min),theintraoperativebloodlosswas5-100ml(mean,28.3±20.8ml),thelengthofhospitalstay after surgery was 3-10 d (mean, 4. 0 ± 1. 7 d). There was no injury of the bladder, ureter or nerve during operation. No recurrence of urinary incontinence, chronic leg pain, erosion of tape, or mesh rejection after surgery occurred. A total of 29 cases were followed up for 3-10 months. The cure rate was 90. 0% (27/30) and the improvement rate was 6. 7% (2/30). Conclusions The improved TVT-O is reliable to treat FSUI, which reaches a high cure rate and has advantages of safety, simple performance, and minimal invasion. It is worthy of clinical application.%目的 探讨改良经阴道闭孔无张力尿道中段悬吊术(tension free vaginal tape-obturator,TVT-O)治疗女性压力性尿失禁(female stress urinary incontinence,FSUI)的临床效果.方法 2015年11月~2016年6月对30例FSUI实施改良TVT-O,利用聚丙烯网片根据患者骨盆大小术中自制成相应的吊带,10号丝线固定于两端;尿道中段宽约1.2 cm切开阴道黏膜及黏膜下层为入口,向耻骨降支方向钝性分离阴道黏膜下层与尿道、膀胱的间隙,经耻骨降支的后缘达闭孔膜所形成的隧道为路径,阴蒂的水平与大腿内侧皮肤皱褶交界处为出口;利用螺旋穿刺针及其头部"L"形的卡槽,以及10号丝线牵引、放置、调整吊带.结果 30例手术成功,1例术后出现尿潴留后经吊带松解术治愈.手术时间25~130 min,(43.9±17.8)min;术中出血5~100 ml,(28.3±20.8)ml;术后住院3~10 d,(4.0±1.7)d.术中未发生膀胱、输尿管、神经等损伤,术后无尿失禁复发,也无慢性腿部疼痛、吊带侵蚀及网片排异反应等.29例随访3~10个月,手术治愈率90.0%(27/30),改善率6.7%(2/30).结论 改良TVT-O治疗FSUI疗效确切,安全可靠,操作简便、微创,值得临床应用.
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