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1、Int Urogynecol JDOI 10.1007/s00192-011-1380-9原始著作用于治疗压力性尿失禁Contasure-Needleless与transobturator-TVT的对比Lluis Amat i Tardiu Eva Martinez Franco Josep Maria Lailla Vicens收于：2010年5月24日/接受：2011年2月4日Urogynecological协会 2011摘要介绍 用于治疗压力性尿失禁(SUI)的单切口设备在过去几年就被引进了。我们报道了在Obturator Tension-free阴道胶带(TVT-O)和Contasur
2、e-Needleless (C-NDL)间的对比。方法 第一年患有SUI的158位妇女将按计划接受TVT-O 或 C-NDL，并做随访。记录了流行病信息、并发症，失血和疼痛程度。我们也分析压力测压和生活质量。结果 跟54 (90%) 的TVT-O比较，(87.5%) C-NDL表现出了负压。Sandvik严重指数在C-NDL组中是75.4%，而在TVT O (p0.015)中是87.3%。并发率和满意程度在两组中是相似的。按照统计学，在TVT O中的术后疼痛存在着差异(p=0.012)。结论 在1年随访后，C-NDL提供了同TVT-O相似的结果。有必要从长期的数据验证我们的结果。关键词 Min
3、i-sling. Needleless . 压力尿失禁 . TVT缩略词SUIStress urinary incontinenceTVT Tension-free vaginal tapeISDIntrinsic sphincter dysfunctionC-NDL Contasure-Needleless TVT-O Transobturator-TVT简介压力性尿失禁(SUI)可能源于在尿道支撑或尿道括约肌机制1的改变，因此，手术治疗的目的在于稳定超流动性的阴道或者对固有括约肌功能紊乱的患者的辅助支撑达到一定的程度。我们遵循SUI完整性原则，它是在1995年由Petros 和 Ulmst
4、en 2开发的，其中他们开发了一种基于耻骨后聚丙烯的网格以在不拉紧的状态下支撑尿道的技术，无张力阴道胶带(TVT)。3基于出版的数据，我们考虑使用了无张力吊带(TVT)，依据自制且有相同效果的程序，当跟吊带程序相比时，短期4和长期5都有证据1的程度。67Delorme在2001年设计了一个新的程序，在无张力下将网格穿过闭孔(TOT)。这就小化了膀胱穿孔和在膀胱前血肿形成的风险。8 在随访期间，结果证明治愈率在82.8% 9, 10和90%11，具有证据1的程度。Jean Leval在203年改进了此技术，使用通常由内而外的技术通过闭孔引进了吊带，12 目的是通过该区域（神经，血管）进一步减少针
5、通过带来的并发症。结果显示中短期的治愈率在89% 和 95.4%之间，同耻骨后方法相比缺有较小的内在术后发病率，13, 14, 15。经闭孔针通路的并发症也源于通过闭孔不通的通路。最常见的疼痛是腹沟内疼痛，发表率是2-7.5%, 16, 17，但是对于有严重的血管损伤18的并发症中也有吊带的故障和挤出10.尝试简化所描述的程序并减小由于针通过闭孔的并发症，一个新的设备，Contasure- Needleless (C-NDL)就被创造了。该设备保持了吊带无张力的原则并引进了“单切口”的概念，对网格的安防完全通过闭孔。该研究的主要目的是评价Contasure-Needleless (C-NDL)
6、吊带在治疗压力性尿失禁且有或者无骨盆器官下垂患者是否差于经闭孔阴道胶带(TVT-O)网格。材料和方法 从2006年到2009年在我们骨盆底装置内进行了随机性前瞻性研究。我们包括了总共158例受到压力性尿失禁且有正压力检测或者与生殖器下垂无关的患者，她们作为手术治疗的人选。排出原则是： 先前对压力性尿失禁做过手术治疗 通过valsalva泄漏点压力(VLPP) 500 ml)10与手术无关 (n=55)00与手术有关 (n=103)10手术时膀胱受伤11与手术无关(n=55)00与手术有关(n=103)11泌尿感染10与手术无关(n=55)00与手术有关(n=103)10术后疼痛5 直观类比17
7、0.023与手术无关(n=55)120.551与手术有关 (n=103)050.024尿滞留431与手术无关(n=55)111与手术有关(n=103)321导管插入(天)1.721.860.491与手术无关(n=55)0.981.140.296与手术有关(n=103)2.182.160.916医院许可 (天)2.022.390.064与手术无关(n=55)1.041.040.982与手术有关(n=103)2.652.960.098表3. 随访12个月的并发症C-NDLTVT-Op value重新失禁7100.298排尿困难010.202网格挤出010.451尿路感染复发111表4. 12个月随
8、访结果C-NDL TVT-O 绝对差(IC 95%) p value负压检测63/72 (87.5%) 54/60 (90%) 2.5(-9.2-13.7) 0.015Sandvik 检测手术前 8/69(11.6%) 5/55(9.1%) 2.5(-9.4-13.7)0.015非常满意29/73 (39.7%)20/60 (33.3%)满意39/73 (53.4%)35/60 (58.3%)不满意 5/73 (6.8%) 5/60 (8.3%) -1.5 (-12.1-8.1)0.001参考文献1. Wahle G, George P, Young H, Raz S (1983) Anato
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