无张力阴道吊带术及相关手术：一项病例对照研究。

Tension-free vaginal tape and associated procedures: a case control study.

作者信息

Rafii Arash, Paoletti Xavier, Haab François, Levardon Michel, Deval Bruno

机构信息

Service de Gynécologie, Hôpital Beaujon, 100 Boulevard du Général Leclerc, 92110 Clichy, France.

出版信息

Eur Urol. 2004 Mar;45(3):356-61. doi: 10.1016/j.eururo.2003.10.008.

DOI:10.1016/j.eururo.2003.10.008

PMID:15036683

Abstract

OBJECTIVES

We compare objective and subjective cure rates after tension-free vaginal tape procedures performed alone or in conjunction with vaginal procedures.

METHODS

One hundred eighty-six women underwent a tension-free vaginal tape procedure for stress or mixed urinary incontinence. One hundred women treated with tension-free vaginal tape alone (group 1) were compared with 40 women treated with tension-free vaginal tape and concomitant vaginal hysterectomy (group 2), and 46 patients treated with tension-free vaginal tape and pelvic floor reconstruction (group 3). Patient outcomes, surgical difficulties and complications are reported. Postoperative voiding diaries, standing stress-test results, and patient satisfaction were compared.

RESULTS

There were no significant differences among the three groups in terms of age, menopausal status, BMI, previous incontinence surgery, or the type and degree of incontinence. Parity was significantly higher in the group treated with tension-free vaginal tape and pelvic floor reconstruction ( p=0.04 ). The overall perioperative complication rate was 15.6%. Women treated with tension-free vaginal tape and hysterectomy (group 2), and those treated with tension-free vaginal tape and pelvic floor reconstruction (group 3) had a significantly higher incidence of bladder injury (17.9% and 13%, respectively, versus 5% in group 1; p=0.05 ). Estimated blood loss and the frequencies of postoperative urgency and voiding disorders did differ significantly between women treated with tension-free vaginal tape alone and those who underwent associated procedures. The mean follow-up time was 24.5+/-2.6 months. No difference in the objective cure rate was found between the tension-free vaginal tape group and the other two groups (93% versus 97.5% and 91.1%; p=0.3 ). No difference in the subjective cure rate was found between the tension-free vaginal tape group and the groups undergoing associated procedures (72% versus 72.5% and 68.8%; p=0.4).

CONCLUSION

Pelvic floor defects, benign uterine disorders and stress urinary incontinence can be safely treated with tension-free vaginal tape and vaginal procedures during the same surgical procedure.

摘要

目的

我们比较单纯行无张力阴道吊带术或联合阴道手术术后的客观治愈率和主观治愈率。

方法

186例女性因压力性或混合性尿失禁接受了无张力阴道吊带术。将单纯接受无张力阴道吊带术治疗的100名女性（第1组）与40名接受无张力阴道吊带术联合阴道子宫切除术治疗的女性（第2组）以及46名接受无张力阴道吊带术联合盆底重建术治疗的患者（第3组）进行比较。报告患者的治疗结果、手术难度及并发症。比较术后排尿日记、站立位压力试验结果及患者满意度。

结果

三组患者在年龄、绝经状态、体重指数、既往尿失禁手术史或尿失禁类型及程度方面无显著差异。接受无张力阴道吊带术联合盆底重建术治疗的组产次显著更高（p = 0.04）。围手术期总体并发症发生率为15.6%。接受无张力阴道吊带术联合子宫切除术治疗的女性（第2组）以及接受无张力阴道吊带术联合盆底重建术治疗的女性（第3组）膀胱损伤发生率显著更高（分别为17.9%和13%，而第1组为5%；p = 0.05）。单纯接受无张力阴道吊带术治疗的女性与接受相关联合手术的女性相比，估计失血量以及术后尿急和排尿障碍的发生率确实存在显著差异。平均随访时间为24.5±2.6个月。无张力阴道吊带术组与其他两组的客观治愈率无差异（93%对97.5%和91.1%；p = 0.3）。无张力阴道吊带术组与接受相关联合手术的组主观治愈率无差异（72%对72.5%和68.8%；p = 0.4）。