经闭孔无张力尿道中段悬吊术治疗女性压力性尿失禁学习曲线的研究

Learning curves of performing transobturator tension-free vaginal tape for stress urinary incontinence

摘要:

目的 探讨经闭孔无张力尿道中段悬吊术(transobturator tension-free vaginal tape, TVT-O)治疗女性压力性尿失禁的学习曲线。方法 回顾分析2008年9月—2017年6月由3名术者（甲、乙、丙）各自完成的60例治疗压力性尿失禁的TVT-O术的临床资料，按手术先后顺序分成A、B、C、D、E、F等6组，每组10例，比较各组的围手术期相关指标及术后6个月并发症及生活质量评分。结果 不同术者手术时间差异有统计学意义（P＜0.05），术后留置尿管时间、术后住院时间、术中脏器损伤、术后血肿、术后尿潴留差异无统计学意义（P>0.05）。同一术者不同手术例数间指标比较结果： 术者甲B组的手术时间长于其他组（P=0.021），A组的术后住院天数长于其他组（P=0.05）。所有患者均未发生严重手术并发症。术后6个月，A、B组的术后疼痛多于其他4组（P=0.040），而尿失禁复发率（P=0.157）、网片侵蚀（P=0.713）及术后生活质量评分组间比较差异无统计学意义（P＞0.05）。结论 经过20例左右TVT-O手术操作训练，医生的操作技能可达到稳定的程度。

Abstract:

Objective To evaluate learning curves of transobturator tension-free vaginal tape(TVT-O) procedure for stress urinary incontinence(SUI). Methods Clinical data of 60 patients with SUI undergoing TVT-O performed by three surgeons from September 2008 to June 2017 were reviewed retrospectively. The patients were assigned in 6 groups according to the sequence of the operation with 10 in each group. The perioperative indexes, complications and quality of life after 6-month follow-up was compared among groups. Results There was significant difference in operative time among three surgeons(P＜0.05）, but there were no significant differences in the time of indwelling urethral catheterization after surgery, postoperative hospital stay, urinary retention, organ injury or hematoma during surgery among three surgeons(P>0.05). For surgeon 1, the operative time of group B was longer than that of other groups(P＜0.05), the postoperative hospital stay in group A was longer than that in other groups(P＜0.05); however, there were no significant differences in urinary retention and complication among 6 groups. For doctor 2 and doctor 3 there were no significant differences in these indicators among 6 groups. Patients in group A and group B reported more pain than other groups（P=0.040）, but there was no significant difference in recurrent SUI（P=0.157）, mesh erosion（P=0.713） and quality of life after operation（P＞0.05）. Conclusion The learning curves show that surgeons can master the skills of TVT-O for stress urinary incontinence patients after performance of 20 cases.