CAJ | 학술논문

目的探讨中段尿道吊带术治疗女性压力性尿失禁的临床疗效、手术指征和并发症的处理.方法单纯压力性尿失禁的患者304例和混合性尿失禁的患者8例,均为女性,纳入本研究.其中接受TVT吊带术134例,TVTO吊带术167例,Monarc吊带术11例.围手术期评估包括:手术时间、出血量、术中术后并发症.手术效果分为治愈、显效、无效.在患者出院时、术后3个月、术后每年评价疗效和并发症.结果 TVT组手术时间(18.5±9.6)min和出血量(32.2±12.6)ml多于TVTO组(11.5±3.1)min,(12.8±8.5)ml和Monarc组(11.1±2.6)min,(12.3±3.5)ml(P<0.05).三种术式均有较高的治愈率和显效率,不同术式的近期和中长期治愈率、显效率和无效率差异无统计学意义(P>0.05).单纯压力性尿失禁患者治愈率(95.7% )显著高于混合性尿失禁患者(37.5% )(P<0.01).3种术式的总并发症发生率差异无统计学意义,但膀胱损伤仅发生在TVT组,闭孔神经损伤和阴道损伤仅发生在TVTO组.术后排尿困难和尿潴留是中段尿道吊带术的最常见并发症.结论经耻骨上途径(TVT)和经闭孔途径(TVTO、Monarc)中段尿道吊带术治疗压力性尿失禁均具有手术简单、微创、中长期疗效好、并发症少等优点.
목적 탐토중단뇨도조대술치료녀성압력성뇨실금적림상료효、수술지정화병발증적처리.방법 단순압력성뇨실금적환자304례화혼합성뇨실금적환자8례,균위녀성,납입본연구.기중접수TVT조대술134례,TVTO조대술167례,Monarc조대술11례.위수술기평고포괄:수술시간、출혈량、술중술후병발증.수술효과분위치유、현효、무효.재환자출원시、술후3개월、술후매년평개료효화병발증.결과 TVT조수술시간(18.5±9.6)min화출혈량(32.2±12.6)ml다우TVTO조(11.5±3.1)min,(12.8±8.5)ml화Monarc조(11.1±2.6)min,(12.3±3.5)ml(P<0.05).삼충술식균유교고적치유솔화현효솔,불동술식적근기화중장기치유솔、현효솔화무효솔차이무통계학의의(P>0.05).단순압력성뇨실금환자치유솔(95.7% )현저고우혼합성뇨실금환자(37.5% )(P<0.01).3충술식적총병발증발생솔차이무통계학의의,단방광손상부발생재TVT조,폐공신경손상화음도손상부발생재TVTO조.술후배뇨곤난화뇨저류시중단뇨도조대술적최상견병발증.결론 경치골상도경(TVT)화경폐공도경(TVTO、Monarc)중단뇨도조대술치료압력성뇨실금균구유수술간단、미창、중장기료효호、병발증소등우점.
Objective To investigate the clinical efficacy,surgical indications and postoperative complications of mid urethral sling procedures in treatment of female stress urinary incontinence.Methods A muhicenter clinical trial was conducted from April 2002 to April 2008 in five hospitals,304 cases of genuine stress urinary incontinence and 8 cases of mixed incontinence were included.TVT procedures were carried out in 134 patients.TVTO procedures in 167 patients,Monare procedures in 11 patients.Perioperative evaluations included: operating time, bleeding volume, and perioperative complications.Operative efficacy was classified into three categories:cure,improved and failure and evaluated before discharge,3 months after surgery and then every year. Results TVT group had longer operating time [(18.5±9.6)min]and more bleeding volume[(32.2±12.6)ml]than those in TVTO group[(11.5 ±3.1)min,(12.8±8.5)m]and in Monarc group[(11.1±2.6)min,(12.3±3.5)ml]with P<0.05.Monarc and TVTO procedures had higher cure rates and impmve rates comparing with TVT,but the differences were of no significance.The cure rate(95.7% )in patients with genuine stress incontinence were significantly higher than that in patients with mixed incontinence(37.5% ).No significant differences oftotal intra- and postoperative complications were noted for all of the three procedures.However,bhdder injury tended to occuned in TVT group and obturator nerve injury and vaginal injury tended to occurre in TVTO group.Transient voiding dysfunction and urinary retention were the most common complications.Conclusions Mid urethral sling procedures have excellent clinical outcomes in the treatment of female stress urinary incontinence.