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咳嗽试验在经阴道无张力尿道吊带术中的应用价值

Evaluation of the effectiveness of cough test during tension-free vaginal tape procedure in preventing post-operative voiding dysfunction

摘要:

目的 探讨咳嗽试验在经阴道无张力尿道吊带术(TVT)中的应用价值. 方法 2004年1月至2010年1月确诊为女性压力性尿失禁( SsUI)的患者85例行前瞻性研究,随机分为试验组(41例)与对照组(44例).两组均行TVT手术,试验组根据咳嗽试验调整吊带张力,对照组将吊带无张力地置于尿道中段下方.比较两组患者术后48 h拔除尿管后排尿情况及术后12个月的疗效. 结果 咳嗽试验组出现排尿困难9例,其中尿潴留4例;对照组术后无排尿困难者.术后12个月随访,咳嗽试验组治愈率为92.6%( 38/41),对照组为93.1% (41/44),组间比较差异无统计学意义(P>0.05). 结论 TVT是治疗女性SUI安全有效的微创术式,但尚无证据支持咳嗽试验有助于降低TVT术后排尿困难发生风险及改善长期疗效.

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abstracts:

Objective To evaluate the value of cough test in the tension-free vaginal tape (TVT)procedure.Methods A cohort of 85 women with stress urinary incontinence underwent the TVT procedure with cough test (n =41) or without cough test (n =44).Patients in cough test group were performed according to the Ulmsten’s method strictly,with the stress of tape adjusted in light of cough test; whereas in other 44 operations,the tape was placed on the urethral tract without stress,and no cough test was performed.The urine catheter was removed after 48 hours postoperatively and follow-up evaluation was carried out at 12 month postoperatively.Results TVT procedure was carried out successfully in all patients by a single experienced surgeon.Four cases of urinary retention and 5 cases of voiding difficulty were observed in the cough test group.However,urinary retention or voiding difficulty was not detected in the nun-cough test group.Based on the twelve-month follow-up results,the cure rate was 92.6% (38/41) in the cough test group and 93.1% (41/44) in the non-cough test group.Flow-pressure study indicated that 11 cases in cough test group were in the obstruction zone,while only 3 cases in the obstruction zone were detected in the non-cough test group.Conclusions TVT is a safe as well as effective minimally invasive surgical procedure to treat female stress urinary incontinence.However,Adjusting stress of tape in accordance with cough test during the TVT may potentially increase the incidence of urinary dysfunction postoperatively.Therefore,no convincing evidence was gained to support the efficacy of cough test during TVT in terms of preventing postoperative voiding dysfunction.

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作者: 朱鑫 [1] 苟欣 [1] 何卫阳 [1] 肖明朝 [1] 王明 [1] 邓远忠 [1] 康简 [1]
期刊: 《中华泌尿外科杂志》2012年33卷9期 669-671页 ISTICPKUCSCD
分类号: R6
栏目名称: 尿控基础与临床研究
DOI: 10.3760/cma.j.issn.1000-6702.2012.09.010
发布时间: 2012-12-28
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