无张力尿道中段悬吊术治疗女性混合性尿失禁的疗效分析

doi:10.3969/j.issn.1671-167X.2017.04.016

摘要/Abstract

摘要： 目的：评估无张力尿道中段悬吊术治疗女性混合性尿失禁的中远期疗效。方法：随访分析2010年4月至2016年9月共26例无张力尿道中段悬吊术治疗女性混合性尿失禁患者的临床资料。26例随访到的患者中，4例采用经耻骨后无张力尿道中段悬吊术（retropubic tension free mid-urethral sling， TVT）， 22例采用经闭孔无张力尿道中段悬吊术（transurethral middle obturator sling，TOT）。术后中远期电话随访尿失禁严重程度评分（urinary incontinence severity score，UISS）、逼尿肌不稳定评分（detrusor instability score，DIS）、尿失禁生活质量量表评价（incontinence quality of life scale evaluation，I-QOL）、泌尿生殖障碍量表简版（Urogenital Distress Inventory short form，UDI6），与术前评分进行比较分析。结果：26例患者年龄42~80岁，平均62岁。体重指数（body mass index, BMI）21.48~31.14 kg/m2，平均26.82 kg/m2。随访时间8~69个月，平均26个月，14例患者手术前曾服用M受体阻滞剂，但未超过2周。术中无膀胱损伤、尿道损伤、闭孔血管及神经损伤等并发症，术后拔除尿管时，患者均无局部疼痛或排尿困难。压力性尿失禁治愈25例，达96.15%，急迫性尿失禁治愈20例，达76.92%。26例随访患者生活质量较手术前显著改善（P<0.05）。结论：无张力尿道中段悬吊术治疗女性混合性尿失禁总体有效率高，即使未长期服用M受体阻滞剂等药物，手术本身对急迫性尿失禁的治愈率达76.92%。手术的远期疗效稳定，患者生活质量能得到显著改善。

关键词: 压力性尿失禁, 急迫性尿失禁, 无张力尿道中段悬吊术, 治疗结果

Abstract: Objective： To evaluate the medium and long term outcomes of tension-free mid-urethral sling in the treatment of female patients with mixed urinary incontinence (MUI). Methods: Twenty-six patients who underwent the tension-free mid-urethral sling procedure for MUI from April, 2010 to September, 2016, were followed up. Four of the 26 patients underwent retropubic tension free mid-urethral sling (TVT), and 22 of them underwent transurethral middle obturator sling (TOT). Scales were used in the follow-up, such as urinary incontinence severity score (UISS), detrusor instability score (DIS), incontinence quality of life scale evaluation (I-QOL), Urogenital Distress Inventory short form (UDI-6), and the outcomes before and after the procedure were compared. Results: The mean age was 62 years, with a range of 42-80 years. The mean body mass index (BMI) was 26.82 kg/m2, with a range of 21.48-31.14 kg/m2. The mean follow-up time was 26 months, with a range of 8-69 months. Twelve patients never took M-blockers and the rest 14 patients took M-blockers within two weeks. None of the pa-tients had complications, including dysuria, injury of bladder, urethra, obturator vessel or nerve during the surgery. After pulling out the catheter, no one suffered moderate or severe pain or difficulty of urination. The overall cure rate for stress urinary incontinence (SUI) was 96.15% with 25 patients cured, and for urge urinary incontinence (UUI) was 76.92% with 20 patients cured. The patients’ life quality also improved significantly (P<0.05). Conclusion: Ten of the 26 patients showed an overactive bladder according to urodynamic study, from whom all of the six failed patient were. And 16 patients didn’t show an overactive bladder, which may due to two reasons. One is that their sense of urge is not so serious, the other one is that their sense of urge is from urethra. Proximal urethra is full of nerve, which plays a role in sense and urine control. The sense of urge may come from urethra instead of bladder. Tension-free mid-urethral sling procedure is an effective treatment for women with mixed urinary incontinence. Even without taking the M-blockers, the cure rate for urge incontinence reached 76.92%. The efficacy of surgery remained stable in medium and long term, and the patients’ quality of life improved significantly.

Key words: Stress urinary incontinence, Urge urinary incontinence, Tension-free mid-urethral sling procedure, Treatment outcome

中图分类号:

R711.5

张维宇，张晓鹏，胡浩，陈京文，刘献辉，许克新. 无张力尿道中段悬吊术治疗女性混合性尿失禁的疗效分析[J]. 北京大学学报(医学版), 2017, 49(4): 638-642.

ZHANG Wei-yu, ZHANG Xiao-peng, HU Hao, CHEN Jing-wen, LIU Xian-hui, XU Ke-xin. Analysis of outcomes of tension-free mid-urethral sling procedure in women with mixed urinary incontinence[J]. Journal of Peking University(Health Sciences), 2017, 49(4): 638-642.

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