无张力经阴道尿道吊带术治疗女性压力性尿失禁的远期疗效随访

摘要

目的 评估无张力经阴道尿道吊带术(tension-free vaginal tape,TVT)治疗女性压力性尿失禁的远期疗效. 方法 追踪观察行TVT术治疗的女性压力性尿失禁患者78例,平均年龄(54.6±10.2)岁.平均随访时间为7(5 ～9)年.按照计划进行术前和术后的症状评估,包括压力测试、生活质量评估和妇科检查.用1h尿垫试验阴性作为客观治愈的标准;同时询问患者主观对尿液渗漏的感觉,采用视觉模拟量表(visual analogue scale,VAS)评估患者对其尿失禁状态的主观感受. 结果 获得长期随访的78例患者中,客观治愈率为85.5％ (53/62);主观治愈率为88.5％ (69/78);主观改善率为9.0％(7/78);手术失败率为2.6％(2/78).有6例(7.7％)出现尿频尿急症状,有2例(2.6％)反复尿路感染,有1例(1.3％)出现吊带外逸.未发现有其他的长期副反应. 结论 TVT手术操作简便、创伤小、远期疗效好,可作为女性压力性尿失禁患者的首选手术治疗方法.%Objective To assess the long term outcomes of tension-free vaginal tape(TVT) for female stress urinary incontinence.Method There were 78 female patients underwent TVT for stress urinary incontinence and were followed up for 7 (5 ～ 9) years,with the average age of (54.6 ± 10.2)years old.All the patients completed symptom assessment,quality of life assessement and gynecologic examinations before and after surgery.The negative result of 1 hour urine pad test was the objective cure standard.And the subjective perception of patients were also assessed via questionnaire and VAS.Results Of all the 78 patients,the objective cure rate was 85.5％ (53/62).The subjective cure rate was 88.5％ (69/78).7 patients (9.0％) significantly improved symptoms,while 2.6％ (2/78) failed to improve their symptoms.6 patients(7.7％) were found frequency and urgency.2 patients(2.6％) were found repeated urinary infection.And 1 patient(1.3％)was found tape out-shifted.No other long term adverse effect was found.Conclusion TVT is a simple operated and minimal invasive surgery and is effective in long term follow-up.It could be the first choice of the surgical treatments for female patients with stress urinary incontinence.