›› 2012, Vol. 32 ›› Issue (4): 412-.doi: 10.3969/j.issn.1674-8115.2012.04.009

• 专题报道(排尿功能障碍及盆底重建) • 上一篇    下一篇

TVT与TVT-O 治疗女性压力性尿失禁的疗效和并发症比较

陈慧兴1,2, 吕坚伟1, 冷 静1, 李佳怡1, 薄隽杰1, 黄翼然1   

  1. 1.上海交通大学 医学院附属仁济医院泌尿外科 |上海交通大学尿失禁及盆底重建诊治中心, 上海 200001; 2.上海浦东医院泌尿外科, 上海 200125
  • 出版日期:2012-04-28 发布日期:2012-04-27
  • 通讯作者: 吕坚伟, 电子信箱: ljwass@126.com。
  • 作者简介:陈慧兴(1979—), 男, 主治医师, 硕士;电子信箱: chenhuixing11111@163.com。

Efficacy and complications of TVT procedure and TVT-O procedure in treatment of female stress urinary incontinence

CHEN Hui-xing1,2, LV Jian-wei1, LENG Jing1, LI Jia-yi1, BO Juan-jie1, HUANG Yi-ran1   

  1. 1.Department of Urology, Renji Hospital, Center of Urinary Incontinence and Pelvic Reconstruction, Shanghai Jiaotong University School of Medicine, Shanghai 200001, China;2.Department of Urology, Pudong Hospital, Shanghai 200125, China
  • Online:2012-04-28 Published:2012-04-27

摘要:

目的 比较经阴道无张力尿道中段吊带术(TVT) 和经闭孔无张力尿道中段吊带术(TVT-O) 治疗女性压力性尿失禁(SUI)的临床疗效和并发症。方法 将2009年2月—2010年2月205例女性SUI患者按随机分配表随机分组,102例采用TVT术式,103例采用TVT-O术式,比较临床疗效和并发症。结果 TVT组手术时间25~45 min,平均为(27.5±13.3) min;TVT-O组手术时间11~25 min,平均为(18.5±7.4) min,两组平均手术时间比较差异有统计学意义(P<0.05);两组术中出血量、平均留置尿管时间、平均住院时间和术后残余尿量比较,差异无统计学意义(P>0.05)。两组共195例(95.1%)患者术后尿失禁得到控制,术后随访12~24个月无再次尿失禁发生。TVT组术中发生膀胱损伤者5例(4.9%),拔除导尿管后尿潴留2例(2.0%);TVT-O组拔除导尿管后尿潴留2例(2%),未发生膀胱损伤,术后大腿内侧疼痛3例(2.9%)。4例(3.8%)患者术后6个月内无尿失禁症状,12个月后出现中度的尿失禁症状,4例均较术前症状有所好转。结论 TVT与TVT-O两种术式治疗女性SUI疗效可靠,两种术式各有优缺点,TVT长期疗效优于TVT-O,但膀胱损伤概率较TVT-O高;TVT-O较TVT 操作简单,手术创伤小,并发症少,但偶有大腿内侧疼痛,且重度SUI患者中期临床疗效略差于TVT。

关键词: 经阴道无张力尿道中段吊带术, 经闭孔无张力尿道中段吊带术, 压力性尿失禁

Abstract:

Objective To compare the clinical efficacy and complications of tension-free vaginal tape (TVT) procedure (TVT group) and transobturator vaginal tape inside out (TVT-O) procedure (TVT-O group) in treatment of female stress urinary incontinence (SUI). Methods Two hundred and five female patients with SUI were randomized to receive TVT procedure (n=102) or TVT-O procedure (n=103) from February 2009 to February 2010, and the clinical efficacy and complications were compared. Results The mean time of operation in TVT group was (27.5±13.3) min (25 to 45 min), the mean time of operation in TVT-O group was (18.5±7.4) min (11 to 25 min), and there were significant differences between two groups (P<0.05). There was no significant difference in the volume of blood loss during operation, mean duration of indwelling catheter, average length of hospital stay and volume of postoperative residual urine between two groups (P>0.05). The symptoms of urinary incontinence in 195 patients (95.1%) in two groups were controlled after operation, and no incidence of urinary incontinence occurred during the follow-up for 12 to 24 months. There were 5 patients (4.9%) with intraoperative bladder injury and 2 patients (2.0%) with urinary retention after catheter removal in TVT group. There were 2 patients (2%) with urinary retention after catheter removal, 3 patietns (2.9%) with postoperative thigh pain and no case of bladder injury in TVT-O group. There was no symptom of urinary incontinence within 6 months after operation in 4 patients (3.8%), moderate urinary incontinence emerged 12 months after operation, and the symptoms improved in all the 4 patients. Conclusion TVT procedure and TVT-O procedure are effective and reliable in treatment of female SUI. TVT procedure has better long-term effect and higher possibility of bladder injury than TVT-O procedure. TVT-O procedure is simpler than TVT procedure, with less surgical trauma, less complications and occasionally-occurred thigh pain. The mid-term clinical efficacy of TVT-O procedure is slightly worse than that of TVT procedure.

Key words: tension-free vaginal tape, transobturator vaginal tape inside out, stress urinary incontinence