耻骨后阴道悬吊术中自体腹直肌筋膜与尸体筋膜在控尿效果方面的比较。

Comparison of autologous rectus fascia and cadaveric fascia in pubovaginal sling continence outcomes.

作者信息

Howden Nancy S, Zyczynski Halina M, Moalli Pamela A, Sagan Elizabeth R, Meyn Leslie A, Weber Anne M

机构信息

Division of Urogynecology, Department of Obstetrics, Gynecology, and Reproductive Sciences, The University of Pittsburgh Health Sciences Center, Magee-Womens Hospital, Pittsburgh, PA, USA.

出版信息

Am J Obstet Gynecol. 2006 May;194(5):1444-9. doi: 10.1016/j.ajog.2006.01.058. Epub 2006 Mar 31.

DOI:10.1016/j.ajog.2006.01.058

PMID:16579930

Abstract

OBJECTIVE

The purpose of this study was to compare autologous versus cadaveric grafts in pubovaginal slings.

STUDY DESIGN

Women who had pubovaginal slings from 1994 to 2003 completed history, questionnaires, prolapse staging, and cough stress testing. Failure was defined by recurrent urinary incontinence symptoms and reoperation for stress incontinence. Group differences were evaluated using Student t test or chi-square test. The log-rank test was used to evaluate time to failure between the groups.

RESULTS

Of 303 women enrolled, 153 had autologous and 150 had cadaveric grafts. Regular urine leakage (39.6% vs 28.3%, P = .04) and reoperation for stress incontinence (12.7% vs 3.3%, P = .003) occurred more in the cadaveric versus autologous group, respectively. Adjusting for differing follow-up times, the cadaveric versus autologous group experienced higher rates of urinary incontinence (16 vs 5 per 100 women-years, P < .0001) and higher rates of reoperation (4 vs 1 per 100 women-years, P < .0003).

CONCLUSION

Autologous grafts used in pubovaginal slings have superior continence outcomes compared with cadaveric fascia.

摘要

目的

本研究旨在比较耻骨阴道吊带术中自体移植物与尸体移植物的效果。

研究设计

对1994年至2003年间接受耻骨阴道吊带术的女性进行病史采集、问卷调查、脱垂分期及咳嗽压力测试。失败定义为复发性尿失禁症状及因压力性尿失禁再次手术。采用Student t检验或卡方检验评估组间差异。采用对数秩检验评估两组间的失败时间。

结果

303名入选女性中，153例使用自体移植物，150例使用尸体移植物。尸体移植物组与自体移植物组相比，分别有更多的持续性尿失禁（39.6%对28.3%，P = .04）和因压力性尿失禁再次手术的情况（12.7%对3.3%，P = .003）。校正不同的随访时间后，尸体移植物组与自体移植物组相比，尿失禁发生率更高（每100女性年分别为16例对5例，P < .0001），再次手术率更高（每100女性年分别为4例对1例，P < .0003）。