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目的:探讨经闭孔无张力尿道中段悬吊改良术式(modified tension-free vaginal tape Abbrevo,TVTA)治疗女性压力性尿失禁的中长期疗效。方法:回顾性分析2013年3月~2016年8月我院经闭孔无张力尿道中段悬吊术治疗的97例女性压力性尿失禁患者的临床资料,根据术式分为TVT-O组38例,TVT-A组59例,术后随访6~32个月,通过尿流动力学、咳嗽诱发试验、国际尿失禁咨询委员会尿失禁问卷表简表(ICI-Q-SF)、视觉模拟评分(VAS)、泌尿生殖困扰简表(UDI-6)、尿失禁影响问卷简表(IIQ-7)及组间对比来评价TVT-A术的中长期主客观疗效。结果:97例手术均顺利完成,未出现膀胱穿孔、大血管损伤及吊带外漏等较严重并发症,两组各1例术后出现排尿困难,经尿道扩张并保留导尿1周后均恢复正常排尿,4例出现术后尿路感染,每组各2例,经抗感染治疗3~5天后症状消失。TVT-O组与TVT-A组术后24小时腹股沟区疼痛发生率分别为7例(18.4%)、2例(3.4%);1周时分别为5例(13.2%)、0例(0);差异均具有统计学意义(P<0.05)。97例于门诊完成随访。TVT-O与TVT-A组中长期主观有效(完全治愈+改善,其中诱发试验阴性为完全治愈)分别为36例(94.7%)、56例(94.9%);客观有效(治愈+改善)分别为35例(92.1%)、55例(93.2%);满意度分别为36例(94.7%)、57例(96.6%),两组比较差异均无统计学意义(P>0.05)。ICI-Q-SF、UDI-6、VAS和IIQ-7评分与术前比较差异均有统计学意义(P<0.05)。结论:TVT-A术能提高ALPP,但对正常储尿排尿功能无影响;TVT-A具有安全有效、中长期疗效稳定的优点,同时可降低术后短期内腹股沟区疼痛的发生率。
Objective: To investigate the long-term effect of modified tension-free vaginal tape Abbrevo (TVTA) on female stress urinary incontinence. Methods: The clinical data of 97 female stress urinary incontinence patients treated with tension-free mid-urethral obstruction in our hospital from March 2013 to August 2016 were retrospectively analyzed. They were divided into TVT-O group 38 In the TVT-A group, 59 patients were followed up for 6 to 32 months. Urine flow dynamics, cough-induced test, ICI-Q-SF, visual analogue scale VAS, UDI-6, IIQ-7, and comparison between groups to evaluate the long-term subjective and objective effects of TVT-A. Results: All of the 97 cases were successfully completed. There were no serious complications such as bladder perforation, macrovascular injury and sling leakage. One patient in each group had dysuria after operation and had normal urination after urethral dilatation and catheterization for 1 week , 4 cases of postoperative urinary tract infection, 2 cases in each group, the symptoms disappeared after 3 to 5 days of anti-infection treatment. The incidence of groin area pain in TVT-O group and TVT-A group was 7 cases (18.4%) and 2 cases (3.4%) at 24 hours after operation, respectively, and 5 cases (13.2% ); The differences were statistically significant (P <0.05). 97 cases were completed in the clinic. 36 patients (94.7%) and 56 patients (94.9%) were objectively effective (cure + improve) respectively in TVT-O and TVT-A groups for subjective and long-term subjectively effective (complete cure + improvement, of which induction test was completely cured) 35 cases (92.1%) and 55 cases (93.2%). Satisfaction was 36 cases (94.7%) and 57 cases (96.6%) respectively. There was no significant difference between the two groups (P> 0.05). The ICI-Q-SF, UDI-6, VAS and IIQ-7 scores were significantly different from those before operation (P <0.05). Conclusion: TVT-A can improve ALPP, but it has no effect on normal urinary urinary storage. TVT-A has the advantages of safe and effective, stable in long-term and long-term efficacy, and can reduce the incidence of pain in groin area in short term.