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目的探讨经闭孔无张力尿道中段悬吊术(TVT-O)治疗女性压力性尿失禁(FSUI)的临床疗效。方法分析采用TVT-O手术治疗38例中、重度FSUI患者的临床疗效,随访患者1个月、6个月最大尿流率及B超残余尿测定,采用ICI-Q-SF评分评价TVT-O手术临床效果及手术安全性。结果所有患者均顺利完成手术,手术成功率为100%,手术时间(16±4)min,术中出血(10±3)ml,术后留置导尿管时间2~5 d,平均2.9 d,住院时间3~6 d,平均4.2 d。术后1个月、6个月随访尿流率及B超残余尿测定,最大尿流率无下降趋势(P>0.05),残余尿无增加(P>0.05),ICI-Q-SF评分明显改善(P<0.01)。术后仅1例患者拔出导尿管1周后出现排尿困难,经膀胱训练、理疗等保守治疗后症状好转,其余患者术后均获得满意的尿控效果。所有患者术后均有不同程度切口渗血,无膀胱、尿道、直肠损伤,无耻骨后血肿形成,无植入物排斥、感染等并发症。结论 TVT-O治疗FSUI临床疗效确切,安全性高,尤其对重度FSUI患者,症状改善更为显著。
Objective To investigate the clinical efficacy of transthoracic tension-free middle urethral suspension (TVT-O) in the treatment of female stress urinary incontinence (FSUI). Methods The clinical efficacy of TVT-O in 38 patients with moderate-severe FSUI and the maximum urinary flow rate at 1 month and 6 months after operation were analyzed. The ICI-Q-SF score was used to evaluate the TVT-O Surgical efficacy and surgical safety. Results All patients underwent successful operation. The successful rate of operation was 100%. The operation time was 16 ± 4 min, the intraoperative bleeding was 10 ± 3 ml, the postoperative catheterization time was 2 to 5 days (average 2.9 days) Hospitalization time 3 ~ 6 d, an average of 4.2 d. After 1 months and 6 months of follow-up, the urinary flow rate and B-residual urine were measured. The maximum uroflow rate did not decrease (P> 0.05), but the residual urine did not increase (P> 0.05) Improve (P <0.01). After surgery, only one patient had difficulty urinating after one week of catheter removal. After conservative treatment such as bladder training and physical therapy, the symptoms improved, and the remaining patients achieved satisfactory urine control after operation. All patients had different degrees of postoperative bleeding incision, no bladder, urethra, rectal injury, no post-pubic hematoma formation, no implant rejection, infection and other complications. Conclusion The clinical efficacy of TVT-O in the treatment of FSUI is accurate and safe, especially for patients with severe FSUI.