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女性压力性尿失禁的手术治疗：尿道中段悬吊术的选择

Authors
J Eric Jelovsek, MD, MMEd, FACOG, FACS
Jhansi Reddy, MD
Section Editor
Linda Brubaker, MD, FACOG
Deputy Editor
Kristen Eckler, MD, FACOG
Translators
孙秀丽, 主任医师，副教授

引言

压力性尿失禁(stress urinary incontinence, SUI)累及4%-35%的女性[1,2]。当腹内压增加超过尿道闭合压时发生不自主的漏尿即称为SUI，在用力、打喷嚏或咳嗽时就可能发生[3]。

SUI的治疗包括保守治疗(例如，阴道子宫托、盆底肌肉锻炼)和手术治疗。采用合成材料的微创尿道中段悬吊术已成为许多女性的首选手术[4]。首例悬吊术是于1996年引入的无张力阴道悬吊术(tension-free vaginal tape, TVT)[5]。第2种重要悬吊术是经闭孔尿道中段悬吊术，于2001年引入[6]。经闭孔悬吊术是用于避免经耻骨后插入的一些并发症(如膀胱穿孔、血管损伤、肠损伤)。此后，还开发出许多其他器材，有多种套管插入机制或网片类型[7]。

本文将总结对无既往抗尿失禁手术史的SUI女性患者应如何选择尿道中段悬吊术的类型。尿道中段悬吊术与其他类型手术之间的选择、SUI的非手术治疗、复发性SUI的治疗、其他类型尿失禁的诊断和治疗等，将单独讨论。 (参见“女性压力性尿失禁：初始手术方式的选择”和“Treatment of urinary incontinence in women”和“女性压力性尿失禁：手术治疗后持续性/复发性症状”和“尿失禁女性的评估方法”)

术语

目前可用于治疗女性SUI的悬吊术有多种类型(表 1)。这些术式根据吊带放置部位和吊带材料的不同而有差异。但总体来讲，这些悬吊术都被称为尿道下悬吊术，需要经小的阴道切口插入吊带并连接到盆腔的另一结构上以支撑尿道。尿道下悬吊术可以是膀胱颈悬吊术和尿道中段悬吊术。

●尿道中段悬吊术–以无张力的方式在尿道中段水平放置尿道下吊带。这些吊带由合成网片制成。

             

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Literature review current through: 2017-06 . | This topic last updated: 2017-06-30.
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