单切口可调节无张力尿道中段悬吊术治疗压力性尿失禁疗效观察.docVIP

单切口可调节无张力尿道中段悬吊术治疗压力性尿失禁疗效观察 　　【摘要】 目的 了解阴道单切口可调节无张力尿道中段悬吊术（ASIS Ajust）治疗压力性尿失禁的疗效。方法 11例因压力性尿失禁接受ASIS Ajust手术治疗的患者， 术后1、3、6个月时行门诊复查， 之后每6个月行1次门诊或者电话随访。采用治愈率、手术并发症及尿失禁生活质量问卷（incontinence quality of life， I-QOL）、泌尿生殖道症状评估表（urogenital distress inventory， UDI-6）评价疗效。结果 ASIS Ajust术后6个月客观及主观治愈率98%， 术后3 d1例尿潴留， 3例排尿困难， 无吊带侵蚀；术后I-QOL评分较术前显著提高， 差异有统计学意义（P 　　【关键词】 压力性尿失禁；单切口；疗效；生活质量 　　Curative effect observation of adjustable single-incision sling in the treatment of stress urinary incontinence ZHU Qing， YE Yong-sheng. Nanyang Central Hospital， Nanyang 473000， China 　　【Abstract】 Objective To estimate the curative effect of the adjustable single-incision sling （ASIS Ajust） in the treatment of stress urinary incontinence. Methods There were 11 cases with stress urinary incontinence received ASIS Ajust. They were in outpatient review at the 1st， 3rd， and 6th month after the surgery， and after that they received outpatient visit or telephone follow-up 1 time in 6 months. The curative effects were evaluated by cure rate， complications， incontinence quality of life （I-QOL） and urogenital distress inventory （UDI-6）. Results Objective and subjective cure rate at the 6th month after ASIS Ajust was 98%. There were 1 case of urinary retention and 3 cases of dysuresia and no condole belt erosion at the 3rd day after surgery. The I-QOL score was increased after surgery， compared with the score before surgery. The difference was statistically significant （P 　　1. 3 手术情况 11例患者具体手术情况见表1。 　　1. 4 方法 患者取截石位， 臀和床边齐， 髋关节屈曲， 排空膀胱， 术区消毒铺巾， 局部麻醉， 分别用2%利多卡因和1/3000肾上腺素液注射于患者阴道前壁、侧壁和耻骨支下内缘。Ailis钳夹提起患者阴道前壁， 在距离尿道口约1.0 cm纵行切开阴道前壁全层， 长约1.0 cm， 解剖剪锐性向尿道侧方分离阴道黏膜至双侧耻骨降支， 小心将其内后缘的结缔组织分开， 将导引器前端水平???向置入切口右侧的尿道阴道间隙， 使手柄与人体纵轴平行， 将固定锚栓的尖部紧贴耻骨降支， 用大拇指将导引器弯曲部轻轻推动并绕耻骨前进， 使针尖越过耻骨降支， 平行向对侧方向转动手柄， 推动固定锚栓穿过闭孔内肌和闭孔膜。推动引导器释放杆释放锚栓， 沿置人路径反向撤出导引器；牵拉尿道下方平片网带确认锚栓固定在闭孔膜上。用同样的方法将可调锚栓固定在左侧闭孔膜的外面。膀胱内注入生理盐水300 ml， 嘱患者用力咳嗽， 根据试验结果将尿道下吊带的张力进行双向微调， 插入柔性探针推进吊带锁锁住锚栓， 取出探针， 于尿道侧面约前侧沟水平剪除多余吊带， 吸收线缝合阴道切口。 　　1. 5 疗效评估及随访 所有患者于术后1、3、6