Tamussino K F, Hanzal E, Kölle D, Ralph G, Riss P A
Department of Obstetrics and Gynecology, University of Graz, Austria.
Obstet Gynecol. 2001 Nov;98(5 Pt 1):732-6. doi: 10.1016/s0029-7844(01)01565-4.
To assess the use of and perioperative complications associated with the tension-free vaginal tape operation with a central registry.
Fifty-five gynecology units completed questionnaires on patients undergoing the tension-free vaginal tape operation. Information was collected on patient, surgical, and postoperative data.
A total of 2795 patients were entered. Overall, 773 patients (28%) had undergone previous surgery for incontinence or prolapse; 1640 (59%) tension-free vaginal tapes were performed as isolated operations, and 1155 (41%) were done in combination with other procedures. The median operating time for tension-free vaginal tapes alone was 30 minutes (range 10-120). Of the isolated tension-free vaginal tapes, 727 (44%) were performed with local, 711 (43%) with regional, and 193 (12%) with general anesthesia. In patients undergoing tension-free vaginal tape only, postoperative bladder drainage was obtained with intermittent catheterization in 389 (24%) patients, an indwelling urethral catheter in 1032 (63%), and a suprapubic catheter in 143 (9%). The bladder perforation rate was 2.7% overall (n = 75) and higher in patients with than in those without previous surgery (4.4% compared with 2.0%, P =.01). There were four bladder perforations (3.3%) among the 120 patients with previous colposuspension. Most patients undergoing tension-free vaginal tape only were able to void the next day (range 0 to over 64). A total of 68 patients (2.4%) required reoperation for reasons related to the tape (39 to loosen, remove, or cut the tape, or to place a suprapubic catheter, 19 for hematoma, one for bowel injury).
The tension-free vaginal tape has become a frequently performed operation in Austria. There are considerable variations in clinical practice. The risk of bladder perforation was increased in patients with previous surgery. Severe complications were rare.
通过中央登记处评估无张力阴道吊带手术的使用情况及围手术期并发症。
55个妇科单位完成了关于接受无张力阴道吊带手术患者的问卷调查。收集了患者、手术及术后数据。
共纳入2795例患者。总体而言，773例患者（28%）曾因尿失禁或盆腔器官脱垂接受过手术；1640例（59%）无张力阴道吊带手术为单独进行，1155例（41%）与其他手术联合进行。单独进行无张力阴道吊带手术的中位手术时间为30分钟（范围10 - 120分钟）。在单独进行的无张力阴道吊带手术中，727例（44%）采用局部麻醉，711例（43%）采用区域麻醉，193例（12%）采用全身麻醉。仅接受无张力阴道吊带手术的患者中，389例（24%）术后通过间歇性导尿进行膀胱引流，1032例（63%）留置尿道导管，143例（9%）留置耻骨上导管。总体膀胱穿孔率为2.7%（n = 75），有既往手术史的患者高于无既往手术史的患者（4.4% 对比2.0%，P = 0.01）。在120例曾接受过阴道前壁悬吊术的患者中有4例膀胱穿孔（3.3%）。大多数仅接受无张力阴道吊带手术的患者术后第二天能够排尿（范围0至超过64天）。共有68例患者（2.4%）因与吊带相关的原因需要再次手术（39例为松解、移除或切断吊带，或放置耻骨上导管，19例为血肿，1例为肠损伤）。
无张力阴道吊带手术在奥地利已成为一种常见手术。临床实践存在较大差异。有既往手术史的患者膀胱穿孔风险增加。严重并发症罕见。
