A Modified Non-incision Non-buffer Endoscopic Bladder Neck Suspension for Female Stress Urinary Incontinence - Surgical Technique and Its Mid-term Result

對於婦女應力性尿失禁，我們自1988年8月至1992年1月間一共對50名病人進行改良的「無切割性膀胱頸懸吊術」。手術重點包括：(1)使用內視鏡在手術前確切地辨認膀胱頸的位置；(2)陰道表皮不進行任何切割或剝離；(3)膀胱頸懸吊時沿著膀胱底部之兩側邊緣；(4)懸吊的尼龍線埋於表皮下，沒有放置緩衝物件。手術後依例放置恥骨上膀胱造廔引流尿液並便利排尿訓練，三天後開始訓練，如病人排尿情形良好即拔除尿管。我們對這50名婦女在手術後6至42個月(平均23月)進行追蹤調查，依據病人的主訴有18位(36%)完全無尿失禁；21位(42%)偶爾有尿失禁但症狀有明顯的改善；其他11位(22%)則在手術後復發輕重不等的尿失禁，認為手術失敗。大部份的失敗病例發生於術後一年內，而且失敗的病例在術後追蹤其經直腸膀胱超音波均發現病人再度失去原有的膀胱頸懸吊的效果。由病人的資料再加以分析，我們發現手術成功與失敗兩組病人中，年齡、體重、尿失禁解剖學上之分類、排尿圖形、最大尿道閉鎖壓力均無統計上之差異。可是在症狀較嚴重的病人手術成功率較差；手術後復原(即能有良好排尿的狀況)時間較長者其最後失敗率較高。經由本研究的結果顯示，膀胱頸懸吊術仍然需要一強有力的組織咬合或放置一緩衝物件以防止線埋入筋膜之中導致懸吊效果失敗。由於中程結果的不理想，我們已經將膀胱頸懸吊術改用Raz手術方法以求得更好的結果。

關鍵字

尿失禁；膀胱頸懸吊術

並列摘要

Fifty women underwent a modified endoscopic bladder neck suspension were evaluated 6 to 42 months (mean 23 months) postoperatively. The surgical procedure included: (1) identification of the bladder neck precisely by endoscopy, (2) no vaginal incision and dissection, (3) the bladder neck was suspended along the border of the bladder base, (4) the suspending suture was threaded submucosally without a buffer. However, the successful rate was not satisfactory (cured in 36% and good in 42%) as compared to other reports. Most of the failed cases occurred within the first 12 months postoperatively. Postoperative endosonography demonstrated loss of suspension function in the failed cases. The results in this study demonstrate that the bladder neck suspension without a buffer will not achieve a high cure rate. A helical suture or suspension buffer should be added to prevent cutting through the endopelvic fascia by the suture.

並列關鍵字

stress urinary incontinence ； endoscopic bladder neck suspension ； trans-rectal endosonography

國際替代計量

A Modified Non-incision Non-buffer Endoscopic Bladder Neck Suspension for Female Stress Urinary Incontinence - Surgical Technique and Its Mid-term Result

全文下載

主題瀏覽