目的 探讨经闭孔无张力尿道中段悬吊术(transobturator vaginal tape inside-out,TVT-O)治疗压力性尿失禁(stress urinary incontinence,SUI)的疗效. 方法 2006年3月～ 2009年6月对89例轻、中、重度压力性尿失禁行TVT-O.采用特制的穿刺器械由阴道内经闭孔穿出,将吊带平铺于尿道中段形成“吊床”达到治疗SUI的目的. 结果 89例手术顺利,72例行单纯TVT-O,5例合并子宫脱垂行阴式子宫全切术,6例合并阴道前后壁脱垂行阴道前后壁修补术,6例(合并阴道前壁脱垂1例,阴道后壁脱垂5例)行网片悬吊术.未出现膀胱损伤或穿孔、血管、神经损伤,无血肿、尿瘘,无吊带侵蚀,术后出现排尿困难2例.89例随访36个月,完全治愈85例,显著好转3例,无效1例,完全治愈率95.5％ (85/89),显著好转率3.4％(3/89),联合手术者未见SUI复发或阴道前后壁脱垂复发,72例单纯行TVT-O者性生活未觉明显异常. 结论 TVT-O治疗轻、中、重度压力性尿失禁,安全有效.%To explore the efficacy of transobturator vaginal tape inside-out ( TVT-O ) for stress urinary incontinence (SUI). Methods Since March 2006 to June 2009, 89 patients with mild, moderate, or severe SUI received TVT-O in our hospital. With a special equipment for puncture, we performed TVT-O to form the "sling" at the middle segment of the urethra. Results The procedure was completed in all the 89 patients, among which, simple TVT-0 was carried out in 72 cases, total transvaginal hysterectomy was made on 5 patients who were complicated with uterine prolapse, anterior and posterior colporrhaphy was performed on 6 patients who had anterior and posterior vaginal wall prolapse, and mesh suspension was used in the other 6 patients because of complicated anterior vaginal wall prolapse ( 1 case) or posterior vaginal wall prolapse ( 5 case). Two patients showed dysuresia after the procedure, no bladder injury or perforation, injury to the vessels or nerves, hematozna, urinary fistula, or erosion of the sling occurred. The 89 patients were followed up for 36 months, during which 85 patients were cured, 3 cases were significantly improved, and one was poor; the cure rate was 95.5% (85/89) , and the rate of significant improvement rate was 3.4% (3/89). Conclusion TVT-O is safe and effective for mild, moderate, and severe SUI.
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