CAJ | 학술논문

目的评估经阴道尿道中段网片耻骨降支悬吊术治疗女性压力性尿失禁(SUI)首次经阴道尿道中段悬吊术(MUSs)后症状持续或复发的效果. 方法选取2005年6月至2011年6月收治的女性SUI患者32例,年龄44～72岁,平均59岁.首次手术前诊断为单纯SUI 26例,以SUI为主的混合性尿失禁6例.尿失禁程度为中度16例,重度16例.首次手术方式为经阴道尿道中段无张力悬吊术(TVT)2例,经阴道无张力悬带成形术(IVS)4例,经闭孔(由内到外)尿道中段悬吊术(TVT-O) 17例,经闭孔(由外到内)尿道中段悬吊术(TOT)3例,赫美经阴道尿道中段吊带术(Tsling)1例,其他改良吊带MUSs术5例.9例术后即主观无效,随访6个月主观症状仍与术前无异；23例术后6个月症状复发并渐加重,随访12个月主观症状与术前无异.对本组32例采用经阴道尿道中段网片耻骨降支悬吊术治疗,记录手术时间、出血量,于术后3、6、12个月随访,统计分析术后残余尿量、术后疗效、并发症等情况. 结果本组32例平均手术时间(41.1±13.1)min,平均出血量(70.6±23.8)ml,无手术相关的损伤及并发症发生.30例术后留置导尿6h、2例留置导尿48 h后均可自行排尿.B超检查测残余尿量0～80 ml,平均(23.8±21.4)ml,平均住院时间(4.8±1.1)d.出院时26例主观治愈,4例明显改善,2例症状仍持续.总有效率为93.8％(30/32).随访3、6、12个月时总有效率分别为93.8％(30/32)、93.3％(28/30)、86.2％(25/29).随访12个月时出现2例复发,1例网片侵蚀,无其他并发症发生. 结论经阴道尿道中段网片耻骨降支悬吊术作为MUSs术后症状持续或复发的补救治疗方法具有总有效率高、手术过程简单、易于掌握、经济性好、可重复操作的优点,其手术操作悬吊点位于耻骨降支,避免了其他补救方法需经闭孔或耻骨后操作引起的各种并发症,同时在解剖上支持其疗效的长期性.
목적 평고경음도뇨도중단망편치골강지현조술치료녀성압력성뇨실금(SUI)수차경음도뇨도중단현조술(MUSs)후증상지속혹복발적효과. 방법 선취2005년6월지2011년6월수치적녀성SUI환자32례,년령44～72세,평균59세.수차수술전진단위단순SUI 26례,이SUI위주적혼합성뇨실금6례.뇨실금정도위중도16례,중도16례.수차수술방식위경음도뇨도중단무장력현조술(TVT)2례,경음도무장력현대성형술(IVS)4례,경폐공(유내도외)뇨도중단현조술(TVT-O) 17례,경폐공(유외도내)뇨도중단현조술(TOT)3례,혁미경음도뇨도중단조대술(Tsling)1례,기타개량조대MUSs술5례.9례술후즉주관무효,수방6개월주관증상잉여술전무이；23례술후6개월증상복발병점가중,수방12개월주관증상여술전무이.대본조32례채용경음도뇨도중단망편치골강지현조술치료,기록수술시간、출혈량,우술후3、6、12개월수방,통계분석술후잔여뇨량、술후료효、병발증등정황. 결과 본조32례평균수술시간(41.1±13.1)min,평균출혈량(70.6±23.8)ml,무수술상관적손상급병발증발생.30례술후류치도뇨6h、2례류치도뇨48 h후균가자행배뇨.B초검사측잔여뇨량0～80 ml,평균(23.8±21.4)ml,평균주원시간(4.8±1.1)d.출원시26례주관치유,4례명현개선,2례증상잉지속.총유효솔위93.8％(30/32).수방3、6、12개월시총유효솔분별위93.8％(30/32)、93.3％(28/30)、86.2％(25/29).수방12개월시출현2례복발,1례망편침식,무기타병발증발생. 결론경음도뇨도중단망편치골강지현조술작위MUSs술후증상지속혹복발적보구치료방법구유총유효솔고、수술과정간단、역우장악、경제성호、가중복조작적우점,기수술조작현조점위우치골강지,피면료기타보구방법수경폐공혹치골후조작인기적각충병발증,동시재해부상지지기료효적장기성.
Objective The aim of study is to evaluate the efficacy of a new complementary midurethral sling surgery in treating recurrent or persist female stress urinary incontinence (SUI) after primary Synthetic mid-urethral slings (MUSs).Methods The methods was used in 32 patients who had suffered recurrent or persist SUI patients after primary MUSs during June 2005 and July 2011.Their primary MUSs were:TVT 2 cases,IVS 4 cases,TVT-O 17 cases,TOT 3 cases,T-sling 1case,other MUSs 5 cases.9 cases complained SUI symptoms continued after primary surgery and had no improvement after 6 months following up.23 cases reported SUI symptoms recurrent and aggravated in 6 months after primary operation and had no improvement 1 year after operation.All these patients have been treated with surgery,a trans-vaginal mid-urethral sling on descending pubic ramus.In this study we followed up these patients for one year after this complementary operation and evaluated operating time,blood loss,efficacy and complications.Results In this study the operating time was 41.1±13.1 minutes,blood loss was 70.6±23.8 ml.30 patients kept urinary catheter 6 h after operation and 2 kept urinary catheter 48 h after operation.All patients could micturate after removed urinary catheter and average residual urine was 23.8 ± 21.4 ml (range 0-80 ml).The average in-patients duration was 4.8± 1.1days.SUI symptoms still persisted in two patients after second operation,subjective cure was achieved in 26 patients and the symptoms obviously improved in 4 patients when they left hospital.The efficient rate was 93.8％ (30/32) left hospital and after 3 months,93.3％ (28/30) after 6 months and 86.2％ (25/29) after 1 year.There were 2 cases of recurrence and 1 case of mesh erosion after 1 year,no other operative complications were reported.Conclusions Our study found that it is a efficient operation to treat SUI recur or persist after primary.