Chung Maurice K, Chung Rosemary P
Ob-Gyn Physicians, Incorporated, Regional Center for Bladder Control & Pelvic Relaxation, Lima, Ohio 45805, USA.
JSLS. 2002 Jan-Mar;6(1):17-21.
To compare the efficacy and safety of the tension-free vaginal tape (TVT) and laparoscopic Burch procedures in treating genuine stress urinary incontinence in obese patients.
This was a retrospective evaluation of 91 consecutive cases of TVT alone or TVT combined with other procedures from April 1999 through March 2000 and 51 consecutive cases of the laparoscopic Burch procedure from January 1998 through February 1999. All procedures were performed in a private practice and community hospitals in the midwest. One hundred forty-two women (ages 34 to 79) with stress urinary incontinence documented by clinical examination and preoperative cystometric and urodynamic evaluation were included in the study. They were also divided into 5 groups based on their body mass index (BMI): NL (normal-BMI < 25), OW (overweight-BMI 25 to 29), OBI (obesity I-BMI 30 to 34), OBII (obesity II-BMI 35 to 39), OBIII (obesity III-BMI > 40). In the TVT group, 66% were obese (OBI-21, OBII-17. OBIII-22) versus 36% in the laparoscopic Burch (OBI-13, OBII-5) group.
All TVT patients remain cured or symptoms improved in their genuine stress urinary incontinence, which favorably compares with the laparoscopic Burch procedure after 1 year. Operating time for the TVT portion ranged from 18 to 40 minutes. The laparoscopic Burch procedure in general took over 1 hour. No bladder, bowel, or vascular injuries have occurred in the TVT group. Superficial suprapubic ecchymoses have occurred in the TVT group occasionally but required no intervention. The average length of stay was 1 day; TVT-only patients usually were released on the same day. Ninety percent of patients were voiding normally by postoperative day 7. Most of the patients with continued urinary retention had had combined procedures.
This preliminary study indicates that TVT is a safer, more effective, and easier minimally invasive surgery for genuine stress urinary incontinence regardless of the patients' BMI and favorably compares with the laparoscopic Burch procedure, which requires advanced surgical skills.
比较无张力阴道吊带术（TVT）与腹腔镜Burch手术治疗肥胖患者真性压力性尿失禁的疗效及安全性。
对1999年4月至2000年3月连续91例行单纯TVT或TVT联合其他手术的病例以及1998年1月至1999年2月连续51例行腹腔镜Burch手术的病例进行回顾性评估。所有手术均在中西部的一家私人诊所和社区医院进行。纳入研究的142名女性（年龄34至79岁），经临床检查及术前膀胱测压和尿动力学评估确诊为压力性尿失禁。她们还根据体重指数（BMI）分为5组：NL（正常 - BMI < 25）、OW（超重 - BMI 25至29）、OBI（肥胖I级 - BMI 30至34）、OBII（肥胖II级 - BMI 35至39）、OBIII（肥胖III级 - BMI > 40）。TVT组中66%为肥胖患者（OBI级21例、OBII级17例、OBIII级22例），而腹腔镜Burch组为36%（OBI级13例、OBII级5例）。
所有TVT患者的真性压力性尿失禁均治愈或症状改善，与腹腔镜Burch手术后1年的情况相比效果良好。TVT部分的手术时间为18至40分钟。腹腔镜Burch手术一般耗时超过1小时。TVT组未发生膀胱、肠道或血管损伤。TVT组偶尔出现耻骨上浅表瘀斑，但无需干预。平均住院时间为1天；单纯TVT患者通常在同一天出院。90%的患者在术后第7天排尿正常。大多数持续尿潴留的患者接受了联合手术。
这项初步研究表明，无论患者的BMI如何，TVT都是一种更安全、有效且操作简便的治疗真性压力性尿失禁的微创手术，与需要先进手术技巧的腹腔镜Burch手术相比效果良好。
