重度盆腔器官脱垂复位手术同时治疗隐匿性尿失禁的疗效

发布时间：2018-05-08 04:08

本文选题：隐匿性压力性尿失禁 + 盆腔器官脱垂　；参考：《中国人民解放军医学院》2014年硕士论文

【摘要】：研究目的：评价重度盆腔器官脱垂复位手术同时行抗尿失禁吊带(TVT/TVT-O)治疗隐匿性压力性尿失禁（occult stress urinary incontinence，OSUI）的临床疗效。研究方法：2003年6月至2012年12月，解放军总医院第一附属医院对符合纳入条件的78例重度盆腔器官脱垂合并OSUI者行脱垂复位手术，包括骶韧带高位悬吊、骶棘韧带固定及骶骨阴道固定术。同时行TVT/TVT-O的37例患者为加抗SUI手术组，未行抗尿失禁手术的41例患者为不加抗SUI手术组。对两组患者的各种临床指标及主、客观疗效进行比较。盆腔器官脱垂客观疗效评价采用POP定量（pelvic organprolapse quantitation，POP-Q）分度法，尿失禁主观疗效采用尿失禁困扰量表（Urinarydistress inventory）UDI-6和尿失禁影响问卷简表(incontinence impact questionnaireshort form)IIQ-7中文简版。研究结果：两组脱垂复位手术在脱垂复位的客观疗效上无显著差异，仅加抗SUI手术组比不加抗SUI手术组的手术时间延长15.8min；术后2、6、12个月随访，不加抗SUI手术组累计出现术后尿失禁主观症状的发生率高于加抗SUI手术组，，前组为12.2%（5/41）、14.6%（6/41）、17.1%（7/41），后组为2.7%（1/37）、2.7%（1/37）、2.7%（1/37），但两组无一例为此要求进一步行抗SUI治疗。两组患者术后随访期间UDI-6、IIQ-7中文简版评分分值较均术前显著下降（P0.01）,术后2、6、12个月两组间分别比较无明显差异。研究结论： 1.骶韧带高位悬吊、骶棘韧带固定及骶骨阴道固定术对阴道穹窿复位效果好。 2.尿道中段无张力聚丙烯吊带术操作安全简单，能有效治疗和预防POSUI的发生。 3.对于OSUI程度重的盆腔器官脱垂患者，盆底复位手术后尿失禁发生可能性大，建议同时行抗SUI手术。 4.对于OSUI程度轻的盆腔器官脱垂患者，术后出现尿失禁症状再做二次手术也不失为一种临床决策。
[Abstract]:Objective: to evaluate the clinical effect of severe pelvic organ prolapse reduction and antiurinary incontinence tape TVT / TVT-O in the treatment of occult stress urinary incontinence (occult stress urinary incontinence). Methods: from June 2003 to December 2012, 78 patients with severe pelvic organ prolapse associated with OSUI were treated in the first affiliated Hospital of PLA General Hospital, including high suspension of sacral ligament. Sacrospinous ligament fixation and sacral vagina fixation. At the same time, 37 patients with TVT/TVT-O were treated with anti SUI and 41 patients with no anti urinary incontinence were treated with anti SUI. The clinical indexes, subjective and objective effects of the two groups were compared. The objective efficacy of pelvic organ prolapse was evaluated by POP quantitative organprolapse quantitative method (POP-QQ). The subjective efficacy of urinary incontinence was evaluated by urinary incontinence distress inventory)UDI-6 and urinary incontinence impact questionnaireshort form)IIQ-7. Results: there was no significant difference in the objective effect of prolapse reduction between the two groups. The operation time of the group with anti SUI was 15.8 minutes longer than that of the group without anti SUI, and the postoperative time was 6 minutes after operation, and followed up for 12 months. The cumulative incidence of subjective symptoms of postoperative urinary incontinence in the group without anti SUI was higher than that in the group with anti SUI. In the former group, there were 5 / 41 / 14. 6 / 41 / 41 and 17 / 41 / 41 of urinary incontinence in the former group, and in the latter group it was 2. 7 / 1. 37 / 2. 7 / 1 / 37 in the latter group, but neither of the two groups required further treatment of anti SUI for this reason. During the follow-up period, the scores of UDI-6 and IIQ-7 were significantly lower than those before operation (P 0.01), but there was no significant difference between the two groups in 6 months and 12 months after operation. The study concluded that: 1. High suspension of sacral ligament, sacrospinous ligament fixation and sacral vagina fixation have good effect on vaginal fornix reduction. 2. Tension-free polypropylene sling in the middle urethra is safe and simple and can effectively treat and prevent the occurrence of POSUI. 3. Urinary incontinence after pelvic floor reduction is more likely in patients with severe OSUI degree of pelvic organ prolapse. It is recommended that anti SUI surgery be performed at the same time. 4. For pelvic organ prolapse patients with mild OSUI, it is a clinical decision to develop urinary incontinence and perform secondary surgery.
【学位授予单位】：中国人民解放军医学院
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R713

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