无张力阴道吊带术微创治疗女性压力性尿失禁

目的:评价无张力阴道吊带术(TVT)治疗女性压力性尿失禁的疗效。方法:对女性压力性尿失禁患者18例,经临床和尿动力学检查确诊,均为稳定性膀胱,无膀胱出口梗阻。采用TVT术,将吊带无张力置于尿道中段。结果:手术时间平均(40±6)min;术中出血量平均(43±11) ml;术后平均留置导尿1.5d;术后平均住院3d。18例患者术后尿失禁症状均消失。1例患者术后出现尿潴留,留置导尿1 周后好转,尿潴留症状消失,尿失禁未复发。结论:TVT手术因其简单,微创,疗效好,并发症少,目前可作为女性压力性尿失禁手术治疗的首选术式。     

无张力阴道吊带术治疗女性压力性尿失禁

目的：探讨无张力阴道吊带术(TVT)治疗女性压力性尿失禁的初步疗效和手术安全性。方法：对20例经过临床和尿动力学检查诊断为压力性或混合性尿失禁的女性患者进行TVT手术治疗，并对手术效果和并发症进行初步的随访研究。结果：平均手术时间40min(25—100min)，平均术后住院3．2d(1—28d)。18例单纯性压力性尿失禁患者16例治愈，治愈率为88．89％(16／18)，另2例显效(11．1％)。2例混合性尿失禁患者中1例显效，另1例无效。术后发生尿潴留3例，2例作松解术，1例延长导尿管留置时间后缓解。发生局部血肿1例经保守治疗后康复。结论：TVT手术是一种治疗压力性尿失禁的安全有效的方法，具有手术简单、创伤小、并发症少、患者康复快等优点。     

无张力阴道吊带术治疗女性压力性尿失禁(附40例报告)

目的探讨无张力阴道吊带(tension-freevaginaltape,TVT)术治疗女性压力性尿失禁的临床疗效及手术安全性。方法对40例单纯性压力性尿失禁女性患者行TVT术,并对手术效果和并发症进行随访研究。结果平均手术时间45min,平均术后住院时间4d。拔尿管后发生急性尿潴留4例,行尿道扩张、保留导尿后恢复正常排尿。术中发生膀胱穿孔1例,予留置尿管7d,不影响疗效。40例随访3~24个月,治愈率为95%,好转率为5%,无尿失禁复发。结论TVT治疗女性压力性尿失禁操作简便、安全有效、创伤小、恢复快、并发症少。     

无张力阴道吊带术治疗女性压力性尿失禁(附13例报告)

目的　评价无张力阴道吊带术 (TVT)治疗女性压力性尿失禁疗效。　方法　女性压力性尿失禁患者 13例 ,经临床和尿动力学检查确诊 ,均为稳定性膀胱 ,膀胱出口无梗阻。采用Prolene聚丙烯网状吊带 ,手术自阴道前壁切口经耻骨后向下腹部穿刺 ,将吊带无张力置于尿道中段。　结果　手术时间平均 (38± 7)min ;术中出血量平均 (4 5± 10 )ml;术后平均留置导尿 2d ;术后平均住院 4d。13例患者术后尿失禁症状均消失。 1例患者术后出现尿潴留 ,留置导尿 2周后无改善 ,予手术切断吊带 ,尿潴留症状消失 ,尿失禁未复发。　结论　TVT手术疗效确切 ,操作简便 ,对患者损伤小 ,并发症发生率低 ,是一种治疗女性压力性尿失禁的有效方法。     

经阴道无张力尿道悬吊带治疗女性压力性尿失禁(附37例报告)

目的 探讨经阴道无张力尿道悬吊带(Tension-free vaginal tape，TVT)方法治疗女性压力性尿失禁的临床疗效。方法 采用TVT术式治疗女性压力性尿失禁患者37例。利用弧形Trocar穿刺针将TVT从阴道前壁切口放置于尿道中段下方，术后24h拔除导尿管自行排尿。结果 2例患者拔除导尿管后出现急性尿潴留，经扩张尿道，保留导尿后恢复正常排尿。37例随访3-16个月，平均13个月，无尿失禁复发。结论 TVT治疗女性压力性尿失禁疗效满意，手术简单，安全可靠，无严重并发症。     

无张力性吊带术治疗女性压力性尿失禁

目的探讨无张力阴道吊带术(tension-free vaginal tape，TVT)治疗女性压力性尿失禁的疗效。方法13例经尿动力学检查证实为压力性尿失禁在连续硬膜外麻醉下经阴道前壁行无张力阴道吊带术，低平截石位，经阴道前壁向上穿刺尿道两侧间隙，从耻骨上腹壁引出TVT吊带，调整张力，关闭切口。结果手术时间15～45min，平均35min。13例随访6～24个月，平均13个月，12例治愈，1例改善，无尿失禁复发或排尿困难。结论TVT操作简单，创伤小，手术时间短，术后恢复快，治疗压力性尿失禁疗效好。     

女性压力性尿失禁的微创治疗

目的探讨女性压力性尿失禁的发病机制和微创治疗方法。方法女性压力性尿失禁患者25例,经临床、尿动力学检查或膀胱尿道造影确诊,均为稳定性膀胱,无膀胱出口梗阻。采用无张力阴道吊带术(TVT),将吊带无张力置于尿道中段。结果手术时间平均(40±5)min;术中出血量平均(43±10)mL;术后平均留置导尿1.5 d;术后平均住院3 d。23例患者术后尿失禁症状均消失,其中2例患者术后出现尿潴留,留置导尿1周后好转,尿潴留症状消失,尿失禁未复发;2例尿失禁症状显著改善。结论TVT等微创术式因简单、微创、疗效好、并发症少等,目前是女性压力性尿失禁外科手术治疗的发展方向。     

TVT术治疗女性压力性尿失禁疗效观察(附11例报告)

目的观察经阴道无张力尿道悬吊术（tension-free vaginal tape procedure,TVT）对女性压力性尿失禁的临床治疗效果。方法采用TVT术对11例女性单纯性真性压力性尿失禁患者进行矫治。结果 11例均一次治愈,手术时间平均29（23~40）min,术后住院时间2~3 d。术后24 h拔除尿管后均可排尿,1例排尿费力1 d后自行缓解;1例下腹疼痛、腹胀,经对症处理后缓解。术后随访4年,无膀胱损伤、排尿困难、吊带感染、耻骨炎、伤口感染等并发症。术后1年有尿不尽感1例,B超检查无残余尿;术后18个月尿流分叉1例,经尿道扩张1次后缓解;有异物感3例。术后4年最大尿流率平均23.3（16.3~29.8）ml/s,均未再发生尿失禁。结论 TVT术是治疗女性压力性尿失禁的一种简单、安全、有效方法 ,长期疗效有待进一步观察。     

无张力阴道吊带治疗女性压力性尿失禁10例报告

目的　评价无张力阴道吊带 (TVT)治疗女性压力性尿失禁中的临床疗效。方法　对 10例女性压力性尿失禁患者进行TVT术治疗 ,并对手术疗效进行随访。结果　 1例术中出现膀胱穿孔 ,2例拔管后出现尿潴留 ,经延长导尿管留置时间后缓解 ,所有患者尿失禁症状完全消失 ,随访 2～ 12个月 ,无尿失禁复发。结论　TVT术治疗女性压力性尿失禁具有创伤小、效果好、并发症少、安全性高的优点 ,值得推广应用。     

经闭孔阴道尿道中段吊带术治疗女性压力性尿失禁

目的探讨经闭孔阴道尿道中段吊带术(TVT-O)治疗女性压力性尿失禁的疗效及安全性。方法2004年3月至2005年11月采用TVT-O术治疗女性压力性尿失禁14例。结果平均手术时间20min,术中出血平均40ml。术后2~3d拔除尿管。2例患者2日内仍有轻微尿失禁,未经治疗3~4d后自行缓解。1例出现尿频尿急,经对症治疗后改善;2例出现股内侧轻度疼痛,1周内自行缓解。术后平均随访8(2~18)个月,14例患者均获得满意控尿。结论TVT-O术操作简便快捷,创伤小,合并症少,疗效肯定,是一种治疗女性压力性尿失禁的有效方法。     

无张力阴道吊带修复女性压力性尿失禁

目的探讨无张力阴道吊带（tension—free vaginal tape，TVT）术的适应证、手术方法及并发症的预防。方法2003年9月～2004年12月共收治女性压力性尿失禁（stress urinary incontinence，SUI）患者40例，年龄30～73岁，平均56．3岁，病程1～42年，平均7．2年。其中伴膀胱或直肠膨出8例，子宫脱垂1例。均采用TVT术进行修复，对合并子宫脱垂或阴道前／后壁膨出者，一并行阴道前后壁部分剪除蝶形补片。结果40例患者术后均获满意效果，术后合并短时轻度排尿困难2例，膀胱穿孔及盆腔血肿各1例，经处理后均痊愈。患者均获随访1～15个月，无尿失禁复发及排尿困难。结论TVT术是一种治疗SUI的有效方法。     

四种吊带手术经腹壁或闭孔固定治疗女性压力性尿失禁的效果比较

目的:探讨四种吊带手术经腹和闭孔途径治疗女性压力性尿失禁的效果.方法:采用人工合成材料的吊带经腹壁固定方式(TVT和IVS技术)治疗女性压力性尿失禁患者23例;用经闭孔固定方式(TOT和TVTO技术)治疗女性真性压力性尿失禁患者16例.并进行疗效比较.结果:绝大多数患者均排尿通畅,无尿失禁复发.但TVT组中有1例排尿不畅,3个月后剪断吊带后变为轻度尿失禁;有1例术中膀胱穿孔,术后停留导尿管1周.结论:用四种吊带手术治疗女性真性压力性尿失禁安全、微创和有效.经闭孔固定技术和用经腹壁固定技术这两种方法各有自己的优缺点.     

经阴道无张力吊带术治疗压力性尿失禁416例报告

目的探讨无张力尿道中段吊带术（TVT）治疗女性压力性尿失禁（SUI）的疗效、手术安全性及并发症的预防。方法2000年1月-2008年3月期间女性SUI患者416例进行TVT手术治疗,对手术效果、并发症等进行了长期随访评估。培杲经过3-96（62±3）月随访,416例患者中366例有效,长期有效检出率88.0％。15例术后3年来出现顽固性尿频、尿急症状,经抗炎、舍尼亭等治疗后,症状未见明显好转;8例术后发生尿潴留,延长导尿时间后或／和经反复尿扩用金属尿道探子向下压后尿潴留消失,但仍有排尿困难症状;27例3-7年复发,其中24例经生物反馈治疗8-10周疗效较好,3例经再次TVT治疗后症状缓解。结论TVT是一种治疗女性SUI的安全、有效的方法,具有微创、简单易掌握、术后恢复快、并发症少等优点。     

Low incidence of post-TVT genital prolapse

Tension-free vaginal tape (TVT) is a well established surgical procedure for the treatment of female urinary stress incontinence. The operation, described by Ulmsten in 1995, is based on a midurethral Prolene tape support. TVT is accepted as an easy-to-learn and safe, minimally invasive surgical technique. Postoperative genital prolapse has been described following the Burch technique, as well as other surgical methods for the correction of female stress urinary incontinence. The aim of this analysis was to evaluate the occurrence of this specific complication in relation to TVT. Of 314 patients undergoing TVT and followed for up to 50 months only 1 suffered genital prolapse, with de novo grade 2 cystocele, rectocele and uterine prolapse, diagnosed 3 months after the operation. This is the first reported case of genital prolapse following TVT.     

Clinical and urodynamic outcomes of tension-free vaginal tape procedure

The tension--free vaginal tape procedure (TVT) has been regarded as a safe, minimally invasive method for the treatment of female stress urinary incontinence. In a prospective multicenter study we evaluated safety and efficacy of TVT procedure for the treatment of female stress incontinence. From 1998. to 2003, a total of 42 patients, mean age 60 years (range 34-76) with urodynamically verified stress urinary incontinence underwent the TVT procedure. The mean follow-up period was 28 months (range 14 to 32). Intra- and postoperative complications were few, including bladder perforations (4.7%), vaginal hematoma (2.4%), complete urinary retention (2.4%), transient urinary retention (19%) and urinary tract infection (7.1%). Postoperatively, voiding time and functional urethral length significant increased. The subjective and objective cure rates were 85.7% and 90.5%, respectively. We conclude that the TVT procedure is associated with high cure rate and low morbidity.     

用人工合成材料的吊带经耻骨固定或经腹壁固定治疗真性女性压力性尿失禁

目的总结用人工合成材料的吊带经不同的途径治疗女性压力性尿失禁的方法和结果。方法采用人工合成材料的吊带经耻骨固定（In—Fast）技术治疗3例，用经腹壁固定（TVT和IVS）技术治疗13例。结果绝大多数病人均排尿通畅．无尿失禁复发。但TVT组有1例排尿不畅，3个月后剪断吊带后变为轻度尿失禁。In-fast组有1例性交不适伴阴道分泌物增加。结论用人工合成材料的吊带进行悬吊技术治疗女性真性压力性尿失禁是安全、微创和有效的手术方式。经耻骨固定技术和用经腹壁固定技术这两种方法各有自己的优缺点。应根据病人的具体情况去选择使用。     

经皮穿刺阴道壁悬吊术和无张力阴道吊带术治疗女性压力性尿失禁对比研究

目的 评价经皮穿刺阴道壁悬吊术(VWS-PP)及无张力阴道吊带术(TVT)治疗女性压力性尿失禁(SUI)的疗效.方法 女性SUI患者26例,其中行VWS-PP14例,TVT12例.术后6周、6个月及1年随访,以术后腹压增加有无尿溢出为疗效判断标准.结果 2组患者年龄,病程比较,差异无统计学意义(P＞0.05).VWS-PP组手术时间60～90 min,平均80 min;TVT组25～50min,平均35 min,2组比较差异有统计学意义(P＜0.01);2组治愈例数比较,差异无统计学意义(P＞0.05).结论 VWS-PP和TVT2种术式均为治疗女性SUI安全有效的微创手术,2者疗效相似,VWS-PP手术时间较长,但创伤小,能准确调整吊带之松紧度.     

Treatment of female stress urinary incontinence with TVT system (tension-free vaginal tape): complications in our first 100 cases

Introduction: The TVT system is the most common surgical technique of female stress urinary incontinence, because of the simplicity, good clinical results and rare complicationsMaterial and methodsFrom april, 1999 to march, 2004, it has been done in our department 100 TVT systems with the revision of the result over the six following months. The average follow-up rate was 10, 36 months (R: 1-54 months) and looses mean the 11% of the cases. All the patients presented stress incontinence and their average age was 56,6 years old (30-80). The 12% of the cases have been previously operated of urinary incontinence. 21 patients presented previous surgery of pelvic floor. In the 17% of the cases, TVT systems was associated to another surgical technique: 15% of them was operated of cystocele, 1% of them had surgical correction of rectocele, 1% of them had a strong surgery of pelvic floor, that included TVT system, correction of pelvic floor and hysterectomyResultsWe obtained 65% of successful cases, defined as objective confirmation of absence of looses from the observer and the subjective reference of the patient; 17% of clear improvement (clear decrease of looses from the patient and subjective improvement) and 7% of failure of the technique. The total percentage of appearance of novo post-surgery urgency is 9%. There were complications in the 12% of the cases: there were three cases of bladder perforation, two of them intra-operative and one of them deferred and associated to an infection of surgical wound; another three cases of residue in the immediate post-operative that were resolved with bladder catheterization; one case of acute urinary retention that was treated with bladder catheterization with suprapubic cistostomy; one case of chemical peritonitis corrected with a conservative treatment; two cases of vaginal extrusion of sling, which were resolved with the section of the outer sling; one patient presented a hipogastric hematoma resolved with conservative measures; and one patient presented pelvic discomfort with spontaneous resolutionConclusionsWe consider the TVT system as an effective surgical technique in the treatment of the female stress urinary incontinence. It is a simple technique with a short stay in the hospital and rare complications.