【作者】 张向凯；

【导师】 徐勇； 方平；

【作者基本信息】 天津医科大学 ， 外科学， 2008， 硕士

【摘要】 目的探讨尿道中段无张力吊带术治疗内括约肌缺失型女性压力性尿失禁的疗效,指导内括约肌缺失型压力性尿失禁的临床治疗。方法总结天津医科大学第二医院泌尿外科2005年6月至2007年6月,有完整影像尿动力学资料的78例患者,其中诊断为单纯压力性尿失禁的40例。患者均为女性,年龄55.35±10.31（23～74）岁,主要表现为咳嗽、喷嚏、大笑、体位改变及腹压增加时不能控制的尿液流出等症状。所有患者无神经系统疾病史、无糖尿病史、无盆腔手术及尿道外伤史。无泌尿系统畸形、无泌尿系感染。绝大部分患者有生育史。除外进行影像尿动力学检查时伴有逼尿肌不稳定的急迫性和/或混合性尿失禁的患者。40例患者根据影像尿动力学检查结果,以腹压漏尿点压（abdominal leakpoint pressure,ALPP）＜60 cmH₂O（1 cmH₂O=0.098 kPa）及同步膀胱尿道造影显示膀胱颈漏斗状开放为诊断内括约肌缺失（intrinsic sphincter deficiency,ISD）型压力性尿失禁标准,分为ISD组12例（占30%）,其中有1例为未产妇;其余28例（占70%）非内括约肌缺失（nonintrinsic sphincter deficiency,NISD）型压力性尿失禁患者作为对照组。所有患者均行尿道中段无张力尿道吊带术（本研究中用SPARC吊带术）,术后6-12月时通过Grouts-Blaivas评分法评价所有患者的手术治疗效果。结果1、两组患者的盆腔脱垂情况、年龄、体重、发病时间、经阴分娩次数及两组患者术前最大尿流率、残尿量、最大尿流率时逼尿肌压力、最大膀胱容量相比没有明显差异（P＞0.05）。2、两组患者的术后尿潴留及新出现的尿频、尿急等并发症发生率差别没有统计学意义（P＞0.05）。3、两组患者术中出血量、手术时间及恢复正常活动时间差别没有统计意义（P＞0.05）,而在ISD组患者的住院时间和保留尿管时间较NISD组患者长,ISD组患者的导尿次数较NISD组多,差别有统计学意义（P＜0.05）。4、ISD组12例患者中治愈11例（占91.67%）、1例改善（占8.33%）、0例失败;NISD组28例患者中治愈28例（占100%）,两组差别没有统计学意义（P＞0.05）。结论尿道中段无张力吊带术作为一种安全、有效和微创的治疗女性压力性尿失禁手段,对于内括约肌缺失型女性压力性尿失禁患者同样有效。更多还原

【Abstract】 Objective This study is to discuss the curative effect of intrinsic sphincter deficiency stress urinary incontience by using mid-urethral Tension- free Tape,and then to guide the managementof ntrinsic sphincter deficiency stress urinary incontience.Methods This study summarized 40 cases of patients, form June, 2004 to June, 2006, who admitted in the 2nd hospital of Tianjin medical university for the treatment of simple stress urinary incontinence. All patients are female, the mean age was 55.35±10.31 （range 23-74）.The main chief complaint are leakage of urine when coughing, sneezing, laughing, changing body posture and increasing abdomen pressure and so on. None of them had neurogenic history, diabetes mellitus history, urinary infection history, pelvic operation history, urinary abnormity history, specificity infection history. Most of the patients have childbearing history. The patients who accompany detrusor instable’s urge and /or mixed urinary incontinence were excludeed.According to Video urodynamics results,intrinsic sphincter deficiency stress urinary incontinence was diagnosed with the standard of by both ALPP<60 cmH₂O and synchronize cystourethrography, which manifest the funnel-shaped openess of bladder neck, then they were divided into ISD group（12\40）, include a nullipara, and the control group:NISD （nonintrinsic sphincter deficiency） group （28\40）.All of the patients were operated by SPARC. 6-12 months after the surgery all of the patients were evaluated by Grouts-Blaivas scoring.Results1. This study has showed there were no statistical significance between 2 groups in procidentia of cavitas pelvis, age, weight, onset time, vaginal delivery times, volume of residual, maximum bladder capacity, Qmax and detrusor pressure during Qmax.2. No statistically difference was seen between the two groups in postoperative urinary retention, newly present frequency and urgency.3. No statistically difference was observed between the two groups in operationbleeding, duration, recovery period, however, ISD group had a shorter length of stay and urinary canal-taking time than NISD group, while ISD group needed more urethral catheterization, there were a statistical significance between them.4. The recovery rate, improvement rate and failure rate of ISD group was 91.67%,8.33%, 0%, respectively, while in the NISD group was 100%, 0%, 0%, there were no statistical significance between the 2 groups.Conclusion Mid-urethral tension-free sling as a safe, effective, minimallyinvasive surgical procedure for the treatment of female stress urinary incontinence, has the same curative effort to intrinsic sphincter deficiency stress urinary incontinence.更多还原