恥骨陰道吊帶術與Burch懸吊術之尿道壓力圖變化和差異

研究目的：探討恥骨陰道吊帶術(Pubovaginal Slingplasty; 簡稱PVS)和改良型Burch懸吊術(Modified Burch Colposuspension; 簡稱MBC)在手術前和手術後之尿道壓力檢查圖檢查(urethral pressure profilometry)之差異和作用的不同。研究設計與方法：本實驗為描述性研究(descriptive study)，本篇研究共收集63位曾接受尿失禁手術成功的病患，術後病患最少在門診定期追蹤兩年以上而且沒有併發症者。其中38位是在1998年之前接受MBC手術用以穩定膀胱頸(bladder neck)和陰道前壁。另外25位是在1998-2000年之間接受PVS手術用以提升尿道近端的背墊效應(backstop effect)。比較手術前和手術後患者的尿道壓力圖(urethral pressure profile)變化。利用統計假說檢定(statistical analysis test)來分析處理： HO：恥骨陰道吊帶術(PVS)的尿道壓力檢查參數(urethral pressure profilometry parameters)與改良型Burch懸吊術(MBC)的尿道壓力檢查參數(urethral pressure profilometry parameters)值在術前與術後是相同。 HA：恥骨陰道吊帶術(PVS)的尿道壓力檢查參數(urethral pressure profilometry parameters)與改良型Burch懸吊術(MBC)的尿道壓力檢查參數(urethral pressure profilometry parameters)值在術前與術後不相同。使用SPSS進行統計分析： 1. 獨立連續性的資料：用雙尾t檢定(two-tailed t test)和配對t檢定(paired t test)來比較手術結果(outcome)。 2. 統計上的顯著差異(statistical significance)為p-value < 0.05。研究結果： 63位曾接受尿失禁手術成功的病患中，38位是行MBC手術，其平均年齡45.5歲(range, 31-61)，另外25位是行PVS手術其平均年齡52.5歲(range, 32-70)。兩組的平均年齡和產次並無明顯差異。兩組術後的尿道壓力傳導比率(pressure transmission ratio; 簡稱PTR)都明顯增加。 MBC組的病患其尿道壓力傳導比率(PTR)增加的位置在尿道四等分段(Quarter; Q)的第1,2,3段(Q1,2,3)。然而，在PVS組病患尿道壓力傳導比率(PTR)只有在尿道的Q3位置才有明顯的增加。尿道閉鎖壓力(urethral closure pressure; UCP)在MBC組有明顯上升，但在PVS組就沒有顯著的升高。研究結論：研究結果顯示恥骨陰道吊帶術(PVS)和改良型Burch懸吊術(MBC)其作用在尿道上的位置可以從尿道壓力圖檢查(urethral pressure profilometry)表現位置不同而得到證實。這兩種手術對於治療尿失禁的作用機轉是不一樣的。

關鍵字

恥骨陰道吊帶術； Burch懸吊術；尿道壓力圖；壓力傳導比率

並列摘要

OBJECTIVE: To evaluate the pre-operative and post-operative difference effects on the urethral pressure profilometry in pubovaginal slingplasty and modified Burch colposuspension procedures. DESIGN: This is a descriptive study of urodynamic parameter and urethral pressure profilometry before and after operation. All the patients were followed at least 24 months after surgery. METHODS: A total of 63 patients with successful anti-incontinence surgery were recruited to this study. Thirty-eight women had received a modified Burch colposuspension (MBC) before 1998, to stabilize the bladder neck and the anterior vaginal wall. Twenty-five cases had undergone autologous pubovaginal slingplasty (PVS) procedure to elevate the backstop effect on the proximal urethra from 1998 to 2000. We compared the changes in parameters of the urethral pressure profilometry between these two groups immediately before and six months and 24 months after the operation. A student t test was used for statistical analysis and p<0.05 was considered the statistical significant level. RESULTS: The mean age of the patients at PVS group was 52.5 years (range 32-70 years) and 45.5 years (range 31-61 years) at MBC group. Age and parity were not significant difference between two groups. The pressure transmission ratio (PTR) of the urethra increased significantly, in both groups, in the postoperative evaluation. Patients who had the MBC procedure showed an increased PTR at quarter (Q) 1, Q2 and Q3 of the urethra. However, in the PVS group, the PTR increased only at Q3. The urethral closure pressure elevated significantly after the MBC procedure, but there were no significant changes after a PVS procedure. CONCLUSION: Our results indicate that differences effects on the urethral pressure profilometry are evident in the PVS and MBC procedures. These two procedures should be considered in different anti-incontinence effect.

並列關鍵字

Pubovaginal Slingplasty ； Burch Colposuspension ； urethral pressure profile ； pressure transmission ratio

參考文獻

1. Leach GE, Dmochowski RR, Appell RA, Blaivas JG, Hadley HR, Luber KM, et al: Female stress urinary incontinence clinical guidelines panel summary report on surgical management of female stress urinary incontinence. J Urol 1997;158:875-880

2. Chaikin DC, Rosenthal JR, Blaivas JG: Pubovaginal fascial sling for all types of stress urinary incontinence: long-term analysis. J Urol 1998;160:1312-1316.

3. Langer R, Lippshitz Y, Halperin R, Pansky M, Bukovsky I and Sherman D: Long-Term (10-15year) Follow-up after Burch Colposuspension for Urinary Stress Incontinence. Int Urogynecol J 2001;12:323-327

4. Ulmsten U, Petros P: Intravaginal slingplasty (IVS): An ambulatory surgical procedure for treatment of female urinary incontinence. Scand J Urol Nephrol 1995;29:75-82

5. Delancey JOL: Structural support of the urethra as it relates to stress urinary incontinence: The hammock hypothesis. Am J Obstet Gynecol 1994;170:1713-1723

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恥骨陰道吊帶術與Burch懸吊術之尿道壓力圖變化和差異

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