目的：分析经闭孔无张力阴道吊带悬吊术（TVT－O）治疗女性压力性尿失禁的有效性、安全性以及并发症，并通过5年随访分析TVT－O的复发及并发症的原因。方法2008年7月至2009年8月应用TVT－O术治疗压力性尿失禁患者75例。通过记录手术时长、术中出血量、围手术期并发症及处理，评价该手术的短期临床疗效；并对患者进行随访观察5年，记录患者的主、客观治愈率，分析复发以及远期并发症原因等。结果75例患者均成功行TVT－O术，手术时间约13～21分钟，平均（17．7±3．2）分钟；术中出血量2～12ml，平均（4．3±2．2）ml；全部患者术中均无膀胱穿孔及继发出血，术后3天拔除导尿管；5例患者拔除导尿管后出现不同程度排尿困难，7例术后大腿内侧疼痛，可耐受，其中6例术后1周内疼痛消失。1例随访1年内症状消失。主观治愈率90．67％，客观治愈率88．0％。术后随访中2例失访，1年随访有3例患者复发，5年随访时共5例患者复发，分析与既往曾行治疗压力性尿失禁（SUI）手术治疗有相关性，但总体治愈率与术后短期治愈率无明显统计学差异，随访时发现部分患者出现膀胱过度活动症（overactive bladder，OAB）。结论 TVT－O治疗女性压力性尿失禁疗效确切，安全有效，并发症少，适用于未行手术治疗过的单纯性压力性尿失禁患者，且5年疗效可靠。%Objectives To analyze the safety,efficacy and complications of transobturator vaginal mid-ure-thral suspension (TVT-O)for female stress urinary incontinence(SUI),and the reason of recurrent and com-plication during the 5-year following-up. Methods A total of 75 patients who were diagnosed SUI underwent TVT-O from July 2008 to August 2009 were evaluated the short-term efficacy through recording the operation time ,bleeding volume and complications. All the patients were followed up for 5 years postoperatively and recor-ded the subjective cure rate,objective cure rate,recurrent cases and long-term complications. Results All the patients underwent the operation were successfully treated. The mean operation time was 13~21 minutes [aver-age (17. 7 ± 3. 2)minutes]. The estimated blood loss in the operation was 2~12ml [average (4. 3 ± 2. 2)ml]. There was no vesical perforation or hematoma in our operation. Catheter was removed 3 days after the operation and 5 patients were troubled with dysuria at different degrees. 7 patients poured tolerated pain located inner thigh,which disappeared in a week postoperatively,except one patient. The postoperative subjective cure rate was 90 . 67% and objective cure rate 88 . 0%. Some patients who were not cured completely had been underwent other failed surgeries. Two patients did not finish the entire following-up. Three patients recurrent in one year after the operation,and another 2 during the next 4 years. It is believed to be associated with the previous anti-incontinence procedures. But there was no statistical difference between postoperation,1-year following-up and 5-year following-up for cure rates,but part of patients occurred OAB. Conclusions TVT-O is a safe and effective method with less complication in the treatment of SUI. It is suitable for the SUI patients who were not underwent other failed surgery for SUI,and TVT-O is effective and reliable in 5-year following-up.
展开▼
