Ross J
Center for Reproductive Medicine and Laparoscopic Surgery, 254 San Jose Street, Salinas, CA 93901, USA.
J Am Assoc Gynecol Laparosc. 1996 May;3(3):351-7. doi: 10.1016/s1074-3804(96)80063-6.
To determine if outpatient laparoscopic Burch procedure performed with mesh and staples is as effective as that done with the suture technique.
Prospective, randomized study.
Community hospital.
Sixty-nine women with genuine stress incontinence (GSI) randomly assigned to either the suture group (group 1) or the mesh-staple group (group 2).
Before surgery each patient had a complete history, physical and neurologic examinations, 24-hour urolog, urology questionnaire, urine culture and sensitivity, Q-Tip test, transperineal ultrasound, cough stress test, cystourethroscopy, and cystometrogram. Stress incontinence was diagnosed by positive Q-Tip, ultrasound, and cough stress tests and a negative cystometrogram for detrusor contraction. The laparoscopic Burch procedures were performed with either sutures for bladder neck elevation or with mesh and staples. Clinical and, if necessary, urodynamic studies were repeated at 6 weeks and 1 year postoperatively. MEASYRENEBTS AND MAIN RESULTS: The cure rate at 1 year was 91% in group 1 and 94% in group 2. Only objective cures by urologic testing are reported. The hypermobile urethra, as tested by transperineal ultrasound, was cured by both procedures. Of the 69 women, 68 were able to void spontaneously within 24 hours.
Early results suggest that laparoscopic Burch colposuspension is effective in curing GSI. Both sutures and mesh with staples yield good outcomes.
确定采用网片和吻合器的门诊腹腔镜Burch手术与缝合技术手术的效果是否相同。
前瞻性随机研究。
社区医院。
69名真性压力性尿失禁（GSI）女性，随机分为缝合组（第1组）或网片-吻合器组（第2组）。
手术前，每位患者均进行了完整的病史、体格和神经系统检查、24小时尿流率测定、泌尿外科问卷、尿培养及药敏试验、棉签试验、经会阴超声检查、咳嗽压力试验、膀胱尿道镜检查和膀胱测压。通过棉签试验、超声检查和咳嗽压力试验阳性以及逼尿肌收缩膀胱测压阴性来诊断压力性尿失禁。腹腔镜Burch手术采用膀胱颈抬高缝合或网片和吻合器进行。术后6周和1年重复进行临床及必要的尿动力学研究。
第1组1年治愈率为91%，第2组为94%。仅报告通过泌尿外科检查的客观治愈情况。经会阴超声检查显示的尿道过度活动在两种手术中均得到治愈。69名女性中，68名在24小时内能够自主排尿。
早期结果表明，腹腔镜Burch阴道悬吊术对治愈GSI有效。缝合和网片加吻合器均能取得良好效果。
