摘要
目的 观察并比较经耻骨后路径阴道无张力尿道中段悬吊术（TVT）及经闭孔路径阴道无张力尿道中段悬吊术（TVT-O）治疗女性压力性尿失禁的临床效果.方法 前瞻性随机对照单盲方法选取315例压力性尿失禁患者,其中行TVT 160例,行TVT-O 155例.分别记录两种手术路径围手术期各种参数和术后不同随访时间的临床治疗效果.结果 术后随访率为95.2%,平均随访时间27个月.300例未失访病例中,TVT 154例,TVT-O 146例.术后6、12、24及36个月TVT组治愈率分别为93.5%、89.6%、87.2%、82.9%;TVT-O组分别为91.1%、89.8%、86.2%、83.3%,两组治愈率组间和组内比较差异均无统计学意义（均P＞0.05）.TVT-O组手术时间（18.7±4.2）min,明显短于TVT组（24.3±4.5）min（P＜0.01）.TVT组耻骨上酸痛发生率为2.6%（4/154）,明显低于TVT-O组腹股沟或大腿内侧酸痛不适感发生率8.2%（12/146）（P＜0.05）.结论 TVT-O较TVT手术时间短,术后腹股沟/大腿内侧疼痛发生率高.术后随访3年,两种手术方式均可有效治疗压力性尿失禁.
Objective To compare the morbidity and efficacy of tension-free vaginal tape（TVT）and transobturator tape （TVT-O） procedures in the treatment of stress urinary incontinence. Methods A total of 315 women were randomly assigned to undergo the procedure of either TVT （n = 160） or TVT-O （n =155）. Some patients underwent vaginal repair, hysterectomy, hysterosalpingo-oophorectomy, posterior intravaginal slingplasty or sacrospinous ligament fixation as concomitant procedures as indicated. Results Fifteen patients were lost to follow-up. And the median follow-up period was 27 months. The curing rates were 93.5%, 89. 6%, 87. 2% and 82. 9% in the TVT group and 91.1%, 89. 8%, 86. 2% and 83.3% in the TVT-O group at 6, 12, 24 and 36 months respectively. No significant difference could be found for the curing rates between two groups at the same follow-up time and between 6 - 36 months follow-up in each group（ P ＞0. 05）. The median operative duration of the TVT-O group was significantly shorter than that of the TVT group [（ 18. 7 ± 4. 2 ） vs （ 24. 3 ± 4. 5 ） min] （ P ＜ 0. 01 ）. Compared with the TVT group, the TVT-O group had more patients complaining of groin and thigh pain （ P ＜ 0. 05 ）. Conclusion Both approaches appear to lower the peri- and post-operative complication rates and have an equal efficacy in the surgical treatment of stress urinary incontinence during a 3-year follow-up. However, TVT-O has a shorter operative duration with a higher rate of groin and thigh pain.
出处
《中华医学杂志》
CAS
CSCD
北大核心
2011年第13期898-901,共4页
National Medical Journal of China
基金
＂十一五＂国家科技支撑项目基金（2007BA104B05）
关键词
尿失禁
压力性
泌尿外科手术
随机对照试验
治疗结果
Urinary incontinence
Stress
Urologic surgical procedures
Randomized controlled trials
Treatment outcome
