经耻骨上尿道中段吊带术治疗女性压力性尿失禁的影像尿动力学评价

目的 采用影像尿动力学检查对经耻骨上尿道中段吊带术(SPARC)治疗女性压力性尿失禁的临床疗效进行评价.方法 对2007年1月至2008年10月收治的35例女性压力性尿失禁患者行SPARC.于术前、术后3个月、术后6个月进行国际尿失禁问卷简表(ICI-Q-SF)症状评分、术后1h尿垫试验、影像尿动力学检查并评价疗效.结果 32例患者获得有效随访,随访时间6～20个月,31例患者术后尿控满意,1例有轻度尿失禁.影像尿动力学检查:术后3、6个月最大膀胱容量(MCC)、残余尿(RU)、最大尿流率时逼尿肌压力(Pdet,Qmax)与术前比较差异无统计学意义(P＞0.05).术后3个月,腹压漏点压力(ALPP)与术前比较差异有统计学意义(P值为0.000).术后6个月,最大尿流率(Qmax)、ALPP与术前比较差异有统计学意义(P值分别为0.003、0.000).静态尿道压力图手术前后参数术前、术后3个月、术后6个月,最大尿道关闭压力(MUCP)分别为(35.2±20.4)、(53.1±22.5)、(62.3±19.8)cm H2O(1 cm H2O=0.098 kPa),功能尿道长度(FUL)分别为(3.5±1.3)、(3.9±0.9)、(4.2±1.1)cm,术后6个月MUCP、FUL与术前比较差异有统计学意义(P值分别为0.000和0.002).影像学方面比较,术后显示在增加腹压或咳嗽试验时,膀胱颈及后尿道活动度下降,中段尿道相对固定,尿道闭合.结论通过影像尿动力学评价,SPARC是治疗女性压力性尿失禁的有效方法之一,6个月内影像尿动力学评价提示手术能提高尿道压力,加强控尿功能,同时对膀胱功能无显著影响.

The evaluation of the efficacy of the suprapubic arch sling in female stress urinary incontinence by video-urodynamic tests

Objective To evaluate the efficacy of the suprapubic arch sling(SPARC)in female stress urinary incontinence by video-urodynamic tests.Method From January 2007 to October 2008,video-urodynamic tests,the pad test and ICI-Q-SF had been performed in all patients who received the SPARC before operation and 3,6 months after operation.Results Thirty-two cases of an effective follow-up for 6 to 20 months,31 patients were satisfied with urinary control,1 patient had mild urinary incontinence.Urodynamics:3,6 months after operation the maximum bladder capacity(MCC),residual urine(RU),detrusor pressure at maximum flow rates(Pdet,Qmax)were no statistical differences compared with those before operation(P＞ 0.05),3 months after operation,abdominal leak point pressure(ALPP)difference was statistically significant compared with that before operation(P =0.000),6 months after operation,the maximum urinary flow rate(Qmax),ALPP differences were statistically significant compared with those before operation(P values were 0.003,0.000).Static urethral pressure profile parameters before operation and 3,6 months after operation,the maximum urethral closure pressure(MUCP)was(35.2 ± 20.4),(53.1 ±22.5),(62.3 ± 19.8)cm H2O(1 cm H20 =0.098 kPa),respectively,functional urethral length(FUL)was (3.5 ± 1.3),(3.9 ± 0.9),(4.2 ± 1.1)cm,respectively,6 months after operation,MUCP,FU L differences were statistically significant compared with before operation(P values were 0.000 and 0.002).Conclusion Urodynamic evaluation by image,SPARC is one of the effective methods to treat the female stress urinary incontinence,the image within 6 months of urodynamic evaluation prompt surgery can increase urethral pressure,strengthen the control of urinary function,while no significant effect on bladder function.