目的: 比较耻骨后尿道中段悬吊术(tension-free vaginal tape，TVT)和经闭孔尿道中段悬吊术(trans-obturator tape，TOT)治疗女性压力性尿失禁后的最大尿流率及残余尿量的改变。方法: 回顾性分析2022年1月至2024年1月于北京大学人民医院行经阴道尿道中段无张力悬吊术的女性压力性尿失禁患者的临床资料，并在术后1、6、12个月对患者进行随访。所有患者术前均行尿动力学评估尿道括约肌功能，同时测定最大尿流率及膀胱残余尿量(B超)，以除外急迫性尿失禁、逼尿肌无力、膀胱出口梗阻，明确诊断为单纯性压力性尿失禁。随访时测定最大尿流率及膀胱残余尿量，并结合国际尿失禁咨询委员会尿失禁问卷表简表，根据患者术后漏尿症状较术前改善的程度，将手术疗效判定为治愈、好转或无效。结果: 共150例女性压力性尿失禁患者纳入本研究，其中60例行TVT，90例行TOT；患者平均年龄(55.12±10.23)岁，随访时间12个月，所有患者均完成术后随访。术后1、6、12个月的总体有效率(治愈+好转)TVT组分别为93.3%(56/60)、91.7%(55/60)、91.7%(55/60)，TOT组分别为92.2%(83/90)、90.0%(81/90)、90.0%(81/90)；平均最大尿流率TVT组分别为(17.21±4.22) mL/s、(18.05±5.33) mL/s、(18.37±4.92) mL/s，TOT组分别为(18.21±5.32) mL/s、(19.05±4.33) mL/s、(19.27±4.92) mL/s；平均残余尿量TVT组分别为(13.21±5.22) mL、(18.25±5.33) mL、(16.37±7.92) mL，TOT组分别为(11.21±6.32) mL、(13.05±5.33) mL、(11.27±5.92) mL；两组间差异均无统计学意义。两组术后1、6、12个月的平均最大尿流率及残余尿量与术前相比，差异亦无统计学意义。结论: TVT及TOT对压力性尿失禁的治疗效果好，术后并发症少，两种术式对术后最大尿流率及残余尿量的影响没有明显区别。

Objective: To compare the changes of maximun flow rate and residual urine volume after tension-free vaginal tape (TVT) and trans-obturator tape (TOT) in the treatment of stress urinary incontinence in women. Methods: The clinical data of female patients with stress urinary incontinence who underwent transvaginal midsection tension-free urethral suspension in Peking University People' s Hospital from January 2022 to January 2024 were retrospectively analyzed. All the patients were followed up 1 month, 6 months and 12 months after surgery. Urodynamics were performed to evaluate urethral sphincter function before surgery. At the same time, B-ultrasonography was improved to determine the residual urinary volume of the bladder, and urgent incontinence, detrusor weakness and bladder outlet obstruction were excluded, and the diagnosis was clearly stress incontinence. Maximum flow rate and residual urinary volume were measured during follow-up, and combined with the urinary incontinence questionnaire of the International Urinary Incontinence Advisory Committee, the surgical effect was judged to be cured, improved or ineffective according to the degree of improvement of urinary leakage symptoms after surgery. Results: A total of 150 female patients with stress urinary incontinence were included in the study, the average age of the patients was (55.12±10.23) years old, and the follow-up time was 12 months. All patients completed postoperative follow-up, of whom 60 underwent TVT and 90 underwent TOT. The overall effective rates (cure + improvement) 1, 6, and 12 months after surgery in the TVT group were 93.3% (56/60), 91.7% (55/60), and 91.7% (55/60), and those in the TOT group were 92.2% (83/90), 90.0% (81/90), 90.0% (81/90), respectively, and there was no statistical difference between the two groups. The average maximum urinary flow rates 1, 6, and 12 months after surgery in the TVT group were (17.21±4.22) mL/s, (18.05±5.33) mL/s, and (18.37±4.92) mL/s, and those in the TOT group were (18.21±5.32) mL/s, (19.05±4.33) mL/s, and (19.27±4.92) mL/s, respectively, and there was no statistical difference between the two groups. The mean residual urine volume 1, 6, and 12 months after surgery in the TVT group was (13.21±5.22) mL, (18.25±5.33) mL, and (16.37±7.92) mL, and those in the TOT group was (11.21±6.32) mL, (13.05±5.33) mL, and (11.27±5.92)mL, respectively, and there was no statistical difference between the two groups. Compared with preoperative levels, there were no significant differences in the average maximum flow rate and the residual urine volume in both group at 1, 6, and 12 months after surgery. Conclusion: Both TVT and TOT are effective in the treatment of stress incontinence, and have no effect on postoperative maximum flow rate and residual urine volume.

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作者贡献声明  王起：设计研究方案、撰写论文；柯涵炜：设计研究方案；丁泽华、张维宇：收集、分析、整理数据；张晓鹏、徐涛：提出研究思路；许克新：总体把关和审定论文。