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LSC 和 TVT-O 治疗合并盆腔器官脱垂的压力性尿失禁的临床疗效及影响术后尿功能恢复的因素。

Clinical Efficacy of LSC and TVT-O for Stress Urinary Incontinence Complicated with Pelvic Organ Prolapse and Factors Influencing Postoperative Urinary Function Recovery.

机构信息

Department of Gynecology and Obstetrics, Wenzhou Central Hospital, Wenzhou 325000, Zhejiang, China.

Department of Urology, Beidahuang Industry Group General Hospital, Harbin 150088, Heilongjiang, China.

出版信息

J Healthc Eng. 2022 Mar 7;2022:1557256. doi: 10.1155/2022/1557256. eCollection 2022.

Abstract

Pelvic organ prolapse is caused by various causes, which leads to the weakness of the tissue supporting the pelvic floor and then causes the downward displacement of female reproductive organs and adjacent organs. Clinical studies have shown that pop is often associated with stress urinary incontinence. This research project aimed to clarify the clinical effect of laparoscopic sacrocolpopexy (LSC) and tension-free vaginal tape obturator (TVT-O) for stress urinary incontinence (SUI) complicated with pelvic organ prolapse (POP) and the influencing factors of postoperative urinary function (UF) recovery. The clinical data of 125 patients with SUI complicated with POP treated in Wenzhou Central Hospital and Beidahuang Industry Group General Hospital between March 2018 and December 2019 were retrospectively analyzed. Patients were assigned to the following two arms based on different treatment methods: the combination group ( = 65, treated with LSC plus TVT-O) and the control group ( = 60, treated with LSC). The alterations of perioperative clinical and urodynamic indexes were analyzed. The objective and subjective response rates were observed and compared. The degree of POP before and after surgery was evaluated. According to the urinary function recovery time, the patients were divided into the fast and non-fast recovery groups, and then, the factors influencing postoperative UF recovery were analyzed between groups. The combination group showed statistically longer operation time (OT) and postoperative indwelling catheter and higher intraoperative blood loss (IBL) than the control group (all < 0.05), but the anal exhaust time and postoperative length of stay (LOS) differed insignificantly between the two arms. The combination group outperformed the control group in the objective response rate, as well as the scores of illness, quality of life (QOL), and sexual life (all < 0.05). Menopause, maximum flow rate (MFR), and preoperative residual urine volume were identified as the influencing factors for normal urination. For patients with SUI complicated with POP, the efficacy of laparoscopic sacrocolpopexy was limited, while combining with TVT-O would obtain more significant short-term and long-term efficacy, which can significantly improve patients' urination and long-term quality of life, with higher safety and clinical promotion value.

摘要

盆腔器官脱垂由多种原因引起,导致盆腔底部组织支撑力减弱,进而导致女性生殖器官和邻近器官向下移位。临床研究表明,POP 常与压力性尿失禁相关。本研究旨在明确腹腔镜骶骨阴道固定术(LSC)和无张力阴道吊带悬闭术(TVT-O)治疗压力性尿失禁(SUI)合并盆腔器官脱垂(POP)的临床效果及影响术后尿功能(UF)恢复的因素。回顾性分析 2018 年 3 月至 2019 年 12 月在温州中心医院和北大荒集团总医院接受治疗的 125 例 SUI 合并 POP 患者的临床资料,根据治疗方法不同分为联合组(LSC+TVT-O)65 例和对照组(LSC)60 例。分析围手术期临床和尿动力学指标的变化,观察并比较两组患者的客观和主观反应率,评估手术前后 POP 程度。根据术后 UF 恢复时间将患者分为快速恢复组和非快速恢复组,然后分析两组间术后 UF 恢复的影响因素。联合组的手术时间(OT)、术后留置导尿管时间和术中出血量(IBL)均长于对照组(均<0.05),但肛门排气时间和术后住院时间(LOS)差异无统计学意义。联合组在客观反应率、疾病评分、生活质量(QOL)评分和性生活评分方面均优于对照组(均<0.05)。绝经、最大尿流率(MFR)和术前残余尿量是正常排尿的影响因素。对于 SUI 合并 POP 患者,腹腔镜骶骨阴道固定术的疗效有限,而与 TVT-O 联合应用可获得更显著的短期和长期疗效,显著改善患者的排尿功能和长期生活质量,且具有较高的安全性和临床推广价值。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0888/8920663/abb9d90aa21a/JHE2022-1557256.001.jpg

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