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目的:分析应用尿道折叠术、耻骨后库柏韧带悬吊术(Burch)、阴道无张力尿道中段悬吊带术(TVT)以及经闭孔经阴道尿道中段悬吊带术(TVT-O)治疗压力性尿失禁(SUI)患者的临床效果。方法:回顾分析83例尿失禁合并子宫、阴道脱垂患者的临床资料,根据行不同手术治疗,将其分为行尿道折叠术组(32例)、Burch组(15例)、TVT组(22例)以及TVT-O组(14例),并对4组的术中、术后及并发症情况进行比较。结果:①TVT-O组患者手术时间最短77.6±4.0分钟,与其他3组比较,差异有统计学意义(P<0.05)。TVT-O组和TVT组的患者在手术时间、留置尿管时间和住院天数上,与尿道折叠术组和Burch组比较,差异均有统计学意义(P<0.05)。②TVT-O组吊带侵蚀1例,术后排尿困难1例;TVT组吊带侵蚀1例,术后排尿困难3例;Burch组排尿困难4例;尿道折叠术组外阴血肿2例,下肢静脉血栓形成1例,术后排尿困难7例。③TVT-O组手术治愈率最高100%,TVT-O组患者2年治愈率92.86%。结论:TVT-O操作简单、治愈率高,在保证较低手术并发症的同时,实现了2年随访期限内理想稳定的治疗效果。TVT-O术是目前治疗压力性尿失禁的比较理想的手术方法。
OBJECTIVE: To analyze the effects of urethral fold, Burch, TPT and TVT-O transvaginal transthoracic urethral obstruction (TVT-O) Clinical effect of urinary incontinence (SUI). Methods: The clinical data of 83 cases with urinary incontinence complicated by uterine and vaginal prolapse were retrospectively analyzed. According to the different operation, they were divided into urethral collapse group (32 cases), Burch group (15 cases) and TVT group (22 cases) Cases) and TVT-O group (14 cases). The intraoperative, postoperative and complications of the four groups were compared. Results: ① The shortest operative time was 77.6 ± 4.0 minutes in TVT-O group, with statistical significance (P <0.05) compared with the other 3 groups. The TVT-O group and TVT group had significant differences in the operation time, indwelling catheter time and hospitalization days compared with the urethral collapse group and the Burch group (P <0.05). 1 case of TVT-O sling erosion, 1 case of dysuria after operation, 1 case of TVT sling erosion, 3 cases of dysuria after operation, 4 cases of dysuria in Burch group, 2 cases of vulvar hematoma in urethral fold group, 2 cases of venous thrombosis of lower extremity 1 case, dysuria in 7 cases. ③TVT-O group, the highest cure rate of 100%, TVT-O group 2-year cure rate was 92.86%. Conclusion: TVT-O is easy to operate and has high cure rate. It achieves the ideal and stable therapeutic effect within the 2-year follow-up period while ensuring lower surgical complications. TVT-O surgery is the ideal surgical treatment of stress urinary incontinence.