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目的:探讨新近开发的单切口尿道中段吊带术(TVT-SECUR)治疗女性压力性尿失禁(SUI)的有效性及手术关键。方法:回顾分析2009～2011年共16例SUI患者资料,ALPP均大于60cmH2O,施行“H”术式,术中以示指引导保持穿刺方向及穿刺层面。术后24、48及72h采用直观模拟量表(VAS)对患者术后早期切口疼痛进行评价,3个月时门诊随访评判疗效及并发症。结果:本研究中16例手术平均24min,无尿道膀胱损伤,无阴道穿孔,无吊带暴露、无明显肢体运动障碍及局部血肿形成,无明确伤口感染及排斥反应发生。术后24小时VAS为(2.6±1.5),术后3个月随访时总有效率为93.7%(15/16),一过性并发症包括排尿困难(2/16),急迫性尿失禁(5/16),泌尿系感染(4/16)。结论:TVT-SECUR“H”术式治疗SUI,操作简单,安全有效,并发症少。术中手指触摸引导有利于确定穿刺方向及深度,对保证术后疗效和减少并发症具有重要意义。
Objective: To investigate the effectiveness and key of surgical treatment of newly diagnosed female stress urinary incontinence (SUI) by newly developed single incision urethral sling (TVT-SECUR). Methods: A total of 16 SUI patients from 2009 to 2011 were retrospectively analyzed. ALPP was greater than 60cmH2O. The operation was performed in “H” mode. The operation direction and puncture level were guided by the index finger. At 24, 48, and 72 hours after surgery, visual analogue scale (VAS) was used to evaluate the early postoperative incisional pain. Three months later, the outpatients were followed up to evaluate the efficacy and complications. Results: In this study, the average operation time was 16 minutes in 24 cases. There was no urethral bladder injury, no vaginal perforation, no strap exposure, no obvious limb movement disorders and local hematoma formation. No definite wound infection and rejection occurred. The VAS was (2.6 ± 1.5) at 24 hours after operation and 93.7% (15/16) at 3 months after operation. The transient complications included dysuria (2/16), urge incontinence 5/16), urinary tract infection (4/16). Conclusion: TVT-SECUR “H” surgical treatment of SUI, simple, safe and effective, with fewer complications. Intraoperative finger touch guide is conducive to determine the direction and depth of puncture, to ensure postoperative efficacy and reduce complications of great significance.