Lee C L, Yen C F, Wang C J, Huang K G, Soong Y K
Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Chang Gung University, Linkou Medical Center, Taipei, Taiwan.
Int Surg. 1998 Jul-Sep;83(3):262-4.
To validate our experience in extraperitoneoscopic colposuspension for genuine stress incontinence.
Between March 1995 and July 1996, 48 women who had genuine stress incontinence underwent extraperitoneoscopic colposuspension in our institute. After standard laparascopic surgery preparation, a 10 mm puncture site was made midline just in the cm above the pubic hair line, and the extraperitoneal space was developed with the higher pressure of insufflating CO2. A pair of sutures was inserted at the level of the midurethral and unrethrovesical junction with Cooper's ligament.
All of these patients underwent the same procedures. The average blood loss was less than 50 ml, with a range from 10 to 200 ml. The operative time was from 20 to 90 min, with a mean time of 32 min. There was one bladder injury, 2 cases of voiding difficulties and 2 of detrussor instability in our series and the overall complication rate was 10.4%. So far, 45 of the 48 patients are satisfied with the surgery.
Laparoscopic Burch colposuspension is a practicable surgical procedure for managing stress incontinence. Extraperitoneal space was created easily with the higher pressure of insufflating CO2. An extraperitoneoscopic approach can reduce the necessity of laparscopic suturing. Moreover, it avoids violating the peritonel cavity and reduces the potential risk of postoperative adhesion formation and the discomfort resulting from pneumoperitonium. Thus, extraperitoneal colposuspension affords an alternative to laparoscopic or abdominal retropubic colposuspension in well-selected patients.
验证我们在腹膜外腹腔镜膀胱颈悬吊术治疗真性压力性尿失禁方面的经验。
1995年3月至1996年7月，48例真性压力性尿失禁女性在我院接受了腹膜外腹腔镜膀胱颈悬吊术。在进行标准的腹腔镜手术准备后，于耻骨联合上缘中线处做一个10mm的穿刺点，以较高压力注入二氧化碳来建立腹膜外间隙。在尿道中段和尿道膀胱交界处与库珀韧带水平插入一对缝线。
所有这些患者均接受了相同的手术操作。平均失血量少于50ml，范围为10至200ml。手术时间为20至90分钟，平均时间为32分钟。本系列中有1例膀胱损伤、2例排尿困难和2例逼尿肌不稳定，总体并发症发生率为10.4%。到目前为止，48例患者中有45例对手术满意。
腹腔镜Burch膀胱颈悬吊术是治疗压力性尿失禁的一种可行的手术方法。通过较高压力注入二氧化碳可轻松建立腹膜外间隙。腹膜外腹腔镜手术方法可减少腹腔镜缝合的必要性。此外，它避免了侵犯腹膜腔，降低了术后粘连形成的潜在风险和气腹引起的不适。因此，在精心挑选的患者中，腹膜外膀胱颈悬吊术为腹腔镜或经腹耻骨后膀胱颈悬吊术提供了一种替代方法。
