Lyons T L, Winer W K
Center for Women's Care and Reproductive Surgery, 3250 Howell Mill Road, Suite 304, Atlanta, GA 30327, USA.
J Am Assoc Gynecol Laparosc. 1995 Feb;2(2):193-8. doi: 10.1016/s1074-3804(05)80016-7.
Laparoscopic minimally invasive approaches to urinary stress incontinence have been described in the literature since 1989. Technical advances have improved both access to the space of Retzius and the operator's ability to accomplish retropubic colposuspension. In addition to the traditional open Burch procedures, a new laparoscopic method of colposuspension is available. In one group of women, laparoscopically guided procedures were performed in the classic fashion using only sutures. In the second laparoscopic group the suspension was performed with a combination of sutures and endoscopic staples (Nolan-Lyons modification of the Burch). The third group was analyzed retrospectively by chart review and patient interview for surgical outcome data. All groups were similar demographically. Clinical outcomes were similar in the laparoscopic groups, and surgical morbidity was significantly decreased compared with traditional open procedures. Relief of symptoms was similar in all groups at 1-year follow-up. We conclude that a laparoscopic approach to retropubic colposuspension is an effective alternative with improved clinical outcomes. Additional modifications that can improve surgeons' accessibility to these techniques are feasible, with comparable clinical outcomes.
自1989年以来，文献中已有关于腹腔镜微创治疗压力性尿失禁的描述。技术进步改善了进入Retzius间隙的途径以及术者完成耻骨后阴道悬吊术的能力。除了传统的开放式Burch手术外，一种新的腹腔镜阴道悬吊方法也已出现。在一组女性中，腹腔镜引导下的手术以经典方式仅使用缝线进行。在第二个腹腔镜组中，悬吊术采用缝线和内镜吻合器联合进行（Burch手术的Nolan-Lyons改良术）。第三组通过病历回顾和患者访谈进行回顾性分析以获取手术结果数据。所有组在人口统计学上相似。腹腔镜组的临床结果相似，与传统开放手术相比，手术并发症显著减少。在1年随访时，所有组的症状缓解情况相似。我们得出结论，腹腔镜耻骨后阴道悬吊术是一种有效的替代方法，临床结果有所改善。能够提高外科医生对这些技术可及性的其他改良方法是可行的，且临床结果相当。
