Evaluation of Tension-Free Vaginal Tape (TVT) Procedure: Its Safety and Efficacy in the Treatment of Female Stress Urinary Incontience

以無張力性陰道人工韌帶治療女性應力性尿失禁：安全性及效果評估

戴慧龍(Hui-Lung Tai) ； 張玉君(Yu-Jun Chang) ； 張進寶(Chin-Pao Chang) ； 嚴孟意(Meng-Yih Yen) ； 黃勝賢(Sheng-Hsien Huang) ； 江恆杰(Herng-Jye Jiang) ； 陳俊吉(Chun-Chi Chen) ； 黃國軒(Kuo-Hsuan Huang) ； 王百孚(Pai-Fu Wang)

《Formosan Journal of Surgery》 37卷4期 (2004/07) Pp. 163-170

https://doi.org/10.29833/FJS.200407.0003

摘要

本篇目的主要是評估，無張力性人工韌帶經陰道懸吊術治療女性應力性尿失禁的安全性及成效。
自西元1999年6月至2001年12月，總共有60位患有不同程度應力性尿失禁的女性或混合性尿失禁，接受無張力性人工韌帶懸吊手術，術前檢查包括多頻道尿動力學檢查。手術方法是依據Dr. Ulmsten所創，而採用局部麻醉，下半身脊髓麻醉或全身麻醉，手術成果評估可分為主觀性及客觀性評估。
這些婦女平均年齡為57.6±10.9（36-79），平均分娩數為4±1.2（2-8），平均手術時問為40.8±3.9（25-55）分鐘。所有接受手術者，術後追蹤至少兩年以上（平均42.1±9.9個月），客觀性的成功率為90%，主觀性的成功率中：85%完全治癒，15%有中等程度的改善。術後尿滯留有9位（15%）：其中，3位後來接受手術切斷人工韌帶，4位（6.7%）發生術中膀胱穿刺但無後續併發症，2位（3.3%）發生人工韌帶從陰道手術傷口暴露。總共有10位（16.7 %）發生術後尿急，包括：持續性尿急6位，及手術後才發生的尿急4位。7位（11.7%）術後追蹤仍有恥骨上不適感覺。
結論是，無張力性人工韌帶懸吊術，雖然是一種治療應力性尿失禁的有效方法，它的成功率不遜於傳統的Burch Procedure及Fascial sling Procedure。這種手術方法可採用局部或非局部性麻醉，而有相同的成功率。然而，此種微創性的手術仍有許多術中及術後的併發症，為避免這些併發症的發生，良好的訓練及術前詳細的評估是非常重要的。

並列摘要

Objectives: To assess the surgical results and the associated complications after the tension-free vaginal tape (TVT) procedure in women with stress urinary incontinence.
Methods: A total of 60 women with different types of stress urinary incontinence or mixed incontinence with urgency in the absence of pelvic prolapse were treated with TVT procedure between June 1999 and December 2001. Preoperative examinations included multi-channel urodynamics. Surgical procedure was performed according to the technique of Ulmsten et al under local, regional or general anesthesia. The surgical results were assessed objectively by urodynamics and subjectively by a three-degree subjective scale.
Results: The average age was 57.6±10.9 (36-79) years and the mean parity was 4 ±1.2 (2-8). The mean operative time was 40.8±3.9 (25-55) minutes. All patients were followed up for at least 2 years after the procedure (mean 42.1±9.9, median 41.7, range 25.7-73.7). Objectively, 90% of the patients were cured of stress incontinence.
Subjectively, 85% of patients were completely cured and 15% were
improved. Nine patients (15%) had postoperative urine retention, three of them finally received section of tape. Bladder penetration occurred in four (6.7%) but there was no subsequent complication after removal of Foley catheter. Tape erosion from the vaginal wound was found in two patients (3.3%). There were no cases of tape rejection after TVT procedure. The amount of intra-operative blood
loss was minimal. Totally, 10 patients (16.7%) had postoperative urgency including persistent urgency in six patients (6/23) and de novo urgency in four patients (4/37) at final follow-up. Seven patients (11.7%) felt mild suprapubic discomfort.
Conclusions: Tension-free vaginal tape procedure seems to be an effective method for treating all types of stress incontinence with results comparable with those obtained by Burch colposuspension and fascial sling procedure. It can be performed under local, regional or general anesthesia with similar high success rates.
However, the procedure also had many postoperative complications and the patients should be informed accordingly. Only well-trained surgeon and careful preoperative evaluation can decrease the postoperative complications and achieve satisfactory surgical results.

並列關鍵字

stress urinary incontinence ； TVT procedure