两种吊带手术治疗女性压力性尿失禁疗效分析

发布时间：2018-08-29 12:49

【摘要】：压力性尿失禁(stress urinary incontinence,SUI)对女性来讲,是一种常见的、令人烦恼的、花费较高的疾病。国外报道约为33%的成年女性会发生尿失禁,且年龄越大,发病率会随之增高。国内报道,SUI在成年女性中平均发病率约是18.9%,SUI发生率最高是在50岁~59岁,为28.0%,且年龄越大,发病率会随之增高。对于SUI的治疗,美国泌尿协会(American Urological Association,AUA)提出手术治疗疗效确定。2013年学者Lucas提出的SUI外科手术治疗指南将尿道中段无张力悬吊术作为治疗SUI的A级推荐。该术式有三代,第二代的经闭孔阴道无张力尿道中段悬吊术(trans-obturator tension-free vaginal tape,TVT-O)成为常用术式,5年治愈率高达90.8%。而后提出的单切口可调节A-JUST吊带悬吊术(adjustable single-incision sling,A-JUST)各国家随访6~12个月治愈率在80%~91%。国外研究报道,A-JUST手术与常用的TVT-O手术相比,主客观治愈率无明显差异,疗效确切。A-JUST手术2012年在我国首次应用,国内对两种手术疗效对比研究较少。本研究通过回顾观察分析两种吊带手术治疗SUI的临床效果,为SUI个体化手术治疗方案的选择提供临床依据。目的对比A-JUST手术和TVT-O手术治疗女性SUI的临床疗效,探讨两种手术方式治疗女性SUI有无异同。为SUI的临床手术个体化方案的选择提供随访依据。资料与方法选取2013年1月至2014年12月就诊郑州大学第三附属医院的确诊为SUI并由同一医师行手术治疗的患者共105例,其中行A-JUST手术治疗组(A-JUST组)患者53例,行TVT-O手术治疗组(TVT-O组)患者52例,记录两组年龄、病程、孕产次、体质指数(BMI)、一小时尿垫试验重量,合并手术等一般资料。统计两组手术时间、术中出血量、术后大腿内侧牵扯痛情况、术后拔除尿管时间、住院天数等围手术期资料。两组患者分别于术前、术后6、12、24个月门诊复查、电话或邮件等方式随访,填写尿失禁生活质量问卷(I-QOL)和抗尿失禁术后患者全身状况改善问卷(PGI-I)进行评分,并了解术后排尿、漏尿情况和术后24个月并发症发生情况。对以上记录的资料进行统计学分析,P0.05为有统计学差异。结果1.两组患者术前资料相比较,无统计学差异(P0.05),两组资料具有可比性。2.两组患者手术时间、术中出血量、术后拔除尿管时间相比,差异无明显统计学意义(P0.05)。A-JUST组1例患者术后第1天出现大腿内侧牵扯痛,TVT-O组8例患者术第2天出现大腿内侧牵扯痛,大腿内侧牵扯痛发生率两组分别为1.9%、13.4%,P=0.010,差异有明显统计学意义。A-JUST组平均住院天数为3.58±1.44天,TVT-O组平均住院天数为7.47±1.83天,P=0.000,差异有明显统计学意义。3.术前、术后6、12、24个月I-QOL评分A-JUST组分别为25.27±4.43、90.43±4.42、90.48±4.39、87.15±5.52,术后各时间段随访后I-QOL评分均较术前显著提高,有统计学差异(P0.05);TVT-O组分别为22.17±3.72、90.28±6.76、90.63±6.05、86.63±5.65,术后评分较术前明显改善,有统计学差异(P0.05)。两组间比较,术前、术后各时间段随访的I-QOL评分之间无明显差异(P0.05),两组患者术前生活质量受疾病影响程度相当,手术治疗后生活质量明显提高。4.术后6月随访的漏尿情况,评价客观治愈率,A-JUST组为88.7%,TVT-O组为86.5%,P=0.932;PGI-I评分评价主观治愈率,A-JUST组为88.7%,TVT-O组为92.3%,P=0.884。两组主、客观治愈率无明显统计学差异,治疗效果相当,均能有效治疗SUI。5.随访术后24个月可能的并发症,A-JUST组3例出现腹压增加时漏尿,1例患者出现性交时异物感,并发症发生率为7.5%(4/53)。TVT-O组2例出现腹压增加时漏尿,1例出现吊带少许外露。并发症发生率为5.8%(3/52)。两组比较无明显统计学差异(χ~2=0.117,P0.05)结论A-JUST手术治疗SUI短期随访疗效明显,与TVT-O手术主、客观治愈率接近,两种手术均适用于各种程度的SUI,且治疗效果明显。A-JUST手术具有住院时间短、术后大腿内侧牵扯痛率低的优势。
[Abstract]:Stressurinary incontinence (SUI) is a common, troublesome and costly disease for women. About 33% of adult women reported abroad will have urinary incontinence, and the older the age, the higher the incidence. Domestic reports, the average incidence of SUI in adult women is about 18.9%, the highest incidence of SUI. Surgical treatment for SUI was proposed by the American Urological Association (AUA). In 2013, Lucas, a scholar, recommended the Middle Urethral tension-free suspension as a Grade A treatment for SUI. In three generations, the second generation of trans-obturator tension-free vaginal tape (TVT-O) has become a common procedure, with a 5-year cure rate of 90.8%. The subsequent single-incision adjustable A-JUST sling (A-JUST) has a cure rate of 80%-91% in 6-12 months follow-up. Overseas studies reported that the subjective and objective cure rates of A-JUST surgery were not significantly different from those of TVT-O surgery. A-JUST surgery was first used in China in 2012, and there were few comparative studies on the efficacy of the two kinds of surgery in China. Objective To compare the clinical effects of A-JUST operation and TVT-O operation in the treatment of female SUI, and to explore the similarities and differences between the two methods. A total of 105 patients with SUI were operated on by the same surgeon. 53 patients in the A-JUST group and 52 patients in the TVT-O group were operated on. The age, course of disease, pregnant and parturient times, body mass index (BMI), weight of one-hour urine pad test and combined operation were recorded. During the operation, the amount of bleeding during the operation, the pain in the medial thigh after operation, the time of catheter removal and the length of hospitalization were recorded. Results 1. There was no significant difference in preoperative data between the two groups (P 0.05). The operative time and intraoperative bleeding were comparable between the two groups. 2. Among the 8 patients in TVT-O group, the incidence of medial thigh traction pain was 1.9%, 13.4%, P = 0.010 respectively. The difference was statistically significant. The average incidence of medial thigh traction pain was 1.9%, 13.4%, P = 0.010 in A-JUST group. The average hospitalization days in TVT-O group were 7.47 [1.83], P = 0.000, and the difference was statistically significant. 3. The I-QOL scores of A-JUST group were 25.27 [4.43], 90.43 [4.42], 90.48 [4.39], 87.15 [5.52] at 6, 12 and 24 months after operation, respectively. The I-QOL scores of TVT-O group were significantly higher than those before operation (P There was no significant difference in I-QOL scores between the two groups (P 0.05). There was no significant difference in I-QOL scores between the two groups (P 0.05). After 6 months follow-up, the leakage of urine in A-JUST group was 88.7%, TVT-O group was 86.5%, P = 0.932; PGI-I score was 88.7% in A-JUST group, 92.3% in TVT-O group, P = 0.884. There was no significant difference in subjective and objective cure rate between the two groups, and the curative effect was comparable. Possible complications occurred 24 months later in group A-JUST, including 3 cases with increased abdominal pressure and 1 case with foreign body sensation during intercourse. The incidence of complications was 7.5%(4/53). In group TVT-O, 2 cases with increased abdominal pressure leaked urine and 1 case with slight sling exposure. The incidence of complications was 5.8%(3/52). There was no significant difference between the two groups (_~2=0.117, P 0.05). The short-term follow-up effect of A-JUST operation on SUI is obvious, which is close to the subjective and objective cure rate of TVT-O operation. Both operations are suitable for various degrees of SUI, and the effect is obvious. A-JUST operation has the advantages of short hospital stay and low incidence of medial thigh traction pain after operation.
【学位授予单位】：郑州大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R699.7

【参考文献】