耻骨后和经闭孔尿道中段悬吊术对不同分型压力性尿失禁疗效的长期随访

目的:评估耻骨后尿道中段悬吊术(tension-free vaginal tape,TVT)和经闭孔尿道中段悬吊术(trans-obturator tape,TOT)治疗不同分型女性压力性尿失禁(female stress urinary incontinence,FSUI)的长期疗效。方法:回顾性分析2008年1月至2016年6月于北京大学人民医院行尿道中段悬吊术(mid-urethral slings,MUS)的FSUI患者的临床资料,并对所有患者进行随访。根据患者腹压漏尿点压(abdominal leak point pressures,ALPP)对FSUI进行分型,ALPP≤60 cmH₂O(1 cmH₂O=0.74 mmHg)为尿道固有括约肌缺陷(intrinsic sphincter deficiency,ISD)型,ALPP>60 cmH₂O为非ISD型。结合国际尿失禁咨询委员会尿失禁问卷表简表,根据患者术后漏尿症状较术前改善的程度,将手术疗效判定为治愈、好转或无效。通过分别对比ISD型、非ISD型患者中TVT术和TOT术的治愈率,来评估TVT术和TOT术对不同分型FSUI的疗效。结果:共170例FSUI患者纳入研究,患者年龄30在~78岁,随访时间12~110个月,其中非ISD型患者共117例,30例行TVT术,治愈率86.7%(26/30), 87例行TOT术,治愈率 69.0%(60/87),TVT术较TOT术治愈率高,但卡方检验显示差异无统计学意义(χ ²=3.589,P>0.05);ISD型患者共53例,16例行TVT术,治愈率87.5%(14/16), 37例行TOT术,治愈率51.4%(19/37),TVT术较TOT术治愈率高,卡方检验显示差异具有统计学意义(χ ²=6.212,P<0.05)。结论:MUS治疗FSUI可取得满意的长期疗效,对于非ISD型患者,TVT术和TOT术两种方式治愈率相当,但对于ISD型患者,TVT术较TOT术治愈率更高。

Long-term follow-up of the efficacy of tension-free vaginal tape and trans-obturator tape for different types of stress urinary incontinence

Objective: To evaluate the long-term efficacy of tension-free vaginal tape(TVT)and trans-obturator tape(TOT)for different types of female stress urinary incontinence(FSUI).Methods: The cli-nical data of all female patients with stress urinary incontinence (SUI) who underwent mid-urethral slings (MUS) in Peking University People’s Hospital from January 2008 to June 2016 were retrospectively analyzed,and all the patients were followed up. Based on the level of abdominal leak point pressure (ALPP), the patients with ALPP lower than or equal to 60 cmH₂O (1 cmH₂O=0.74 mmHg) were regarded as intrinsic sphincter deficiency (ISD) type, and the patients with ALPP higher than 60 cmH₂O were regarded as non-ISD type. According to the degree of remission of leakage of urine by using the International Consultation on Incontinence Questionnaire Short Form (ICI-Q-SF), the surgical outcomes were divided into three categories: cured, improved or failed. The efficacy of TVT and TOT for different types of FSUI was evaluated by comparing the cure rate of TVT with the cure rate of TOT in ISD type and non-ISD type separately.Results: A total of 170 patients were included in this study. The patients were among 30-78 years, and the follow-up period were among 12-110 months. In the study, 117 patients belonged to non-ISD type. Of whom 30 underwent TVT with a cure rate of 86.7% (26/30), and the other 87 underwent TOT with a cure rate of 69.0% (60/87). The cure rate of TVT was higher than that of TOT in non-ISD type, however, Chi-square test showed that there was no significant difference (χ ²=3.589, P>0.05). In addition, 53 patients belonged to ISD type, of whom 16 underwent TVT with a cure rate of 87.5% (14/16), and the other 37 underwent TOT with a cure rate of 51.4% (19/37). The cure rate of TVT was higher than that of TOT in ISD type, and Chi-square test showed that the difference was statistically significant (χ ²=6.212, P<0.05).Conclusion: For the treatment of FSUI, MUS can achieve satisfactory long-term efficacy. For non-ISD type, the cure rates of TVT and TOT are similar, while for ISD type, the cure rate of TVT is higher than that of TOT.