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目的对比观察经耻骨后径路无张力阴道吊带术(TVT)和经闭孔径路无张力阴道吊带术(TVT-O)治疗女性压力性尿失禁(SUI)的效果。方法2002年6月至2005年5月,行女性SUI无张力阴道吊带术81例。患者年龄35~79岁,平均51岁。病程6个月~30年。其中行TVT58例、行TVT-O术者23例。以术后增加腹压有无尿液溢出为疗效判断标准。结果TVT组TVT-O组手术时间分别为30~60min[平均(36.4±7.6)min]、20~35min[平均(24.4±5.1)min](P<0.01)。81例中,74例(91.4%)尿失禁症状完全消失,5例(6.2%)改善,2例(2.5%)失败。TVT组治愈52例(89.7%)、改善4例(6.9%)、失败2例(3.4%);TVT-O组治愈22例(95.7%)、改善1例(4.3%);2组比较差异无统计学意义(P>0.05)。TVT组和TVT-O组分别有6例(10.3%)和2例(8.7%)发生术后排尿困难;TVT组3例(5.2%)术中发生膀胱损伤,1例(1.7%)术后发生耻骨后血肿;TVT-O组3例(13.0%)术后2d内出现双下肢短暂性活动障碍自行缓解。结论无张力阴道吊带术是一种治疗女性SUI安全有效的方法,TVT-O较TVT更为简单,创伤更小,并发症轻。
Objective To compare the effects of TVT and TVT-O on female stress urinary incontinence (SUI) after transvaginal approach. Methods From June 2002 to May 2005, 81 women underwent tension-free vaginal tape. Patients aged 35 to 79 years, mean 51 years. Course of 6 months to 30 years. One line TVT58 cases, line TVT-O operation in 23 cases. Postoperative increase in abdominal pressure with urine overflow for the efficacy of judging criteria. Results The TVT-O group had a mean operation time of 30-60 min [mean (36.4 ± 7.6) min] and 20-35 min [mean (24.4 ± 5.1) min], respectively (P <0.01). Of the 81 patients, 74 (91.4%) had no symptoms of urinary incontinence, 5 (6.2%) improved, and 2 (2.5%) failed. The TVT group was cured in 52 cases (89.7%), improved in 4 cases (6.9%), and failed in 2 cases (3.4%). The TVT-O group was cured in 22 cases (95.7%) and improved in 1 case (4.3% No statistical significance (P> 0.05). There were 6 cases (10.3%) and 2 cases (8.7%) of the TVT group and the TVT-O group had dysuria after operation. Bladder injury occurred in 3 cases (5.2%) in the TVT group and in 1 case (1.7% In 3 cases (13.0%) of TVT-O group, the transient lower extremity movement disorder was relieved within 2 days after operation. Conclusion Tension-free vaginal tape is a safe and effective method for the treatment of female SUI. TVT-O is more simpler, less invasive and less complicated than TVT.