CAJ | 학술논문

目的探讨第三代无张力阴道悬吊系统TVT-S治疗女性压力性尿失禁的适应证和疗效.方法回顾性分析采用TVT-S术式治疗女性压力性尿失禁27例患者的资料.年龄25～69岁,平均51岁;病程1～20年,平均7年,既往曾行阴道前壁折叠术1例.根据美国妇产科学会POP-Q分级系统评价,Aa为-2～-1 cm,棉签试验尿道夹角＞60°,临床症状评估均为Ⅱ度.27例术前尿动力学检查膀胱顺应性正常,最大尿道闭合压(mUCP)25～60 cm H2O(1 cm H2O=0.098 kPa),平均40 cm H2O,腹压漏尿点压(VLPP)均＞60 cm H2O.混合性尿失禁1例,单纯型压力性尿失禁26例.观察指标包括手术时间、术后并发症,随访患者的疗效及生活质量.结果局麻下手术,行U形手术4例(MUCP＜30 cm H2O),H形手术23例.手术时间6～15 min,平均8 min.术中失血量少,无尿道及膀胱损伤.术后留置尿管时间平均1 d.术后随访3～15个月,平均8.7个月,26例无需尿垫达到临床治愈,1例混合性尿失禁患者急迫性尿失禁症状改善.I-QOL问卷调查患者生活质量评价良好.25例(93%)患者对术后尿失禁症状改善表示满意,且术前尿失禁症状较重者满意度更高.结论 TVT-S是一种治疗女性压力性尿失禁安全有效且并发症低的微创术式,适合于膀胱顺应性正常、最大尿道闭合压正常、尿道移动度较大的患者,部分高龄或尿道压力较低者建议行U形TVT-S或TVT术.
목적 탐토제삼대무장력음도현조계통TVT-S치료녀성압력성뇨실금적괄응증화료효.방법 회고성분석채용TVT-S술식치료녀성압력성뇨실금27례환자적자료.년령25～69세,평균51세;병정1～20년,평균7년,기왕증행음도전벽절첩술1례.근거미국부산과학회POP-Q분급계통평개,Aa위-2～-1 cm,면첨시험뇨도협각＞60°,림상증상평고균위Ⅱ도.27례술전뇨동역학검사방광순응성정상,최대뇨도폐합압(mUCP)25～60 cm H2O(1 cm H2O=0.098 kPa),평균40 cm H2O,복압루뇨점압(VLPP)균＞60 cm H2O.혼합성뇨실금1례,단순형압력성뇨실금26례.관찰지표포괄수술시간、술후병발증,수방환자적료효급생활질량.결과 국마하수술,행U형수술4례(MUCP＜30 cm H2O),H형수술23례.수술시간6～15 min,평균8 min.술중실혈량소,무뇨도급방광손상.술후류치뇨관시간평균1 d.술후수방3～15개월,평균8.7개월,26례무수뇨점체도림상치유,1례혼합성뇨실금환자급박성뇨실금증상개선.I-QOL문권조사환자생활질량평개량호.25례(93%)환자대술후뇨실금증상개선표시만의,차술전뇨실금증상교중자만의도경고.결론 TVT-S시일충치료녀성압력성뇨실금안전유효차병발증저적미창술식,괄합우방광순응성정상、최대뇨도폐합압정상、뇨도이동도교대적환자,부분고령혹뇨도압력교저자건의행U형TVT-S혹TVT술.
Objective To evaluate the effectiveness and indications of a new minimally invasive surgical procedure,the tension-free vaginal tape-SECUR (TVT-S),in the treatment of female stress urinary incontinence (SUI). Methods Twenty-seven consecutive women with stress urinary incontinence underwent the procedure under local anesthesia.The mean age of the study group was 51 (range 25-69)years,average disease duration was 7 (1-20) years.In one case,repair of pelvic floor defects had been made previously.According to the pelvic organ prolapse quantitive(POP-Q) (American College of Obstetrics and Gynecology),the Aa＞-1 cm.Swab tests have shown that the angle of urethra Was greater than 60 degrees,while the evaluation of clinical symptoms were grade Ⅱ.The urodynamie test preoperatively of 27 cases display that bladder compliance was normal,mean maximum urethral closure pressure was 40cm H2O(25-60 cm H2O),and VLPP was greater than 60 cm H2O.Minimum follow up was three months (range 3-15 months).The pre-operative maximal urethral cloSHre pressure (MUCP) of all patients was above 30 cm H2O.Ninety-six percent of patients had pure USI,one patient had mixed urodynamic incontinence (MUI).Collection of the data included operative time a well as pre-and post-operative complications.Patients were post-operatively assessed by a validated urinary incontinence-specific measure of Quality of Life (QoL) questionnaire which was completed by all patients at least three months after surgery. Results All patients who underwent the procedure were under local anesthesia.Of these patients,4 cases (MUCP＜30 cm H2O) underwent TVT-S with "U" position while the other 23 underwent TVT-S with "Hammock" position.The mean operation time was 8 minutes (range 6-15 min) and blood loss during operation was about 10 ml.There were no urethral and bladder injuries during the procedure.Postoperative indwelling duration was 0-1 day.After follow-up,26 patients were cured without pad usage and 1 with mixed UI had prominent improvement in urgency incontinence symptoms.The quality of life was also improved significantly.93 % patients were satisfied with the postoperative improvement in urinary incontinence symptoms,and the more severe preoperative symptoms the higher satisfaction rate postoperatively. Conclusions TVT-S iS a safe,effective and minimally invasive procedure for SUI with less complication.The patients with normal bladder compliance and MUCP,urethral hypermobility are indicated for this surgery,some elderly patients or patients with low urethral pressure were proposed to undergo "U" position TVT-S or TVT.