CAJ | 학술논문

目的：探讨经闭孔无张力吊带尿道中段悬吊术（ inside-out transobturator transvaginal tape，TVT-O）治疗女性中重度单纯性压力性尿失禁（ SUI）的安全性及中长期疗效。方法回顾性分析2008年1月至2013年12月接受TVT-O治疗的女性中重度单纯性SUI患者236例的临床资料。年龄44～88岁，平均（56±9）岁。主要症状为腹压增加及起立活动时频繁出现的尿失禁，均需使用尿垫。 Valsalva诱发试验和指压试验均提示为 SUI。国际尿失禁咨询委员会尿失禁问卷简表（ international consultation committee on incontinence questionnaire short form ， ICI-Q-SF ）评分平均为（15．6±3．9）分。分析236例的术中、术后并发症，并通过ICI-Q-SF评分、诱发实验、尿失禁事件发生频率和尿动力学检查对随访期≥6个月者的主客观疗效进行评估。根据术式分为单行TVT-O的TVT-O组和因伴有盆底脱垂同时行盆底修复术的TVT-O＋盆底修复组。根据随访时间分为中期组（随访时间6个月～3年）和长期组（随访时间＞3年）。结果本组236例中，术中发生膀胱穿孔和阴道内吊带外露各1例（0．4％）；术后发生腹股沟／穿刺点疼痛36例（19．1％），新发尿频18例（9．5％），尿潴留／排尿困难8例（4．2％），其中2例排尿困难患者经尿道扩张＋吊带松解后症状仍然存在，需长期间歇自助导尿，其余患者予观察、对症治疗或手术治疗后症状均缓解。189例随访时间≥6个月，平均随访时间（35．0±12．5）个月，其中TVT-O组135例，TVT-O＋盆底修复组54例；中期组116例（61．4％），长期组73例（38．6％）。临床治愈率为88．9％（168／189），临床改善率为9．5％（18／189）。术后ICI-Q-SF评分为（6．7±2．3）分，与术前比较差异有统计学意义（P＜0．05）。中期组和长期组的客观疗效（治愈率＋改善率）分别为97．4％和95．9％，差异无统计学意义（ P＞0．05）；术后ICI-Q-SF评分分别为（5．8±1．2）分和（7．9±2．0）分，与术前[（14．3±2．8）分和（16．7±3．4）分]比较，差异均无统计学意义（P＞0．05）。 TVT-O组和TVT-O＋盆底修复组的客观疗效（治愈率＋改善率）分别为97．8％和100．0％，差异无统计学意义（ P＞0．05）。结论 TVT-O治疗女性中重度SUI总体安全有效，中长期疗效持久稳定，且其疗效与是否行盆底修复术无明显相关性。目的：探討經閉孔無張力弔帶尿道中段懸弔術（ inside-out transobturator transvaginal tape，TVT-O）治療女性中重度單純性壓力性尿失禁（ SUI）的安全性及中長期療效。方法迴顧性分析2008年1月至2013年12月接受TVT-O治療的女性中重度單純性SUI患者236例的臨床資料。年齡44～88歲，平均（56±9）歲。主要癥狀為腹壓增加及起立活動時頻繁齣現的尿失禁，均需使用尿墊。 Valsalva誘髮試驗和指壓試驗均提示為 SUI。國際尿失禁咨詢委員會尿失禁問捲簡錶（ international consultation committee on incontinence questionnaire short form ， ICI-Q-SF ）評分平均為（15．6±3．9）分。分析236例的術中、術後併髮癥，併通過ICI-Q-SF評分、誘髮實驗、尿失禁事件髮生頻率和尿動力學檢查對隨訪期≥6箇月者的主客觀療效進行評估。根據術式分為單行TVT-O的TVT-O組和因伴有盆底脫垂同時行盆底脩複術的TVT-O＋盆底脩複組。根據隨訪時間分為中期組（隨訪時間6箇月～3年）和長期組（隨訪時間＞3年）。結果本組236例中，術中髮生膀胱穿孔和陰道內弔帶外露各1例（0．4％）；術後髮生腹股溝／穿刺點疼痛36例（19．1％），新髮尿頻18例（9．5％），尿潴留／排尿睏難8例（4．2％），其中2例排尿睏難患者經尿道擴張＋弔帶鬆解後癥狀仍然存在，需長期間歇自助導尿，其餘患者予觀察、對癥治療或手術治療後癥狀均緩解。189例隨訪時間≥6箇月，平均隨訪時間（35．0±12．5）箇月，其中TVT-O組135例，TVT-O＋盆底脩複組54例；中期組116例（61．4％），長期組73例（38．6％）。臨床治愈率為88．9％（168／189），臨床改善率為9．5％（18／189）。術後ICI-Q-SF評分為（6．7±2．3）分，與術前比較差異有統計學意義（P＜0．05）。中期組和長期組的客觀療效（治愈率＋改善率）分彆為97．4％和95．9％，差異無統計學意義（ P＞0．05）；術後ICI-Q-SF評分分彆為（5．8±1．2）分和（7．9±2．0）分，與術前[（14．3±2．8）分和（16．7±3．4）分]比較，差異均無統計學意義（P＞0．05）。 TVT-O組和TVT-O＋盆底脩複組的客觀療效（治愈率＋改善率）分彆為97．8％和100．0％，差異無統計學意義（ P＞0．05）。結論 TVT-O治療女性中重度SUI總體安全有效，中長期療效持久穩定，且其療效與是否行盆底脩複術無明顯相關性。
목적：탐토경폐공무장력조대뇨도중단현조술（ inside-out transobturator transvaginal tape，TVT-O）치료녀성중중도단순성압력성뇨실금（ SUI）적안전성급중장기료효。방법회고성분석2008년1월지2013년12월접수TVT-O치료적녀성중중도단순성SUI환자236례적림상자료。년령44～88세，평균（56±9）세。주요증상위복압증가급기립활동시빈번출현적뇨실금，균수사용뇨점。 Valsalva유발시험화지압시험균제시위 SUI。국제뇨실금자순위원회뇨실금문권간표（ international consultation committee on incontinence questionnaire short form ， ICI-Q-SF ）평분평균위（15．6±3．9）분。분석236례적술중、술후병발증，병통과ICI-Q-SF평분、유발실험、뇨실금사건발생빈솔화뇨동역학검사대수방기≥6개월자적주객관료효진행평고。근거술식분위단행TVT-O적TVT-O조화인반유분저탈수동시행분저수복술적TVT-O＋분저수복조。근거수방시간분위중기조（수방시간6개월～3년）화장기조（수방시간＞3년）。결과본조236례중，술중발생방광천공화음도내조대외로각1례（0．4％）；술후발생복고구／천자점동통36례（19．1％），신발뇨빈18례（9．5％），뇨저류／배뇨곤난8례（4．2％），기중2례배뇨곤난환자경뇨도확장＋조대송해후증상잉연존재，수장기간헐자조도뇨，기여환자여관찰、대증치료혹수술치료후증상균완해。189례수방시간≥6개월，평균수방시간（35．0±12．5）개월，기중TVT-O조135례，TVT-O＋분저수복조54례；중기조116례（61．4％），장기조73례（38．6％）。림상치유솔위88．9％（168／189），림상개선솔위9．5％（18／189）。술후ICI-Q-SF평분위（6．7±2．3）분，여술전비교차이유통계학의의（P＜0．05）。중기조화장기조적객관료효（치유솔＋개선솔）분별위97．4％화95．9％，차이무통계학의의（ P＞0．05）；술후ICI-Q-SF평분분별위（5．8±1．2）분화（7．9±2．0）분，여술전[（14．3±2．8）분화（16．7±3．4）분]비교，차이균무통계학의의（P＞0．05）。 TVT-O조화TVT-O＋분저수복조적객관료효（치유솔＋개선솔）분별위97．8％화100．0％，차이무통계학의의（ P＞0．05）。결론 TVT-O치료녀성중중도SUI총체안전유효，중장기료효지구은정，차기료효여시부행분저수복술무명현상관성。
Objective To evaluate the complications and long-term efficacy of inside-out transobturator transvaginal tape ( TVT-O) for the treatment of stress urinary incontinence ( SUI) .Methods From January 2008 to December 2013,236 consecutive female patients (mean age 56 ±9 years,range 44-88 years)with the symptom of incontinence when abdominal pressure increasing (such as walking), underwent TVT-O operation.All these patients needed pads and were diagnosed with SUI by cough test and Marshall -bonny test before surgery , with the mean international consultation committee on incontinence questionnaire short form ( ICI-Q-SF) score of 15.6 ±3.9.Two grouping methods were used:the mid-term group including patients whose follow-up time was between 6 months and 3 years, the long-term group including patients whose follow-up time >3 years,the group of patients who underwent TVT-O only and the group of patients who underwent TVT-O plus pelvic floor repair at the same time . Their clinical and follow-up data , intraoperative and postoperative complications , subjective and objective effects were recorded and analyzed.Results Of these 236 patients,there were 1 case of bladder perforation (0.4%) and 1 case of intraoperative sling exposure to vagina ( 0.4%) .Postoperative complications included 36 ( 19.1%) groin/puncture point pain ,18 (9.5%) de novo frequency of micturition ,8 (4.2%) urinary retention /difficulty of urination.All the complications were relieved after symptomatic treatment or surgery except 2 cases of urinary retention/difficulty of urination.Their symptom kept existing after urethral dilatation and sling dissection and long-term intermittent self-catheterization was needed .One hundred and eighty-nine patients completed more than six months of follow-up, with mean follow-up time of ( 35.0 ±12.5 ) months.One hundred and sixteen (61.4%) cases was arranged to mid-term group and 73(38.6%) was arranged to long-term group.88.9%patients ( 168/189 ) were cured objectively and 9.5% patients ( 18/189 ) improved. There was also a significant subjective improvement ( ICI-Q-SF scores:15.6 ±3.9 preoperative versus 6.7 ± 2.3 postoperative,P<0.01).There was no significant difference of both objective and subjective efficacy between mid-term group and long-term group ( cured +improved rate 97.4% versus 95.9%;ICI-Q-SF scores 14.3 ±2.8 versus 16.7 ±3.4 preoperative ,5.8 ±1.2 versus 7.9 ±2.0 postoperative , P>0.05 ) . Patients who underwent TVT-O and those who underwent TVT-O +pelvic floor repair had no significant difference in efficacy (cured +improved rate 97.8%versus 100.0%,P>0.05).Conclusion TVT-O is a safe,effective and durable treatment for SUI , whether or not with concomitant procedure of pelvic floor repairment.