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目的探讨耻骨后无张力阴道吊带术(tension-free vaginal tape technique,TVT)治疗女性压力性尿失禁(stress urinary incontinence,SUI)的临床疗效。方法回顾分析2004年1月-2010年1月57例采用TVT治疗的女性SUI患者临床资料。患者年龄36～64岁,平均54岁;病程1年6个月～13年。均有1～3次生育史。诱发试验及膀胱颈抬举试验均呈阳性。14例合并阴道前壁脱垂。5例有逼尿肌不稳定表现。漏尿点压测定为3.93～10.98 kPa。结果 4例术中发生穿破膀胱,重新调整方向后完成手术。3例拔除尿管后出现排尿困难,经对症处理后恢复正常排尿。术后12个月采用Grouts-Blaivas评分法评价疗效,治愈48例(84.2%),改善良好8例(14.0%),改善中等1例(1.8%)。尿流动力学检查示,术后3、12个月尿流率较术前显著下降,最大尿道闭合压显著升高(P<0.05)。根据尿失禁生活质量量表(I-QOL)评价,术后3个月患者在日常活动、心理障碍及社会尴尬方面的主要评分指标较术前有显著性提高(P<0.05);术后12个月患者各项指标均较术前改善(P<0.05)。结论 TVT手术操作简便、安全有效,能显著提高患者生活质量,是治疗女性SUI的有效手段。
Objective To investigate the clinical efficacy of tension-free vaginal tape technique (TVT) in the treatment of female stress urinary incontinence (SUI). Methods The clinical data of 57 female SUI patients treated with TVT from January 2004 to January 2010 were retrospectively analyzed. Patients aged 36 to 64 years, mean 54 years; duration of 1 year 6 months to 13 years. Have 1 to 3 childbirth history. Induction test and bladder neck lift test were positive. 14 cases of vaginal anterior wall prolapse. 5 cases of detrusor instability. Urine leakage pressure was measured 3.93 ~ 10.98 kPa. Results In 4 cases, the bladder had been punctured and the operation was completed after readjusting the direction. 3 cases of dysuria after removal of the catheter, the symptomatic treatment returned to normal urination. Efficacy was assessed by Grouts-Blaivas score 12 months after operation, cured in 48 cases (84.2%), improved in 8 cases (14.0%), and improved in 1 case (1.8%). Urodynamic examination showed that the urinary flow rate decreased significantly at 3 and 12 months after operation, and the maximum urethral closure pressure was significantly increased (P <0.05). According to the evaluation of I-QOL, the main score indexes of daily activities, psychological disorders and social awkwardness of patients at 3 months after operation were significantly higher than those before operation (P <0.05); after 12 All the indexes of patients in one month were better than those before operation (P <0.05). Conclusion The operation of TVT is simple, safe and effective and can significantly improve the quality of life of patients. It is an effective method to treat female SUI.