Kiilholma P, Haarala M, Polvi H, Mäkinen J, Chancellor M B
Department of Obstetrics and Gynecology, Turku University Central Hospital, Finland.
Tech Urol. 1995 Summer;1(2):81-3.
Endoscopic colposuspension by using fibrin sealant as a substitute for sutures was performed in 17 women suffering from urodynamically verified type I-II stress urinary incontinence. Two-puncture technique was used with a 10-mm trocar for optics and a 5-mm trocar for instrumentation. The two-component fibrin sealant, Tisseel (1 ml) by using special applicator device, Duploject was applied with tube on both sides of the urethrovesical area. After that the urethrovesical junction was pressed for 5 min against the retropubic periost by the surgeon's index and middle fingers placed in the vagina. The average duration of the procedure was 20 min, excluding learning curve for the first two cases. The indwelling catheter and vaginal packing were removed and all patients discharged on the first postoperative day. All but two patients experienced excellent immediate response. Of the 12 patients followed > 6 months, 10 patients were completely dry and two were markedly improved. In our experience, laparoscopic colposuspension with fibrin sealant appears to be a promising new approach in correcting stress incontinence in women.
对17例经尿动力学证实为I-II型压力性尿失禁的女性患者实施了内镜下阴道膀胱悬吊术，使用纤维蛋白胶替代缝线。采用两穿刺技术，用10毫米套管针置入光学设备，5毫米套管针用于器械操作。使用特殊的涂抹装置Duploject将双组分纤维蛋白胶Tisseel（1毫升）通过导管涂抹于尿道膀胱区域两侧。之后，外科医生将食指和中指放入阴道，将尿道膀胱交界处向耻骨后骨膜按压5分钟。手术平均时长为20分钟，不包括前两例的学习曲线阶段。术后第一天拔除留置导尿管和取出阴道填塞物，所有患者均出院。除两名患者外，所有患者均立即获得了极佳的效果。在12例随访超过6个月的患者中，10例患者完全无尿失禁，2例明显改善。根据我们的经验，使用纤维蛋白胶的腹腔镜阴道膀胱悬吊术似乎是治疗女性压力性尿失禁的一种有前景的新方法。
