本文選題：壓力性尿失禁 + 網(wǎng)片�。� 參考：《復旦大學》2014年碩士論文

【摘要】：目的尿道中段懸吊術(shù)已經(jīng)成為壓力性尿失禁的手術(shù)金標準,本研究的目的是建立利用二維超聲監(jiān)測吊帶形態(tài)變化的手段,研究吊帶形態(tài)與療效的關(guān)系,并以此為主要依據(jù)對比分析聚丙烯材料(Polypropylene, PP)與聚偏氟乙烯材料(polyvinylidene fluoride, PVDF)的吊帶在經(jīng)閉孔尿道中段懸吊術(shù)中、體外及動物體內(nèi)所體現(xiàn)出的生物學及力學特性。方法通過經(jīng)會陰B超回顧性研究尿道中段懸吊術(shù)后的患者吊帶的形態(tài)改變,參與研究患者83人,比較兩種不同材料吊帶在B超下的截面寬度、與尿道距離及Valsalva運動時的位移,并分析這些參數(shù)與療效及并發(fā)癥的聯(lián)系。對兩種吊帶進行了力學實驗以了解其力學特性。同時,兩種吊帶被分別植入大鼠的腹壁及陰道前壁下方,在15,30,60天后吊帶周圍組織被取出并評估炎癥反應。結(jié)果手術(shù)主觀改善率91.6%,沒有陰道侵蝕等嚴重并發(fā)癥出現(xiàn),經(jīng)會陰B超檢查下PP組吊帶截面寬度為8.22±1.84mmm,PP組吊帶截面寬度為9.49±1.60m m,兩組之間的差異有統(tǒng)計學意義(P0.001),PVDF組的皺縮程度大于PVDF組(P0.001),且吊帶截面寬度及皺縮程度與術(shù)后時間無有意義的線性關(guān)系(P0.05)。PP組吊帶與尿道的距離為5.93±150mm, PVDF組吊帶與尿道的距離為5.62±184mm,該數(shù)值與術(shù)后時間無有意義的線性關(guān)系(P0.05)。局部炎癥細胞反應方面,PP和PVDF吊帶擁有類似的表現(xiàn)(PO.05)。力學特性方面,PP材料吊帶的塑性變形率和彈性恢復率優(yōu)于PVDF材料吊帶,但初始模量遠低于PVDF材料吊帶,平均末次預加張力后伸長也高于PVDF材料吊帶,同時,PP材料吊帶在同樣縱向應力時橫向皺縮率也較高。結(jié)論使用經(jīng)會陰二維超聲觀察吊帶形態(tài)是一種可行的手段。PP吊帶比PVDF吊帶更易出現(xiàn)皺縮且皺縮程度更大,其中,術(shù)中或術(shù)后極短時間內(nèi)出現(xiàn)的皺縮占據(jù)吊帶皺縮的絕大部分,之后的皺縮過程緩慢且不明顯,這一皺縮是否會對術(shù)后并發(fā)癥的產(chǎn)生和發(fā)展產(chǎn)生影響需要進一步的研究證實。在泌尿道/生殖道侵蝕、手術(shù)療效、炎癥細胞反應等方面PP材料及PVDF材料的吊帶并沒有表現(xiàn)出明顯差異,PVDF材料的吊帶可能會是原有PP材料吊帶的一種優(yōu)秀的替代材料。
[Abstract]:Objective Urethral suspension has become the gold standard of stress urinary incontinence. The purpose of this study was to establish a method to monitor the shape of the sling by two-dimensional ultrasound, and to study the relationship between the shape of the sling and the curative effect. The biological and mechanical properties of polypropylene (PP) and polyvinylidene fluoride (PVDF) were analyzed in vitro and in vivo. Methods the morphological changes of suspensions were studied retrospectively by transperineal B-mode ultrasonography. 83 patients were involved in the study. The cross-section width of two different material sling under B-ultrasound, the distance between urethra and the displacement of Valsalva movement were compared. The relationship between these parameters and curative effect and complications was analyzed. Mechanical experiments were carried out on two kinds of suspenders to understand their mechanical properties. At the same time, the two suspensions were implanted into the abdominal wall and the anterior wall of vagina, respectively. The tissue around the sling was removed and the inflammatory response was evaluated 60 days later. Results the subjective improvement rate of operation was 91.6 and there were no serious complications such as vaginal erosion. After transperineal B-ultrasound examination, the width of sling section in PP group was 8.22 鹵1.84 mm ~ (-1) PP group was 9.49 鹵1.60 mm ~ (-1) m ~ (-1), the difference between the two groups was statistically significant (P < 0.05). The shrinkage degree of PVDF group was higher than that of PVDF group (P ~ (0.001), and the width and degree of sling band cross-section and the postoperative time were higher than those in PVDF group. There was no significant linear relationship between the sling and urethra in the PP group (5.93 鹵150mm) and the PVDF group (5.62 鹵184mm). There was no significant linear relationship between this value and the postoperative time. In terms of local inflammatory cell response, PP and PVDF sling showed similar manifestations. In terms of mechanical properties, the plastic deformation rate and elastic recovery rate of PP sling are better than that of PVDF material sling, but the initial modulus is much lower than that of PVDF material sling, and the average elongation of PVDF material sling is also higher than that of PVDF material sling after the last pretension. At the same time, the sling of PP material has higher transverse shrinkage rate under the same longitudinal stress. Conclusion it is a feasible method to observe the shape of sling by transperineal two-dimensional ultrasound. PP sling is more prone to shrinkage and the degree of shrinkage is greater than that of PVDF sling. Among them, the shrinkage occurred in a very short period of time during or after operation is the majority of the sling band shrinkage. The process of subsequent shrinkage is slow and not obvious. Whether this shrinkage will have an effect on the occurrence and development of postoperative complications needs further study to confirm. In the aspects of urinary / genital tract erosion, surgical efficacy and inflammatory cell reaction, there was no obvious difference between the suspensions of PP and PVDF materials.
【學位授予單位】：復旦大學
【學位級別】：碩士
【學位授予年份】：2014
【分類號】：R699.7

【共引文獻】

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