Ghezzi Fabio, Cromi Antonella, Raio Luigi, Bergamini Valentino, Triacca Paola, Serati Maurizio, Kuhn Annette
Department Obstetrics and Gynecology, University of Insubria P.zza Biroldi 1, 21100 Varese, Italy.
Eur J Obstet Gynecol Reprod Biol. 2005 Jan 10;118(1):96-100. doi: 10.1016/j.ejogrb.2004.06.019.
To evaluate the success rate of tension-free vaginal tape (TVT) performed under spinal and general anesthesia and to assess the efficacy of hydrodissection of the space of Retzius in reducing intraoperative and postoperative complications.
A total of 149 patients, were enrolled. Of these, 53 patients underwent the TVT placement (alone or in combination with other pelvic surgery) under general anesthesia and 96 under spinal anesthesia. TVT placement was performed as originally described, apart from the hydrodissection of the space of Retzius, that was performed only in 82 cases. In the remaining 67 patients the TVT needles were introduced directly without hydrodissection. Postoperatively, the patients were scheduled for evaluation at 1, 3, 6 and 12 months. Cure was defined as no postoperative stress incontinence.
Overall, the incidence of intraoperative and postoperative complications was 3.3% and 14.7%, respectively. No statistical difference was found in the intraoperative (1.9% versus 4.2%, P = 0.65) and postoperative complications (11.3% versus 16.7%) rates between the general and spinal anesthesia groups. No difference was found in the cure rate between groups (96.2% versus 95.8%). Similarly, no difference was found in the rate of intraoperative (3.7% versus 3.0%) and postoperative (15.9% versus 13.4%) complications between patients who had hydrodissection and those who did not. When the analysis was restricted to patients who underwent the TVT placement without concomitant surgery (n = 88), there was no difference in the incidence of intraoperative (2.1% versus 5.0%, P = 0.59) and postoperative complications (14.6% versus 15.0%, P = 1.0) between patients who had hydrodissection and those who did not.
Efficacy and safety of the TVT procedure are not affected by the type of anesthesia (general or loco-regional). Hydrodissection of the space of Retzius during TVT placement does not reduce the risks of intraoperative complications.
评估在脊髓麻醉和全身麻醉下进行无张力阴道吊带术（TVT）的成功率，并评估膀胱前间隙水分离术在降低术中及术后并发症方面的疗效。
共纳入149例患者。其中，53例患者在全身麻醉下接受TVT置入术（单独或与其他盆腔手术联合），96例在脊髓麻醉下接受该手术。TVT置入术按原描述进行，但仅82例患者进行了膀胱前间隙水分离术。其余67例患者直接插入TVT针而未进行水分离术。术后，安排患者在1、3、6和12个月时进行评估。治愈定义为术后无压力性尿失禁。
总体而言，术中及术后并发症发生率分别为3.3%和14.7%。全身麻醉组和脊髓麻醉组在术中（1.9%对4.2%，P = 0.65）及术后并发症发生率（11.3%对16.7%）方面未发现统计学差异。两组治愈率无差异（96.2%对95.8%）。同样，进行水分离术和未进行水分离术的患者在术中（3.7%对3.0%）及术后并发症发生率（15.9%对13.4%）方面也未发现差异。当分析仅限于未同时进行其他手术而接受TVT置入术的患者（n = 88）时，进行水分离术和未进行水分离术的患者在术中（2.1%对5.0%，P = 0.59）及术后并发症发生率（14.6%对15.0%，P = 1.0）方面无差异。
TVT手术的疗效和安全性不受麻醉类型（全身或局部区域）的影响。TVT置入术中膀胱前间隙水分离术并不能降低术中并发症的风险。
