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[腹腔镜骶骨阴道固定术(LSC)与UPHOLD型经阴道网状植入术:一项病例对照研究]

[LSC (LAPAROSCOPIC SACROCOLPOPEXY) VERSUS UPHOLD TYPE TVM: A CASE CONTROL STUDY].

作者信息

Sato Hirotaka, Teramoto Sakiko, Abe Hirokazu, Mochida Junichi, Takahashi Satoru

机构信息

Department of Urology, Hokusuikai Memorial Hospital.

Department of Urology, Kikuna Memorial Hospital.

出版信息

Nihon Hinyokika Gakkai Zasshi. 2019;110(2):112-118. doi: 10.5980/jpnjurol.110.112.

Abstract

(Objective) The comparative analysis of post-surgery condition of lower urinary tract symptoms of LSC and Uphold-type TVM. (Methods) Since August 2015, our hospital introduced LSC and launched Uphold-type TVM in May 2017. 25 cases were examined by December 2017. In comparison with 37 cases of LSC conducted simultaneously, OABSS, IPSS, ICIQ-SF as well as uroflowmetry and residual urine measurement were performed with focus on perioperative complications and postoperative (3 months) lower urinary tract symptoms. As can be observed from the patient background, the average age of subject patients were close to 77 years old for TVM group, 70 years old for LSC group. LSC group showed a tendency to be observed among younger patients. (Result) In Stage II of Pelvic organ prolapse quantification (POP-Q) most of the mild cases (8 cases in TVM group and 3 cases in LSC group) existied. The type of pelvic organ prolapse (most protruding part) was bladder. Many cystoceles in the TVM group (15 cases in the TVM group and 10 cases in the LSC group) were observed. The average operation time was 115 minutes in the TVM group and 214 minutes in the LSC group which was longer. The average bleeding amount was 54 ml in the TVM group and 10 ml in the LSC group, which was quite small. For the intraoperative complication, in 2 cases bleeding volume 100 ml or more were observed in the TVM group. Bladder injury was found in 1 case. (Conclusion) Regarding postoperative complications, one case of vaginal erosion in TVM group, one case of port suture failure in LSC group, one case of de novo OAB were observed respectively. OABSS, total urinary urgency, IPSS, residual urine were improved in both groups. Both types of surgery are expected to improve lower urinary symptoms and considered to be a useful tool for treatment of pelvic organ prolapse.

摘要

(目的)对LSC和支撑型经阴道网状物(Uphold-type TVM)术后下尿路症状情况进行对比分析。(方法)自2015年8月起,我院引入LSC,并于2017年5月开展支撑型经阴道网状物手术。截至2017年12月,共检查了25例患者。与同期进行的37例LSC患者相比,重点关注围手术期并发症和术后(3个月)下尿路症状,进行了膀胱过度活动症症状评分(OABSS)、国际前列腺症状评分(IPSS)、国际咨询问卷-简表(ICIQ-SF)以及尿流率和残余尿量测量。从患者背景来看,TVM组受试患者的平均年龄接近77岁,LSC组为70岁。LSC组在年轻患者中更为常见。(结果)在盆腔器官脱垂定量分期(POP-Q)的II期,大多为轻度病例(TVM组8例,LSC组3例)。盆腔器官脱垂类型(最突出部位)为膀胱。TVM组观察到许多膀胱膨出(TVM组15例,LSC组10例)。TVM组平均手术时间为115分钟,LSC组较长,为214分钟。TVM组平均出血量为54毫升,LSC组为10毫升,量相当少。术中并发症方面,TVM组有2例出血量达100毫升或更多。发现1例膀胱损伤。(结论)术后并发症方面,TVM组有1例阴道糜烂,LSC组有1例端口缝合失败,各有1例出现新发膀胱过度活动症。两组的OABSS、总尿急、IPSS、残余尿量均有所改善。两种手术方式均有望改善下尿路症状,被认为是治疗盆腔器官脱垂的有效手段。

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