三种不同手术方式治疗中老年女性压力性尿失禁疗效及对患者膀胱功能和术后并发症的影响

摘要 目的：探讨耻骨后膀胱尿道悬吊术（Burch）、阴道无张力尿道悬吊术（TVT）及经闭孔经阴道尿道中段悬吊带术（TVT-O）三种不同手术方式治疗中老年女性压力性尿失禁（SUI）疗效及对患者膀胱功能和术后并发症的影响。方法：回顾性分析2019.1-2022.4收治的101例中老年女性SUI患者资料,按手术方式分为Burch组（n=30,Burch术治疗）、TVT组（n=31,TVT术治疗）和TVT-O组（n=40,TVT-O术治疗）,观察三组患者临床疗效和手术情况[手术时间、出血量、住院时间、尿管留置时间],并发症发生率,治疗前后膀胱功能[24h排尿次数、膀胱容量、每次排尿量、残余尿量]及尿道功能指标[尿道长度（FUL）、最大尿道闭合压（MUCP）、Valsalva漏尿点压（VLPP）]变化。结果：Burch组、TVT组、TVT-O组治愈及改善率分别为83.34%、87.10%、87.50%,13.33%、12.90%、12.50%,三组之间比较差异无统计学意义（P>0.05）;TVT组、TVT-O组患者手术时间、出血量、住院时间、尿管留置时间均显著短于Burch组（P<0.05）,且TVT-O组患者手术时间显著短于TVT组（P<0.05）;治疗后,三组患者24 h排尿次数、残余尿量均显著降低（P<0.05）,膀胱容量、每次排尿量、FUL、MUCP、VLPP水平均显著增加（P<0.05）,但三组之间比较差异无统计学意义（P>0.05）;Burch组、TVT组、TVT-O组并发症总发生率分别为20.00%、12.91%、15.00%,三组之间比较差异无统计学意义（P>0.05）。结论：三种术式治疗中老年女性SUI疗效相当,均可有效改善膀胱功能及尿道指标,但TVT与TVT-O术患者康复快,TVT-O手术时间最短,TVT并发症低,可依据患者情况酌情选择。

Efficacy of Three Different Surgical Methods on Stress Urinary Incontinence in Middle-aged and Elderly Women and Their Effects on Bladder Function and Postoperative Complications

ABSTRACT Objective: To explore the efficacy of three different surgical methods of retropubic bladder urethral suspension surgery (Burch), tension-free vaginal tape procedure (TVT) and transobturator vaginal tape inside-out (TVT-O) in the treatment of middle-aged and elderly women with stress urinary incontinence (SUI) and their effects on bladder function and postoperative complications. Methods: The data of 101 middle-aged and elderly women with SUI admitted from January 2019 to April 2022 were retrospectively analyzed, and the patients were divided into Burch group (n=30, Burch treatment), TVT group (n=31, TVT treatment) and TVT-O group (n=40, TVT-O treatment) according to the surgical methods. The clinical efficacy, surgical conditions (surgical time, blood loss, hospital stay, urinary catheter indwelling time), incidence rates of complications and changes in bladder function (24 h urination frequency, bladder capacity, volume per urination, residual urine volume) and urethral function indicators [functional urethral length (FUL), maximum urethral closure pressure (MUCP), Valsalva leak point pressure (VLPP)] before and after treatment were observed among the three groups of patients. Results: The cure rates in Burch group, TVT group and TVT-O group were 83.34%, 87.10% and 87.50%, and the improvement rates were 13.33%, 12.90% and 12.50% respectively (P>0.05). The surgical time, blood loss, hospital stay and urinary catheter indwelling time in TVT group and TVT-O group were significantly shorter than those in Burch group (P<0.05), and the surgical time in TVT-O group was significantly shorter than that in TVT group (P<0.05). After treatment, the 24h urination frequency and residual urine volume were significantly decreased in the three groups (P<0.05) while the bladder capacity, volume per urination, FUL, MUCP and VLPP were significantly increased (P<0.05), but there were no statistical differences among the three groups (P>0.05). The total incidence rates of complications in Burch group, TVT group and TVT-O group were 20.00%, 12.91% and 15.00% respectively (P>0.05). Conclusion: Three surgical methods have similar efficacy in the treatment of middle-aged and elderly women with SUI, and can effectively improve the bladder function and urethral indicators. However, TVT and TVT-O have rapid rehabilitation, TVT-O has the shortest surgical time and TVT has low complications, which can be selected according to the patients'' conditions.