标准TVT-O与改良TVT-O手术治疗女性压力性尿失禁的对照研究
A control study on the clinical outcome of tension-free vaginal tape-obturator and modified tension-free vaginal tape-obturator for female stress urinary incontinence

摘要：目的 对标准由内向外经闭孔尿道中段无张力悬吊术(TVT-O)与改良TVT-O治疗女性压力性尿失禁(SUI)的疗效进行评估。 方法 选取2013年1月至2013年12月就诊我院确诊为SUI的女性患者113例，随机分为两组：标准TVT-O组(56例)和改良TVT-O组(57例)，对两组的手术安全性、短期疗效及并发症进行前瞻性分析。结果 标准TVT-O组双侧闭孔膜至皮肤穿出点所植入吊带长度、术中平均出血量大于改良TVT-O组；术后大腿内侧疼痛平均NRS疼痛评分标准TVT-O组显著高于改良TVT-O组(P<0.05)。两组患者手术时间、术后导尿时间、平均住院时间无统计学差异；术后吊带位置及双侧闭孔膜至尿道间所植入吊带形态及位置无统计学差异(P>0.05)；手术疗效无明显统计学差异(P>0.05)。结论 标准TVT-O术与改良TVT-O术均可有效治疗女性SUI；改良TVT-O术吊带穿过内收肌群路径缩短、出血减少，可显著减少患者术后疼痛等并发症，进一步提高生活质量。
ABSTRACT: Objective To evaluate the curative effect of tension-free vaginal tape-obturator (TVT-O) and modified TVT-O in treating female stress urinary incontinence (SUI). Methods We selected 113 female patients diagnosed with SUI from January to December 2013 in our department and divided them into standard TVT-O group (group A, 56 cases) and modified TVT-O group (group B, 57 cases). We evaluated prospectively the safety, short-term efficacy and complications of operation in the two groups. Results The length from bilateral obturator membrane to the puncture point in the skin was greater in group A than in group B. The average intraoperative blood loss was more in group A than in group B. The median NRS score of postoperatie thigh pain in group A was higher than in group B (P<0.05). The two groups did not differ significantly in operation duration, postoperative catheterization, mean hospital stay duration, the length and position from bilateral obturator membrane to the puncture point, or surgical efficacy (P>0.05). Conclusion Both TVT-O and modified TVT-O techniques are effective in treating female SUI. Modified TVT-O has a short path to get through the adductor muscles and less intraoperative blood loss; therefore, it can significantly reduce the complications such as postoperative pain to enhance the quality of life after operation