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中華民國泌尿科醫學會雜誌

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篇名 The Results of the Tension-Free Vaginal Tape Procedure for the Treatment of Stress Urinary Incontinence
卷期 13:2
並列篇名 以無張力性人工吊帶懸吊術治療女性應力性尿失禁的結果
作者 戴慧龍嚴孟意張進寶陳俊吉黃勝賢江恒杰黃國軒王百孚林介山張玉君
頁次 058-061
關鍵字 無張力性人工吊帶應力性尿失禁tension-free vaginal tapestress urinary incontinenceTSCI
出刊日期 200206

中文摘要

研究目的:以無張力性懸吊帶手術治療第二或第三類型女性應力性尿失禁患者的經驗。材料與方法:自1999年6月至2000年12月共20位尿動力學檢查後證實為應力性尿失禁的女性,接受無張力性懸吊帶的手術,這些女性根據腹部漏尿壓的測量(Valsalva leak point pressure)而分為三種型態,8位被歸類為第三型,8位為二、三型的混合,4位為第二型。20位女性中有三位曾接受過骨盆腔手術,但是沒有任何人曾接受過尿失禁的手術。結果:這些婦女平均年齡為61.0±10.4歲(34-74),17位(85%)完全痊癒,2位(10%)有明顯改善,1位(5%)失敗。平均追蹤期間為18.5±5.3月(10-28),主觀性的成功率為95%(包括完全治癒及明顯改善者)。手術中有2位(10%)膀胱被刺穿;術後則有1位(5%)因無法排尿而持續性的自我導尿,2位(10%)發生術後急迫性的排尿,1位(5%)發生持續性的急迫性排尿,1位(5%)發生陰道傷口的感染。術後沒有任何人發生人工吊帶的排斥現象,所有病患的失血都很少。結論:無張力性的人工吊帶術是一種微創傷口的手術,它是一種有效且安全的方法,可用於第二或第三類型的應力性尿失禁,但是對於內生性括約肌功能失常者,或者曾接受過尿失禁手術而失敗的病例,更長期的研究仍然是必須的。

英文摘要

OBJECTIVE: To report our experiences in using tension-free vaginal tape (TVT) procedure as a primary treatment of type II or type III of female stress urinary incontinence. MATERIALS AND METHODS: Twenty women with urodynamically confirmed stress urinary incontinence underwent TVT procedure. A multichannel urodynamic study with Valsalva leak point pressure was used to classify the types of stress urinary incontinence. Of the 20 patients, 8 (40%) were diagnosed with type III incontinence, 8 (40%) with type II/III, and 4 (20%) with type II. Three patients had a past history of pelvic surgery; none had undergone anti-incontinence surgery. RESULTS: The mean age of the women was 61.0±10.4 years (range: 34-74). Seventeen (85%) were completely cured, 2 (10%) were improved, and 1 (5%) failed to improve. The average follow-up was 18.7±5.3 months (range: 10-28). The subjective success rate was 95% (cure and improvement). Intraoperative bladder penetration occurred in 2 patients (10%). One patient (5%) had post-operative urinary retention and continued clean intermittent self-catheterization. Two patients (10%) developed de novo urgency: 1 (5%) had persistent urgency and the other had a vaginal wound infection (5%). There was no tape rejection and blood loss was rare. CONCLUSIONS: The tension-free vaginal tape procedure is a minimally invasive surgery. It can be used as an effective and safe procedure for treatment of type II or type III female stress urinary incontinence. But further long-term studies are necessary for cases with intrinsic sphincter deficiency or those who had failed anti-incontinence surgery.