TVT-EXACT治疗Ⅲ型女性压力性尿失禁的疗效和安全性的分析

王怡君; 柯润疆; Muhiyadin Sheikh Ali; 杨森; 南存金; 陈映鹤

doi:10.3760/cma.j.issn.1008-1372.2017.03.009

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中国医师杂志

• 盆底功能障碍性疾病诊治专栏 •

ENGLISH ABSTRACT

TVT-EXACT治疗Ⅲ型女性压力性尿失禁的疗效和安全性的分析

作者及单位信息

出版日期： 2017 -03 -20 ·

DOI： 10.3760/cma.j.issn.1008-1372.2017.03.009

Efficacy and safety of TVT-EXACT procedure for treatment of ISD female stress urinary incontinence

Authors Info & Affiliations

Wang Yijun

Department of Urology, the Second Affiliated Hospital of Wenzhou Medical University, Wenzhou 325027, China

Ke Runjiang

Muhiyadin Sheikh Ali

Yang Sen

Nan Cunjin

Chen Yinghe

Published： 2017 -03 -20 ·

DOI： 10.3760/cma.j.issn.1008-1372.2017.03.009

APP内阅读

摘要

目的探讨新型经耻骨后尿道中段无张力悬吊术(TVT-EXACT)治疗Ⅲ型女性压力性尿失禁(SUI)的疗效及并发症。

方法采用回顾性方法，收集本院2013年11月至2016年6月期间收治的20例行TVT-E术的Ⅲ型压力性尿失禁患者的资料，观察手术的疗效及并发症的情况。

结果手术时间19～25(20.7±1.6)min，术中出血量20～50 ml。术中均无膀胱、尿道损失，无血管、神经损伤。3例患者因术后排尿困难，予延长导尿时间及尿道扩张，处理后症状均好转，复测尿流率及残余尿均正常。2例混合性尿失禁患者，术后均存在急迫性尿失禁，经抗胆碱能药物治疗后症状均逐渐好转。均无阴道、尿道侵蚀。疗效判定：治愈15例(75%)，好转5例(25%)，无效0例，有效率100%。

结论TVT-E术操作简便、微创，对Ⅲ型压力性尿失禁患者的治疗安全有效。但本研究手术数量及术后随访时间有限，长期疗效仍需要大量的临床数据和随访资料证明。

关键词：耻骨/外科学;尿道下悬吊术;尿失禁，压力性/外科学

ABSTRACT

ObjectiveTo investigate the efficacy and complication of Tension-free Vaginal Tape (TVT)-Exact for the treatment of type-Ⅲ female stress urinary incontinence (SUI).

MethodsA total of 20 type-Ⅲ SUI patients enrolled from November 2013 to June 2016 were retrospectively analyzed. The efficacy and complication of the surgery were evaluated.

ResultsThe mean operation time was (20.7±1.60)min (range, 19-25 min). The blood loss was 20-50 ml. There were no intraoperative bladder or urethral injury, and no vessel or nerve damage. 2 cases with mixed SUI were relieved by medicine. No case had urethral or vaginal erosion. Therapeutic efficacy: 15 cases were cured (75%), 5 cases were improved (25%), and no case was ineffective.

ConclusionsTVT-E is a simple, min-invasive, safe and effective surgery for type-Ⅲ SUI. While the long-term efficacy needs great amount of clinical data and long-term follow-up to prove.

KEYWORDS： Pubic bone/AH/SU;Suburethral slings;Urinary incontinence, stress/SU

Corresponding author: Chen Yinghe, Email: mocdef.habtlaehzwhynehc

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引用本文

王怡君,柯润疆,Muhiyadin Sheikh Ali,等. TVT-EXACT治疗Ⅲ型女性压力性尿失禁的疗效和安全性的分析[J]. 中国医师杂志,2017,19(3)：352-354.

DOI:10.3760/cma.j.issn.1008-1372.2017.03.009

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未经授权，不得转载、摘编本刊文章，不得使用本刊的版式设计。

除非特别声明，本刊刊出的所有文章不代表中华医学会和本刊编委会的观点。

女性压力性尿失禁(stress urinary incontinence，SUI)是女性常见疾病，在老年女性中发病率可达20%～27% ^{[
1
]}。其中约10%的症状严重者是属于尿道固有括约肌缺陷型(intrinsic sphincter deficiency，ISD)，由之引起的定义为Ⅲ型SUI，其尿动力学上往往表现为腹压漏尿点压(abdominal leak point pressure，ALPP)<60 cmH ₂O(1 cmH ₂O＝0.098 kPa)，及最大尿道闭合压(maximum urethral closure pressure，MUCP)<20 cmH ₂O。长期以来Ⅲ型SUI的治疗一直是一个难点，早期用以治疗SUI的耻骨后悬吊术对Ⅲ型SUI的治疗效果不佳。之后出现的膀胱颈悬吊术、尿道注射法、人工括约肌等，因疗效参差不齐、术后并发症多等原因均未成为Ⅲ型SUI的一线治疗方法。根据吊床理论推出的经阴道尿道中段无张力吊带术(Tension-free Vaginal Tape，TVT)，使SUI的治疗获得了重大突破 ^{[
2
]}。而后的临床研究证实TVT系列术式对Ⅲ型SUI的治疗有效，但因穿刺路径不同，TVT的手术疗效要优于经闭孔尿道中段无张力吊带术(transobturator tape，TVT-O) ^{[
3
]}。为了优化TVT术式，减少术中及术后并发症，2010年一种新的TVT手术方式，即经耻骨后尿道中段无张力悬吊术(TVT-EXACT)正式上市。本院于2013年11月开始对诊断为Ⅲ型压力性尿失禁患者施行TVT-E术，至2016年6月已施行20例，初步结果报告如下。

摘要
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通信作者：陈映鹤，Email： mocdef.habtlaehzwhynehc

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