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目的:验证剪断尿道下的吊带未消除吊带抗尿失禁作用的假说,探讨尿道吊带的无张力原则。方法:用持续阴道扩张(VD)的方法预先在40只雌性wistar大鼠建立压力性尿失禁(SUI)模型。10只接受完整的尿道吊带手术;10只植入完整的尿道吊带后,把吊带的尿道下部分剪断一半;10只植入完整的尿道吊带后,把吊带的尿道下部分完全剪断;10只接受了伪吊带手术。术后6周,所有大鼠通过预先放置的耻骨上导管测定crede手法诱导的腹腔漏尿点压(ALPP),并测定膀胱内压。Kruskal-Wallis H检验比较数据,P<0.05为差异有统计学意义。结果:吊带完全切断组、吊带切断一半组和吊带完整组都可同样升高ALPP,且都显著高于伪手术组的值(分别为24.9、26.7、27.9vs20.7cmH_2O,P<0.0001)。4组排尿高峰压无显著的差别,表示吊带术的各组不存在膀胱出口梗阻(BOO)。吊带完全切断组、吊带切断一半组和吊带完整组的膀胱顺应性6周后同伪手术组相比显著降低(P=0.007、0.05、0.05)。结论:吊带尿道下部分的完整性并不是吊带治疗SUI大鼠模型所必需的。然而吊带手术可以降低膀胱的顺应性。这可以解释在临床中观察到的同吊带手术有关的排尿功能障碍。
OBJECTIVE: To verify the hypothesis that sling under the urethra is not sutured to eliminate urinary incontinence and to explore the principle of tension-free urethral sling. METHODS: Stress urinary incontinence (SUI) models were established in 40 female wistar rats with continuous vaginal dilation (VD). 10 underwent intact urethral sling surgery. After implanting a complete urethral sling in 10, the lower part of the urethra of the sling was cut in half. Ten intact urethral slings were completely implanted and the lower urethral part of the sling was completely cut. Pseudo-sling surgery. At 6 weeks after operation, all rats were subjected to the induced abdomen atelectasis (ALPP) by a pre-placed suprapubic catheter and the intravesical pressure was measured. Kruskal-Wallis H test comparison data, P <0.05 for the difference was statistically significant. RESULTS: ALPP was equally elevated in the complete sling group, half sling hallucination group and intact sling group, both of which were significantly higher than those of the sham-operated group (24.9, 26.7, 27.9 vs 20.7 cmH2O, respectively; P <0.0001). There was no significant difference in peak urination pressure among the four groups, indicating that there was no bladder outlet obstruction (BOO) in each group of sling. The cyst compliance in the full hallucination group, hallucination hallucination group and intact cymbal group was significantly lower than that in the sham operation group after 6 weeks (P = 0.007, 0.05, 0.05). CONCLUSIONS: The integrity of the lower part of the sling urethra is not necessary for the sling to treat SUI rat models. However, sling surgery can reduce bladder compliance. This can explain the clinically observed voiding dysfunction associated with sling surgery.