摘要
目的探讨经阴道经耻骨后无张力尿道中段合成吊带术(RMUS)中通过解剖定位调整吊带张力治疗尿失禁的安全性和有效性。方法回顾性分析2019年1—8月于上海交通大学医学院附属仁济医院采用RMUS治疗的36例尿失禁患者的资料。均为女性,年龄(60.83±7.93)岁,体质指数(24.43±2.44)kg/m^(2)。36例术前压力诱发试验、尿道抬举试验均为阳性。其中单纯性压力性尿失禁(SUI)20例(55.6%),混合性尿失禁(MUI)16例(44.4%)。1h尿垫试验提示轻度尿失禁5例(13.9%),中度14例(38.9%),重度13例(36.1%),极重度4例(11.1%)。17例术前完成尿动力学检查,其中5例(29.4%)出现逼尿肌过度活动(DO),3例(17.7%)表现为固有括约肌功能缺陷(ISD)。所有患者RMUS术中均通过解剖定位调整吊带张力:在尿道与吊带之间放置一把直角钳,腹侧端紧贴耻骨联合下缘,背侧端平行于处女膜环后缘,调整吊带张力。术后不留置尿管。分析术后主观疗效、客观疗效及安全性(术后尿潴留发生率及术后3个月残余尿情况)。主观治愈:术后无漏尿发生,或在过度憋尿、剧烈咳嗽等状态下极少量漏尿,不影响正常生活。主观有效:术后尿失禁程度较术前改善≥50%。客观治愈:术后压力诱发试验阴性。结果本研究36例住院时间8(5~95)h。术中无膀胱穿孔及输血病例。术后无尿潴留者。术后3个月27例获得随访,其中22例有残余尿量数据,23例有主观疗效数据,23例有客观疗效数据;残余尿量7.5(5~64)ml,主观治愈率为91.3%(21/23),客观治愈率为95.7%(22/23);排尿困难2例(2/23,8.7%),无需临床处理。术后无尿道侵蚀和阴道裸露病例。术后2年完成电话随访34例,主观治愈率为91.2%(31/34),排尿困难1例(1/34,2.9%)。术后3个月,SUI与MUI患者的主观治愈率[100.0%(12/12)与81.8%(9/11)]和客观治愈率[91.7%(11/12)与100.0%(11/11)]差异均无统计学意义;轻度、中度、重度、极重度尿失禁患者的主观治愈率[75.
Objective To investigate the safety and effectiveness of tension adjustment technique using anatomical landmarks during retropubic midurethral synthetic sling.MethodsThe data of 36 consecutive female patients with urinary incontinence,who had underwent retropubic midurethral synthetic sling procedure from January to August 2019 were analyzed retrospectively.The mean age was(60.83±7.93)years old and the body mass index was(24.43±2.44)kg/m^(2).Among the recruited subjects,36 had positive stress test and Marshall-Marchetti test.20(55.6%)were pure stress urinary incontinence,and 16(44.4%)were mixed urinary incontinence.The severity of incontinence was classified into mild(5 cases,13.9%),moderate(14 cases,38.9%),severe(13 cases,36.1%)and very severe(4 cases,11.1%)using one-hour pad tests.Urodynamics were performed in 17 cases,with 5(29.4%)presented detrusor overactivity,3(17.7%)possessed intrinsic sphincter deficiency.For each case,the tension of the sling was adjusted based on the anatomical landmarks,i.e.using an angled clamp attached closely to the pubic symphysis ventrally and the tip parallel to the edge of hymen dorsally.All patients were catheter-free right after the procedure.The subjective and objective effectiveness,and safety(the rate of urinary retension after surgery and postvoid residual volume 3 months later)were evaluated.The subjective cure rate was was defined as complete leakage free or very mild leakage during excessive bladder filling and fierce cough.The subjective effectiveness was defined as over 50%improvement of the leakage symptom.The objective cure rate was defined as a negative stress test.Results For all 36 patients,the median hospital stays was 8(5-95)h.No bladder perforation or transfusion cases.All patients were catheter-free right after the procedure,with no incidence of urinary retention.27 patients completed a 3-month follow-up,with 22 had post-void residual data,23 had subjective effectiveness data and 23 had objective effectiveness data.The median post-void residual was 7.5(5-64
作者
李佳怡
宋奇翔
方伟林
顾懿元
郭韵悦
张薇
徐蕾
薛蔚
Li Jiayi;Song Qixiang;Fang Weilin;Gu Yiyuan;Guo Yunyue;Zhang Wei;Xu Lei;Xue Wei(Department of Urology,Renji Hospital,Shanghai Jiaotong University School of Medicine,Shanghai 200127,China;Clinical Research Unit,Renji Hospital Affiliated to Shanghai Jiaotong University School of Medicine,Shanghai 200127,China)
出处
《中华泌尿外科杂志》
CAS
CSCD
北大核心
2022年第9期675-680,共6页
Chinese Journal of Urology
关键词
尿失禁
压力性
尿道中段吊带术
无张力吊带术
疗效
安全性
Urinary incontinence,stress
Midurethral sling
Tension-free vaginal tape
Effectiveness
Safety
