治療女性壓力性尿失禁_1課件

TVTTVT尿道中段懸吊術(shù)尿道中段懸吊術(shù) 微創(chuàng)傷手術(shù)微創(chuàng)傷手術(shù) 1.1. 減少手術(shù)時(shí)間減少手術(shù)時(shí)間 Reduce surgical timeReduce surgical time 2.2. 減少住院時(shí)間減少住院時(shí)間 Reduce length of hospitalization Reduce length of hospitalization 3.3. 減少并發(fā)癥減少并發(fā)癥 Reduce complication rates/risksReduce complication rates/risks 4.4. 復(fù)原快復(fù)原快 Allow quicker return to normal, daily activitiesAllow quicker return to normal, daily activities 5.5. 減少費(fèi)用減少費(fèi)用 Lower costsLower costs GYNECARE TVT Tension-free Support for IncontinenceGYNECARE TVT Tension-free Support for Incontinence TVTTVT尿失禁的無(wú)張力支撐尿失禁的無(wú)張力支撐 TVTTVT尿失禁的無(wú)張力支撐是一種創(chuàng)新的微創(chuàng)傷尿失禁的無(wú)張力支撐是一種創(chuàng)新的微創(chuàng)傷 手術(shù)方法手術(shù)方法, , 它對(duì)壓力性尿失禁治療的有效性它對(duì)壓力性尿失禁治療的有效性 已得到了充分的臨床證明已得到了充分的臨床證明 GYNECARE TVT Tension-free Support for Incontinence is an GYNECARE TVT Tension-free Support for Incontinence is an innovative minimally invasive surgical alternative for the innovative minimally invasive surgical alternative for the effective treatment of stress urinary incontinence, with effective treatment of stress urinary incontinence, with proven results.proven results. GYNECARE TVT Tension-free Support for IncontinenceGYNECARE TVT Tension-free Support for Incontinence TVT TVT尿失禁的無(wú)張力支撐尿失禁的無(wú)張力支撐 使用使用ProleneProlene網(wǎng)帶進(jìn)行無(wú)張力尿道中段懸吊術(shù)網(wǎng)帶進(jìn)行無(wú)張力尿道中段懸吊術(shù) The placement of a piece of PROLENE mesh (45 cm x 1.1 cm x The placement of a piece of PROLENE mesh (45 cm x 1.1 cm x 0.7 mm) without tension, at the mid urethra0.7 mm) without tension, at the mid urethra GYNECARE TVT Tension-free Support for IncontinenceGYNECARE TVT Tension-free Support for Incontinence TVT TVT尿失禁的無(wú)張力支撐尿失禁的無(wú)張力支撐 局麻局麻, , 阻滯阻滯/ /硬膜外硬膜外Local anesthesia, sedation/regionalLocal anesthesia, sedation/regional 切口小切口小, , 分離少分離少 Minimal incisions and dissectionMinimal incisions and dissection 網(wǎng)帶無(wú)張力地置于尿道中段下網(wǎng)帶無(wú)張力地置于尿道中段下Tape placed at mid Tape placed at mid urethra without tensionurethra without tension 術(shù)中使用膀胱鏡術(shù)中使用膀胱鏡 Cystoscopy performedCystoscopy performed 術(shù)后插尿管時(shí)間短術(shù)后插尿管時(shí)間短 Infrequent use of post-op cathetersInfrequent use of post-op catheters 當(dāng)天出院當(dāng)天出院 Discharge home the same dayDischarge home the same day Goal of SurgeryGoal of Surgery 手術(shù)目的手術(shù)目的 1. 1. 修復(fù)和修復(fù)和/ /或加強(qiáng)陰道尿道韌帶或加強(qiáng)陰道尿道韌帶 Restore and/or Restore and/or reinforce the pubourethral ligaments.reinforce the pubourethral ligaments. 2.2.修復(fù)和修復(fù)和/ /或加強(qiáng)尿道下陰道吊筋膜或加強(qiáng)尿道下陰道吊筋膜 Restore and/or Restore and/or reinforce the suburethral vaginal hammockreinforce the suburethral vaginal hammock 3.3.加強(qiáng)尿道旁結(jié)締組織加強(qiáng)尿道旁結(jié)締組織 Reinforce the paraurethral Reinforce the paraurethral connective tissueconnective tissue GYNECARE TVT Tension-free Support for IncontinenceGYNECARE TVT Tension-free Support for Incontinence TVT TVT尿失禁的無(wú)張力支撐尿失禁的無(wú)張力支撐 普理靈聚丙烯網(wǎng)帶普理靈聚丙烯網(wǎng)帶 PROLENE* polypropylene mesh tapePROLENE* polypropylene mesh tape 無(wú)需和任何組織固定無(wú)需和任何組織固定 No fixationNo fixation 經(jīng)陰道進(jìn)路經(jīng)陰道進(jìn)路 Trans-vaginal approachTrans-vaginal approach 組織分離少組織分離少 Minimal tissue dissectionMinimal tissue dissection GYNECARE TVT Tension-free Support for IncontinenceGYNECARE TVT Tension-free Support for Incontinence TVT TVT尿失禁的無(wú)張力支撐尿失禁的無(wú)張力支撐 局麻局麻 Local anestheticLocal anesthetic 導(dǎo)尿管使用時(shí)間短導(dǎo)尿管使用時(shí)間短 Minimal catheter useMinimal catheter use 可在門診進(jìn)行可在門診進(jìn)行 Out-patientOut-patient GYNECARE TVT Tension-free Support for Incontinence IndicationsGYNECARE TVT Tension-free Support for Incontinence Indications TVT TVT尿失禁的無(wú)張力支撐尿失禁的無(wú)張力支撐 適應(yīng)癥適應(yīng)癥 適應(yīng)于以下原因引起的女性張力性尿失禁適應(yīng)于以下原因引起的女性張力性尿失禁 Intended to be used for treatment of Female Stress Intended to be used for treatment of Female Stress Urinary Incontinence resulting fromUrinary Incontinence resulting from 尿道過(guò)度活動(dòng)尿道過(guò)度活動(dòng) urethral hypermobilityurethral hypermobility 內(nèi)源性內(nèi)源性尿道括約肌功能障礙尿道括約肌功能障礙intrinsic intrinsic sphincter deficiencysphincter deficiency GYNECARE TVT Tension-free Support for Incontinence GYNECARE TVT Tension-free Support for Incontinence ContraindicationsContraindications TVT TVT尿失禁的無(wú)張力支撐尿失禁的無(wú)張力支撐 禁忌征禁忌征 懷孕病人懷孕病人 Pregnant patientsPregnant patients 未完成發(fā)育的病人未完成發(fā)育的病人 Patients withPatients with future growth potentialfuture growth potential 計(jì)劃要懷孕的病人計(jì)劃要懷孕的病人 Women with plans for future pregnancyWomen with plans for future pregnancy Warnings and PrecautionsWarnings and Precautions 注意事項(xiàng)注意事項(xiàng) 不要進(jìn)行抗凝治療不要進(jìn)行抗凝治療 No anticoagulation therapyNo anticoagulation therapy No UTINo UTI 要有一定膀胱頸懸吊術(shù)的經(jīng)驗(yàn)要有一定膀胱頸懸吊術(shù)的經(jīng)驗(yàn) Familiar with bladder neck suspension surgeryFamiliar with bladder neck suspension surgery 用最小的張力在尿道中段下放置用最小的張力在尿道中段下放置TVTTVT網(wǎng)帶網(wǎng)帶 TVT placed with minimal tension at mid urethraTVT placed with minimal tension at mid urethra 使用膀胱鏡觀察確保膀胱完好使用膀胱鏡觀察確保膀胱完好 Cystoscopy to confirm bladder integrityCystoscopy to confirm bladder integrity 注意盆腔結(jié)構(gòu)注意盆腔結(jié)構(gòu), , 避免組織損傷避免組織損傷 Attention to pelvic anatomy to avoid injuries to structuresAttention to pelvic anatomy to avoid injuries to structures 出院前觀察是否有恥骨后血腫出院前觀察是否有恥骨后血腫 Observe for retropubic hematoma before dischargeObserve for retropubic hematoma before discharge GYNECARE TVT Tension-Free Support for Incontinence SystemGYNECARE TVT Tension-Free Support for Incontinence System TVT TVT產(chǎn)品系列產(chǎn)品系列 TVT TVT 網(wǎng)帶網(wǎng)帶 GYNECARE TVT DeviceGYNECARE TVT Device GYNECARE TVT Introducer GYNECARE TVT Introducer GYNECARE TVT Rigid Catheter Guide GYNECARE TVT Rigid Catheter Guide GYNECARE TVT Tension-free Support for IncontinenceGYNECARE TVT Tension-free Support for Incontinence Description: PROLENE*polypropylene mesh covered by a plastic sheath Prolene*網(wǎng) 帶: 網(wǎng) 狀 鉤 形 編 織 , 外 面 套 有 塑 料 膜 Prolene*網(wǎng) 帶 Prolene Prolene 普理靈普理靈 特點(diǎn)特點(diǎn) 惰性強(qiáng)惰性強(qiáng) 組織相容性強(qiáng)組織相容性強(qiáng)/ /組織反應(yīng)小組織反應(yīng)小 有延展性有延展性 表面光滑表面光滑 易于操作易于操作 心血管吻合的專用縫線心血管吻合的專用縫線, ,在縫合材料中有在縫合材料中有“ “縫縫 線之王線之王” ”的稱號(hào)的稱號(hào) GYNECARE TVT IntroducerGYNECARE TVT Introducer 推針器推針器 GYNECARE TVT Rigid Catheter GuideGYNECARE TVT Rigid Catheter Guide 導(dǎo)引桿導(dǎo)引桿 GYNECARE TVT - Preoperative EvaluationGYNECARE TVT - Preoperative Evaluation 術(shù)前評(píng)估術(shù)前評(píng)估 確診確診為壓力性尿失禁為壓力性尿失禁 進(jìn)行排尿分析進(jìn)行排尿分析 GYNECARE TVT Patient InformationGYNECARE TVT Patient Information 病人情況病人情況 手術(shù)介紹手術(shù)介紹 Procedure overviewProcedure overview 病人手術(shù)風(fēng)險(xiǎn)病人手術(shù)風(fēng)險(xiǎn)Potential risksPotential risks 血腫血腫 B Bleeding-hematoma formationleeding-hematoma formation 感染感染 InfectionInfection 膀胱穿孔膀胱穿孔 Bladder perforationBladder perforation 尿潴留尿潴留 Urinary retentionUrinary retention 排斥反應(yīng)排斥反應(yīng) Mesh erosion or rejectionMesh erosion or rejection 復(fù)原復(fù)原 RecoveryRecovery 期望期望 ExpectationsExpectations GYNECARE TVT - Pre OpGYNECARE TVT - Pre Op TVT TVT 術(shù)前術(shù)前 術(shù)前抗菌素術(shù)前抗菌素 Peri-operative antibioticsPeri-operative antibiotics 停止使用抗凝劑停止使用抗凝劑 Cessation of anti-coagulants Cessation of anti-coagulants Postmenopausal patient should have estrogenized vaginal Postmenopausal patient should have estrogenized vaginal wall tissue.wall tissue. Instrument RequirementsInstrument Requirements 手術(shù)需要的器械手術(shù)需要的器械 陰道重錘陰道重錘/ /拉鉤拉鉤 彎剪彎剪- -組織分離組織分離 蚊式鉗蚊式鉗 - - 鉗住塑料套鉗住塑料套, , 抽出抽出. . 長(zhǎng)的硬膜外針頭長(zhǎng)的硬膜外針頭- -局麻局麻 5050cccc注射器注射器 - - 向膀胱內(nèi)注生理鹽水向膀胱內(nèi)注生理鹽水 7070度膀胱鏡度膀胱鏡 - - 觀察膀胱情況觀察膀胱情況 1818號(hào)號(hào)( (單槍單槍/ /雙槍雙槍) )導(dǎo)尿管導(dǎo)尿管 GYNECARE TVT - ProcedureGYNECARE TVT - Procedure 手術(shù)過(guò)程手術(shù)過(guò)程 病人準(zhǔn)備病人準(zhǔn)備 Patient preparation Patient preparation 切口切口 IncisionsIncisions Dissection, needle passage and tape Dissection, needle passage and tape placement placement Tension adjustment Tension adjustment Completing the procedure Completing the procedure Patient PositionPatient Position 病人體位病人體位 Insert 18 fr catheter and empty bladder Insert 18 fr catheter and empty bladder 插插1818號(hào)導(dǎo)尿管號(hào)導(dǎo)尿管, , 排空膀胱排空膀胱 Anesthetic Anesthetic 麻醉麻醉 局麻局麻 + +靜脈加強(qiáng)靜脈加強(qiáng) Local Anesthesia with IV sedation, Local Anesthesia with IV sedation, recommendedrecommended 骶麻或全麻骶麻或全麻 Regional or General anesthesia possible.Regional or General anesthesia possible. AnesthesiaAnesthesia Abdominal InjectionsAbdominal Injections Anesthesia Anesthesia 麻醉麻醉 Abdomen Abdomen 腹部腹部 AnesthesiaAnesthesia Vaginal WallVaginal Wall Anesthesia Anesthesia 麻醉麻醉 Vaginal Wall Vaginal Wall 陰道前壁陰道前壁 Incisions Incisions 切口切口 陰道前壁陰道前壁 VaginalVaginal 在離尿道外口在離尿道外口1 1cmcm處作處作1.5 1.5 cm cm 縱向切口縱向切口 腹部腹部 AbdominalAbdominal 在恥骨聯(lián)合上方，腹中線兩側(cè)各作一個(gè)在恥骨聯(lián)合上方，腹中線兩側(cè)各作一個(gè)0.5 0.5 cm - cm - 1.0 cm1.0 cm切口切口 2 2 incisions each side of midline incisions each side of midline 兩切口相距最寬兩切口相距最寬4-54-5公分公分 just above symphysis just above symphysis 4 - 5 4 - 5 cm cm apart max. apart max. Vaginal Wall IncisionVaginal Wall Incision 陰道前壁切口陰道前壁切口 IncisionsIncisions Vaginal WallVaginal Wall DissectionDissection Blunt dissection of anterior wall sub and paraurethrallyBlunt dissection of anterior wall sub and paraurethrally Abdominal Incisions Abdominal Incisions 腹部切口腹部切口 GYNECARE TVT - ProcedureGYNECARE TVT - Procedure 手術(shù)過(guò)程手術(shù)過(guò)程 PreparationPreparation IncisionsIncisions Dissection, needle passage and tape Dissection, needle passage and tape placement placement 組織分離組織分離, , 穿針和放置網(wǎng)帶穿針和放置網(wǎng)帶 Tension adjustmentTension adjustment Completing the procedureCompleting the procedure Dissection of Anterior WallDissection of Anterior Wall 陰道前壁分離陰道前壁分離 Blunt Dissection sub and paraurethrallyBlunt Dissection sub and paraurethrally 在尿道旁和尿道下進(jìn)行鈍性分離在尿道旁和尿道下進(jìn)行鈍性分離 Insert TVT Rigid Catheter GuideInsert TVT Rigid Catheter Guide 插入插入TVTTVT導(dǎo)引桿導(dǎo)引桿 Introduction of the GYNECARE TVT DeviceIntroduction of the GYNECARE TVT Device 推入推入TVTTVT網(wǎng)帶網(wǎng)帶 通過(guò)陰道切口推入通過(guò)陰道切口推入 Introduce through vaginal incision Introduce through vaginal incision 針頭指向髂骨針頭指向髂骨 Aim toward ipsilateral shoulder Aim toward ipsilateral shoulder 繞過(guò)恥骨繞過(guò)恥骨 Hug the pubic bone (do not scrapHug the pubic bone (do not scrap 從腹壁切口出從腹壁切口出 Exit at abdominal incisionExit at abdominal incision Introducer/needle pointed toward ipsilateral shoulderIntroducer/needle pointed toward ipsilateral shoulder 針尖指向同側(cè)肩膀針尖指向同側(cè)肩膀 Finger in vagina guides needle Finger in vagina guides needle 食指經(jīng)陰道導(dǎo)引針的放行食指經(jīng)陰道導(dǎo)引針的放行 Needle hugs the pubic bone during insertion Needle hugs the pubic bone during insertion 穿針時(shí)針緊貼著恥骨穿針時(shí)針緊貼著恥骨 Abdominal incisions act as a guide Abdominal incisions act as a guide 腹部切口可作為方向引導(dǎo)腹部切口可作為方向引導(dǎo) Cystoscopy performed after each needle passage Cystoscopy performed after each needle passage 穿針后進(jìn)行膀胱鏡檢查穿針后進(jìn)行膀胱鏡檢查 Bladder is drained again and needle is passed on other Bladder is drained again and needle is passed on other sideside 再次排空膀胱，在另一側(cè)穿針再次排空膀胱，在另一側(cè)穿針 After confirming bladder integrity, needles are passed After confirming bladder integrity, needles are passed through abdominal incisionsthrough abdominal incisions 確認(rèn)膀胱完好，將針拉出腹壁 Needle Passage and Tape PlacementNeedle Passage and Tape Placement Introduction of the GYNECARE TVT DeviceIntroduction of the GYNECARE TVT Device 推入推入TVTTVT網(wǎng)帶網(wǎng)帶 Guide the Needle Tip to the Abdominal IncisionGuide the Needle Tip to the Abdominal Incision 將針頭導(dǎo)向腹壁切口將針頭導(dǎo)向腹壁切口 針頭不要拔出針頭不要拔出 Cystoscopy Cystoscopy 膀胱鏡膀胱鏡 針穿過(guò)后針穿過(guò)后, , 使用膀胱鏡確保膀胱完好使用膀胱鏡確保膀胱完好 After each After each passage of the needle, cystoscopy should be completed to passage of the needle, cystoscopy should be completed to verify bladder integrityverify bladder integrity 將膀胱注液后使用膀胱鏡將膀胱注液后使用膀胱鏡 Cystoscopy should be done Cystoscopy should be done with bladder half-fullwith bladder half-full Bladder Perforation Bladder Perforation 膀胱穿孔膀胱穿孔 Bladder Perforation Bladder Perforation 膀胱穿孔膀胱穿孔 Second Passage of the GYNECARE TVT DeviceSecond Passage of the GYNECARE TVT Device 第二根針的穿入第二根針的穿入 重新插導(dǎo)尿管重新插導(dǎo)尿管, , 排空膀胱排空膀胱 Re-insert the catheter and Re-insert the catheter and drain the bladderdrain the bladder 重復(fù)第一次穿針的步驟重復(fù)第一次穿針的步驟 The opposite side is The opposite side is completed in the same manner as the firstcompleted in the same manner as the first 確保網(wǎng)帶沒(méi)有扭轉(zhuǎn)確保網(wǎng)帶沒(méi)有扭轉(zhuǎn) Ensure that the tape does not Ensure that the tape does not twist twist 再次使用膀胱鏡再次使用膀胱鏡 Cystoscopy after the second pass of Cystoscopy after the second pass of the TVT needlethe TVT needle 針從腹壁切口拉出針從腹壁切口拉出 Pull TVT needle through the Pull TVT needle through the abdomen incisionabdomen incision Tape AdjustmentTape Adjustment 調(diào)整網(wǎng)帶調(diào)整網(wǎng)帶 在網(wǎng)帶和尿道間放置一把剪刀或止血鉗在網(wǎng)帶和尿道間放置一把剪刀或止血鉗 Place Place scissors or hemostat between the tape and the urethrascissors or hemostat between the tape and the urethra 拉腹壁端的網(wǎng)帶拉腹壁端的網(wǎng)帶, , 直到網(wǎng)帶貼住剪刀直到網(wǎng)帶貼住剪刀 Pull the Pull the abdominal ends of the tape until there is contact between tape abdominal ends of the tape until there is contact between tape and instrumentand instrument 將針剪去將針剪去 Separate needles from the tapeSeparate needles from the tape 先不要拉出塑料薄膜先不要拉出塑料薄膜 Do not remove the plastic sheathDo not remove the plastic sheath Cough Test Cough Test 腹壓測(cè)試腹壓測(cè)試 膀胱注液膀胱注液250250毫升毫升 Fill bladder with 250 ml of saline Fill bladder with 250 ml of saline 取出尿道下的剪刀取出尿道下的剪刀/ /或止血鉗或止血鉗 Remove instrument under the Remove instrument under the urethraurethra 取下陰道重錘取下陰道重錘 Remove vaginal speculumRemove vaginal speculum 要病人用力咳嗽要病人用力咳嗽 Ask patient to coughAsk patient to cough 調(diào)整網(wǎng)帶松緊度調(diào)整網(wǎng)帶松緊度 Adjust TVT tapeAdjust TVT tape 調(diào)整松緊度時(shí)調(diào)整松緊度時(shí), , 剪刀要置于網(wǎng)帶和尿道之間剪刀要置于網(wǎng)帶和尿道之間 Instrument should be placed between the tape and the urethra Instrument should be placed between the tape and the urethra during adjustmentduring adjustment Initial Cough Test Initial Cough Test 初步腹壓測(cè)試初步腹壓測(cè)試 Adjust Tape with Instrument in PlaceAdjust Tape with Instrument in Place 器械放置在網(wǎng)帶和尿道間器械放置在網(wǎng)帶和尿道間, , 調(diào)整網(wǎng)帶調(diào)整網(wǎng)帶 Completing the ProcedureCompleting the Procedure 完成手術(shù)完成手術(shù) 抽出塑料薄膜抽出塑料薄膜 Remove plastic sheathRemove plastic sheath 剪去腹壁上多余的網(wǎng)帶剪去腹壁上多余的網(wǎng)帶 Cut Prolene MeshCut Prolene Mesh 縫合皮膚和陰道粘膜切口縫合皮膚和陰道粘膜切口 Close skin and vaginal Close skin and vaginal epithelium epithelium 排空膀胱排空膀胱 Empty bladderEmpty bladder 取出導(dǎo)尿管取出導(dǎo)尿管 Remove catheterRemove catheter Completing the ProcedureCompleting the Procedure 完成手術(shù)完成手術(shù) removing plastic sheathremoving plastic sheath取出塑料薄膜取出塑料薄膜 Completing the ProcedureCompleting the Procedure完成手術(shù)完成手術(shù) Trimming the meshTrimming the mesh剪去多余的網(wǎng)帶剪去多余的網(wǎng)帶 GYNECARE TVT Postoperative Assessment Before DischargeGYNECARE TVT Postoperative Assessment Before Discharge 出院前的術(shù)后評(píng)估出院前的術(shù)后評(píng)估 出血出血/ /血腫血腫 Bleeding/hematomaBleeding/hematoma 餐飲餐飲 Eating and drinkingEating and drinking 排尿排尿 VoidingVoiding GYNECARE TVT Postoperative InstructionsGYNECARE TVT Postoperative Instructions 術(shù)后要求術(shù)后要求 術(shù)后排尿殘留術(shù)后排尿殘留 Post void residual Post void residual 3-43-4天抗菌素天抗菌素 Antibiotics 3-4 Days Antibiotics 3-4 Days 限制活動(dòng)限制活動(dòng) Activity limitationsActivity limitations - -駕駛駕駛 - -鍛煉鍛煉 - -性生活性生活 - -工作工作 GYNECARE TVT Postoperative CareGYNECARE TVT Postoperative Care Follow-up appointmentsFollow-up appointments 隨訪隨訪 3 3 weeksweeks 6 months6 months YearlyYearly GYNECARE TVT Complications 3 5 prior 11 2 prior operations; 3 5 prior operationsoperations 82% (28/34) cured82% (28/34) cured Neg SST, 90%Neg SST, 90% 9% (3/34) significantly improved9% (3/34) significantly improved Neg SST, QOL 75% 75% 90%, 90%, 90% 90% 70 yrs, MUCP 70 yrs, MUCP 10cm H2O, fixed urethra Rezapour M, Falconer C, Ulmsten U. Int Urogynecol J (2001) (suppl 2):S12-14. Concomitant Vaginal Surgery with TVT for Treatment of Concomitant Vaginal Surgery with TVT for Treatment of Female SUI and Pelvic Support DefectsFemale SUI and Pelvic Support Defects TVTTVT合并手術(shù)治療女性合并手術(shù)治療女性SUISUI和盆底支持缺損和盆底支持缺損 Retrospective reviewRetrospective review 回顧性研究回顧性研究 133 pts TVT vs. 47 TVT +133 pts TVT vs. 47 TVT + Demographics similar except ageDemographics similar except age 除了年齡病人統(tǒng)計(jì)學(xué)上相似除了年齡病人統(tǒng)計(jì)學(xué)上相似 Concomitant surgeryConcomitant surgery 1 SSLVS1 SSLVS- 8 - 8 前壁修補(bǔ)前壁修補(bǔ) 1 1 陰式子宮陰式子宮- 13 - 13 post colporrhaphypost colporrhaphy后壁修后壁修 補(bǔ)補(bǔ) 4 enterocele rep4 enterocele rep直腸膨出修補(bǔ)直腸膨出修補(bǔ)- 14 - 14 LeFort colpocleisisLeFort colpocleisis 15 perineorrhaphy 15 perineorrhaphy 會(huì)陰修補(bǔ)會(huì)陰修補(bǔ) Horton TR, Druckenmiller J, Lucente V. Poster Presentation, SGS Annual Mtg, March, 2001 Concomitant Study ResultsConcomitant Study Results 合并研究結(jié)果合并研究結(jié)果 相近的治愈率相近的治愈率 TVT 98%, TVT + 100%TVT 98%, TVT + 100% 24 hr 24 hr 排尿率接近排尿率接近 膀胱穿孔率接近膀胱穿孔率接近 沒(méi)有傷口感染和排異沒(méi)有傷口感染和排異 TVT + associated with expected TVT + associated with expected in: in: OR time (p 0.001)OR time (p 0.001) EBL ( p 0.03)EBL ( p 0.03) Length of hospital stay ( p 0.0003)Length of hospital stay ( p 0.0003) 麻醉麻醉 TVT 95% local, 4% regional, 0.8% GETTVT 95% local, 4% regional, 0.8% GET TVT + 41% local, 55% regional, 4% GETTVT + 41% local, 55% regional, 4% GET A Randomized Control Trial of Colposuspension and TVT for A Randomized Control Trial of Colposuspension and TVT for Primary Genuine Stress Incontinence Primary Genuine Stress Incontinence 3 Year Follow-up 3 Year Follow-up BurchBurch手術(shù)和手術(shù)和TVTTVT手術(shù)對(duì)比的手術(shù)對(duì)比的3 3年隨訪年隨訪 在英國(guó)和愛(ài)爾蘭的在英國(guó)和愛(ài)爾蘭的1414個(gè)醫(yī)院個(gè)醫(yī)院 包括婦產(chǎn)科、泌尿科和女性泌尿大夫包括婦產(chǎn)科、泌尿科和女性泌尿大夫 344344個(gè)病人隨機(jī)分成個(gè)病人隨機(jī)分成TVTTVT和和BurchBurch兩組兩組 結(jié)果結(jié)果 6 6個(gè)月時(shí)個(gè)月時(shí), , 需要自主導(dǎo)尿的病人需要自主導(dǎo)尿的病人BurchBurch組比組比TVTTVT組多組多 BurchBurch的病人有更多并發(fā)癥的病人有更多并發(fā)癥 BurchBurch組比組比TVTTVT組更多排尿問(wèn)題組更多排尿問(wèn)題 Ward,Hilton, et.al, Intl Urogyn Journal 2002 結(jié)論結(jié)論 女性尿失禁的發(fā)生逐年增長(zhǎng)女性尿失禁的發(fā)生逐年增長(zhǎng) GYNECARE TVT GYNECARE TVT 是一種有效和微創(chuàng)的手術(shù)方是一種有效和微創(chuàng)的手術(shù)方 式。式。 獨(dú)特的獨(dú)特的GYNECARE TVT PROLENE GYNECARE TVT PROLENE 材料使得手材料使得手 術(shù)并發(fā)癥比使用合成材料少術(shù)并發(fā)癥比使用合成材料少 長(zhǎng)期隨訪數(shù)據(jù)很優(yōu)秀長(zhǎng)期隨訪數(shù)據(jù)很優(yōu)秀 合并陰道手術(shù)并發(fā)癥少，而且有效合并陰道手術(shù)并發(fā)癥少，而且有效