Comparison of clinical effect of different methods of middle urethral sling in female patients with stress urinary incontinence
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摘要: 目的 探讨不同尿道中段吊带手术方式对女性压力性尿失禁(SUI)患者的治疗效果。方法 回顾性收集2015年8月—2020年12月本院收治的130例女性SUI患者临床资料，将采取经耻骨后尿道中段无张力悬吊术(TVT)治疗的65例患者纳入A组，将采取经闭孔尿道中段无张力悬吊术(TOT)治疗的65例患者纳入B组。比较2组围术期指标、术后6周时的治疗效果、术前与术后6周时的尿流动力学指标以及术后并发症发生情况。结果 相较于A组，B组术中出血量较少，手术、留置导尿管及住院时间较短，差异有统计学意义(均P < 0.05)。术后6周，2组治愈率及整体手术效果差异无统计学意义；2组最大尿道压、功能尿道长度及残余尿量均较术前增大，差异有统计学意义(均P < 0.05)；但无论是术前还是术后6周时，2组最大尿道压、功能尿道长度及残余尿量比较均差异无统计学意义。B组术后大腿内侧疼痛发生率较A组高，差异有统计学意义(P < 0.05)。2组膀胱损伤、排尿困难及尿潴留发生率均差异无统计学意义。结论 TOT及TVT对于女性SUI患者均有较好的治疗效果，可有效改善患者尿流动力学指标。与TVT相比，TOT具有术中出血量少以及手术、留置导尿管及住院时间短的优势，但会增加术后大腿内侧疼痛的发生风险。
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关键词:
- 压力性尿失禁 /
- 经闭孔尿道中段无张力悬吊术 /
- 经耻骨后尿道中段无张力悬吊术 /
- 大腿内侧疼痛
Abstract: Objective To investigate the therapeutic effect of different methods of middle urethral sling in female patients with stress urinary incontinence(SUI).Methods A retrospective analysis was conducted, and the clinical data of 130 female SUI patients treated in our hospital from August 2015 to December 2020 were collected. Sixty-five patients treated with tension-free vaginal tape(TVT) were included in group A, while other 65 patients treated with transobturator tape(TOT) were included in group B. The perioperative indexes, therapeutic effect 6 weeks after operation, urodynamic indexes before and 6 weeks after operation, and postoperative complications between the two groups were compared.Results Compared with group A, group B had less intraoperative bleeding amount, shorter operation, indwelling catheter and hospitalization time, and the differences were statistically significant(all P < 0.05). Six weeks after operation, there was no statistical significant difference in the cure rate or overall operation effect between the two groups. However, the maximum urethral pressure, functional urethral length and residual urine volume in the two groups were higher than those before operation, and the differences were statistically significant(all P < 0.05). There were no significant differences in maximum urethral pressure, functional urethral length, or residual urine volume between the two groups, whether preoperative or 6 weeks postoperatively. The incidence of postoperative thigh pain in group B was higher than that in group A, and the difference was statistically significant(P < 0.05). There was no statistical significant difference in bladder injury, dysuria or urinary retention between the two groups.Conclusion TOT and TVT have good therapeutic effect on female SUI patients, and can effectively improve the urodynamic indexes. Compared with TVT, TOT has the advantages of less intraoperative bleeding amount, shorter operation, indwelling catheter and hospitalization time, but it will increase the risk of postoperative inner thigh pain. -
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表 1 A组与B组患者临床资料比较
例(%)，X±S，M(P25，P75) 组别 年龄/岁 病程/年 产次 疾病分型 疾病严重程度 绝经情况 Ⅰ型 Ⅱ型 中度 重度 是 否 A组(65例) 55.27±4.42 3.76±1.02 2.00
(2.00，2.00)21(32.31) 44(67.69) 49(75.38) 16(24.62) 36(55.38) 29(44.62) B组(65例) 54.79±4.28 3.57±1.05 2.00
(2.00，2.00)17(26.15) 48(73.85) 45(69.23) 20(30.77) 38(58.46) 27(41.54) t/U/χ2 1.207 1.048 0.253 0.595 0.615 0.125 P值 0.229 0.297 0.800 0.441 0.433 0.723 
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表 2 A组与B组围术期指标比较
X±S，M(P25，P75) 组别 术中出血量/mL 手术时间/min 留置导尿管时间/d 住院时间/d A组(65例) 37.18±4.47 41.53±5.57 2.00(2.00，3.00) 4.00(3.00，4.00) B组(65例) 29.86±4.19 29.76±4.19 2.00(2.00，2.00) 3.00(3.00，3.00) t/U 9.446 13.602 2.209 4.507 P值 < 0.001 < 0.001 0.027 < 0.001
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表 3 A组与B组尿流动力学指标比较
X±S，M(P25，P75) 时间 组别 最大尿道压/cmH2O 功能尿道长度/mm 残余尿量/mL 术前 A组(65例) 63.85±5.78 24.58±2.42 10.00(9.00，11.00) B组(65例) 63.79±5.53 24.76±2.38 10.00(9.00，10.00) t/U 0.062 0.404 1.078 P值 0.951 0.687 0.281 术后6周 A组(65例) 83.18±7.521) 28.33±2.351) 13.00(12.00，14.00)1) B组(65例) 84.29±7.711) 28.47±2.401) 13.00(12.00，14.00)1) t/U 0.832 0.334 1.087 P值 0.407 0.739 0.277 与同组术前比较，1)P < 0.05。
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表 4 A组与B组术后并发症比较
例(%) 组别 大腿内侧疼痛 膀胱损伤 排尿困难 尿潴留 A组(65例) 0(0) 3(4.62) 1(1.54) 2(3.08) B组(65例) 8(12.31) 1(1.54) 2(3.08) 0(0) χ2 6.527 0.258 ＜0.001 0.508 P值 0.011 0.612 >0.999 0.476
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