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題名 | Combination of a Tension-Free Vaginal Tape Procedure and Laparoscopic-Assisted Vaginal Hysterectomy for the Treatment of Benign Uterine Disease Associated with Stress Urinary Incontinence=合併腹腔鏡子宮全切除術及無張力性尿道中段懸吊術治療同時患有良性子宮疾病及壓力性尿失禁患者 |
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作者 | 梁西米; 黃寬慧; 龔福財; 陳智偉; 張旭陽; | 書刊名 | 長庚醫學 |
卷期 | 28:3 2005.03[民94.03] |
頁次 | 頁166-173 |
分類號 | 417.142 |
關鍵詞 | 腹腔鏡子宮全切除術; 無張力性尿道中段懸吊術; 壓力性尿失禁; Stress urinary incontinence; Laparoscopic-assisted vaginal hysterectomy; LAVH; Tension-free vaginal tape; TVT; |
語文 | 英文(English) |
中文摘要 | Background: Women undergoing hysterectomy for benign uterine disease (BUD) may experience stress urinary incontinence (SUI). We performed tension-free vaginal tape (TVT) procedure and laparoscopic-assisted vaginal hysterectomy (LAVH) simultaneously and assessed the feasibility and efficacy of TVT performed under general anesthesia and the resultant anti-incontinence effects following the combined procedures. Methods: Between March, 2000 and March, 2002 inclusively, 63 patients, who suffered from both BUD and SUI, underwent LAVH and TVT. Preoperative evaluation included history-taking, physical examination and ultrasonography. One-hour pad test, multichannel urodynamics and urinary questionnaire were conducted preoperatively and postoperatively. Details about surgical procedures undertaken, hospitalization and urinary problems in the follow-up period were recorded. Results: 50 patients completed the study with a mean follow-up period of 34 (25-48) months. The mean age was 49 (39-67) years and mean parity 3 (2-6). The mean surgical duration was 163 (95-240) minutes and blood loss 284 (100-1,500) milliliters. Mean duration of hospital stay was 5.5 days and bladder drainage 1.9 days. Three patients suffered bladder perforation and one patient was complicated with excess blood loss. Postoperative urinary problems included transient urine retention, de novo frequency/urgency symptoms and voiding difficultly. Conclusions: The efficacy of concomitant TVT in LAVH procedure remained satisfactory in treatment of SUI associated with BUD. Both procedures reflect the benefits of less-invasive surgery. So the combination of LAVH and TVT is probably a good alternative for the patient who needs to undergo hysterectomy and anti-incontinence surgery simultaneously. |
英文摘要 | 背景:由於良性子宮疾病而需要接受子宮全切除術的病患可能同時合併有壓力性尿失禁的困擾。在考慮同時能以微創手術處理此兩項問題,所以我們評估同時進行腹腔鏡子宮全切除術及無張力性尿道中段懸吊術之可行性,及無張力性尿道中段懸吊術在全身麻醉下進行之可行性及術後效果評估。 方法:從2000年3月至2002年3月期間,共63位同時患有良性子宮疾病及壓力性尿失禁患者接受腹腔鏡子宮全切除術合併無張力性尿道中段懸吊術治療。病患術前評估包括病史、理學及超音波檢查,另外術前及術後均接受一小時棉墊測試、尿動力學檢查及泌尿道症狀問卷,我們亦詳細記錄手術中、住院中及術後解尿等各項細節問題。 結果:最後共50位病患完成本研究,平均術後追蹤時間為34個月,平均年齡49歲,生產次數為3。手術時間及失血量分別為163分鐘及284毫升,住院時間5.5天,尿管放置時間為45.7小時。3位病患有膀胱穿孔及1位失血過多之併發症,術後泌尿道症狀包括暫時性尿滯留、頻尿/急尿症狀及解尿困難。 結論:使用腹腔鏡子宮全切除術合併無張力性尿道中段懸吊術來治療患有良性子宮疾病及同時有壓力性尿失禁患者,結果是令人滿意的,而且兩者均有微創手術的好處。根據我們的研究結果如病患同時需要接受子宮切除術及壓力性尿失禁手術時,腹腔鏡子宮全切除術合併無張力性尿道中段懸吊術是很好的另一種選擇。 |
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