【摘要】：壓力性尿失禁(stress urinary incontinence,SUI)對(duì)女性來(lái)講,是一種常見(jiàn)的、令人煩惱的、花費(fèi)較高的疾病。國(guó)外報(bào)道約為33%的成年女性會(huì)發(fā)生尿失禁,且年齡越大,發(fā)病率會(huì)隨之增高。國(guó)內(nèi)報(bào)道,SUI在成年女性中平均發(fā)病率約是18.9%,SUI發(fā)生率最高是在50歲~59歲,為28.0%,且年齡越大,發(fā)病率會(huì)隨之增高。對(duì)于SUI的治療,美國(guó)泌尿協(xié)會(huì)(American Urological Association,AUA)提出手術(shù)治療療效確定。2013年學(xué)者Lucas提出的SUI外科手術(shù)治療指南將尿道中段無(wú)張力懸吊術(shù)作為治療SUI的A級(jí)推薦。該術(shù)式有三代,第二代的經(jīng)閉孔陰道無(wú)張力尿道中段懸吊術(shù)(trans-obturator tension-free vaginal tape,TVT-O)成為常用術(shù)式,5年治愈率高達(dá)90.8%。而后提出的單切口可調(diào)節(jié)A-JUST吊帶懸吊術(shù)(adjustable single-incision sling,A-JUST)各國(guó)家隨訪6~12個(gè)月治愈率在80%~91%。國(guó)外研究報(bào)道,A-JUST手術(shù)與常用的TVT-O手術(shù)相比,主客觀治愈率無(wú)明顯差異,療效確切。A-JUST手術(shù)2012年在我國(guó)首次應(yīng)用,國(guó)內(nèi)對(duì)兩種手術(shù)療效對(duì)比研究較少。本研究通過(guò)回顧觀察分析兩種吊帶手術(shù)治療SUI的臨床效果,為SUI個(gè)體化手術(shù)治療方案的選擇提供臨床依據(jù)。目的對(duì)比A-JUST手術(shù)和TVT-O手術(shù)治療女性SUI的臨床療效,探討兩種手術(shù)方式治療女性SUI有無(wú)異同。為SUI的臨床手術(shù)個(gè)體化方案的選擇提供隨訪依據(jù)。資料與方法選取2013年1月至2014年12月就診鄭州大學(xué)第三附屬醫(yī)院的確診為SUI并由同一醫(yī)師行手術(shù)治療的患者共105例,其中行A-JUST手術(shù)治療組(A-JUST組)患者53例,行TVT-O手術(shù)治療組(TVT-O組)患者52例,記錄兩組年齡、病程、孕產(chǎn)次、體質(zhì)指數(shù)(BMI)、一小時(shí)尿墊試驗(yàn)重量,合并手術(shù)等一般資料。統(tǒng)計(jì)兩組手術(shù)時(shí)間、術(shù)中出血量、術(shù)后大腿內(nèi)側(cè)牽扯痛情況、術(shù)后拔除尿管時(shí)間、住院天數(shù)等圍手術(shù)期資料。兩組患者分別于術(shù)前、術(shù)后6、12、24個(gè)月門(mén)診復(fù)查、電話或郵件等方式隨訪,填寫(xiě)尿失禁生活質(zhì)量問(wèn)卷(I-QOL)和抗尿失禁術(shù)后患者全身狀況改善問(wèn)卷(PGI-I)進(jìn)行評(píng)分,并了解術(shù)后排尿、漏尿情況和術(shù)后24個(gè)月并發(fā)癥發(fā)生情況。對(duì)以上記錄的資料進(jìn)行統(tǒng)計(jì)學(xué)分析,P0.05為有統(tǒng)計(jì)學(xué)差異。結(jié)果1.兩組患者術(shù)前資料相比較,無(wú)統(tǒng)計(jì)學(xué)差異(P0.05),兩組資料具有可比性。2.兩組患者手術(shù)時(shí)間、術(shù)中出血量、術(shù)后拔除尿管時(shí)間相比,差異無(wú)明顯統(tǒng)計(jì)學(xué)意義(P0.05)。A-JUST組1例患者術(shù)后第1天出現(xiàn)大腿內(nèi)側(cè)牽扯痛,TVT-O組8例患者術(shù)第2天出現(xiàn)大腿內(nèi)側(cè)牽扯痛,大腿內(nèi)側(cè)牽扯痛發(fā)生率兩組分別為1.9%、13.4%,P=0.010,差異有明顯統(tǒng)計(jì)學(xué)意義。A-JUST組平均住院天數(shù)為3.58±1.44天,TVT-O組平均住院天數(shù)為7.47±1.83天,P=0.000,差異有明顯統(tǒng)計(jì)學(xué)意義。3.術(shù)前、術(shù)后6、12、24個(gè)月I-QOL評(píng)分A-JUST組分別為25.27±4.43、90.43±4.42、90.48±4.39、87.15±5.52,術(shù)后各時(shí)間段隨訪后I-QOL評(píng)分均較術(shù)前顯著提高,有統(tǒng)計(jì)學(xué)差異(P0.05);TVT-O組分別為22.17±3.72、90.28±6.76、90.63±6.05、86.63±5.65,術(shù)后評(píng)分較術(shù)前明顯改善,有統(tǒng)計(jì)學(xué)差異(P0.05)。兩組間比較,術(shù)前、術(shù)后各時(shí)間段隨訪的I-QOL評(píng)分之間無(wú)明顯差異(P0.05),兩組患者術(shù)前生活質(zhì)量受疾病影響程度相當(dāng),手術(shù)治療后生活質(zhì)量明顯提高。4.術(shù)后6月隨訪的漏尿情況,評(píng)價(jià)客觀治愈率,A-JUST組為88.7%,TVT-O組為86.5%,P=0.932;PGI-I評(píng)分評(píng)價(jià)主觀治愈率,A-JUST組為88.7%,TVT-O組為92.3%,P=0.884。兩組主、客觀治愈率無(wú)明顯統(tǒng)計(jì)學(xué)差異,治療效果相當(dāng),均能有效治療SUI。5.隨訪術(shù)后24個(gè)月可能的并發(fā)癥,A-JUST組3例出現(xiàn)腹壓增加時(shí)漏尿,1例患者出現(xiàn)性交時(shí)異物感,并發(fā)癥發(fā)生率為7.5%(4/53)。TVT-O組2例出現(xiàn)腹壓增加時(shí)漏尿,1例出現(xiàn)吊帶少許外露。并發(fā)癥發(fā)生率為5.8%(3/52)。兩組比較無(wú)明顯統(tǒng)計(jì)學(xué)差異(χ~2=0.117,P0.05)結(jié)論A-JUST手術(shù)治療SUI短期隨訪療效明顯,與TVT-O手術(shù)主、客觀治愈率接近,兩種手術(shù)均適用于各種程度的SUI,且治療效果明顯。A-JUST手術(shù)具有住院時(shí)間短、術(shù)后大腿內(nèi)側(cè)牽扯痛率低的優(yōu)勢(shì)。
[Abstract]:Stressurinary incontinence (SUI) is a common, troublesome and costly disease for women. About 33% of adult women reported abroad will have urinary incontinence, and the older the age, the higher the incidence. Domestic reports, the average incidence of SUI in adult women is about 18.9%, the highest incidence of SUI. Surgical treatment for SUI was proposed by the American Urological Association (AUA). In 2013, Lucas, a scholar, recommended the Middle Urethral tension-free suspension as a Grade A treatment for SUI. In three generations, the second generation of trans-obturator tension-free vaginal tape (TVT-O) has become a common procedure, with a 5-year cure rate of 90.8%. The subsequent single-incision adjustable A-JUST sling (A-JUST) has a cure rate of 80%-91% in 6-12 months follow-up. Overseas studies reported that the subjective and objective cure rates of A-JUST surgery were not significantly different from those of TVT-O surgery. A-JUST surgery was first used in China in 2012, and there were few comparative studies on the efficacy of the two kinds of surgery in China. Objective To compare the clinical effects of A-JUST operation and TVT-O operation in the treatment of female SUI, and to explore the similarities and differences between the two methods. A total of 105 patients with SUI were operated on by the same surgeon. 53 patients in the A-JUST group and 52 patients in the TVT-O group were operated on. The age, course of disease, pregnant and parturient times, body mass index (BMI), weight of one-hour urine pad test and combined operation were recorded. During the operation, the amount of bleeding during the operation, the pain in the medial thigh after operation, the time of catheter removal and the length of hospitalization were recorded. Results 1. There was no significant difference in preoperative data between the two groups (P 0.05). The operative time and intraoperative bleeding were comparable between the two groups. 2. Among the 8 patients in TVT-O group, the incidence of medial thigh traction pain was 1.9%, 13.4%, P = 0.010 respectively. The difference was statistically significant. The average incidence of medial thigh traction pain was 1.9%, 13.4%, P = 0.010 in A-JUST group. The average hospitalization days in TVT-O group were 7.47 [1.83], P = 0.000, and the difference was statistically significant. 3. The I-QOL scores of A-JUST group were 25.27 [4.43], 90.43 [4.42], 90.48 [4.39], 87.15 [5.52] at 6, 12 and 24 months after operation, respectively. The I-QOL scores of TVT-O group were significantly higher than those before operation (P There was no significant difference in I-QOL scores between the two groups (P 0.05). There was no significant difference in I-QOL scores between the two groups (P 0.05). After 6 months follow-up, the leakage of urine in A-JUST group was 88.7%, TVT-O group was 86.5%, P = 0.932; PGI-I score was 88.7% in A-JUST group, 92.3% in TVT-O group, P = 0.884. There was no significant difference in subjective and objective cure rate between the two groups, and the curative effect was comparable. Possible complications occurred 24 months later in group A-JUST, including 3 cases with increased abdominal pressure and 1 case with foreign body sensation during intercourse. The incidence of complications was 7.5%(4/53). In group TVT-O, 2 cases with increased abdominal pressure leaked urine and 1 case with slight sling exposure. The incidence of complications was 5.8%(3/52). There was no significant difference between the two groups (_~2=0.117, P 0.05). The short-term follow-up effect of A-JUST operation on SUI is obvious, which is close to the subjective and objective cure rate of TVT-O operation. Both operations are suitable for various degrees of SUI, and the effect is obvious. A-JUST operation has the advantages of short hospital stay and low incidence of medial thigh traction pain after operation.
【學(xué)位授予單位】：鄭州大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R699.7

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