How important is TVT location?
How important is TVT location?
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DOI：
10.1111/j.0001-6349.2004.00198.x
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发表时间：
2004-10-01
影响因子：
4.3
通讯作者：
Wilson, PD
中科院分区：
文献类型：
--
作者：
Dietz, HP;Mouritsen, L;Wilson, PD
背景资料。无张力阴道吊带术(TVT)被认为是一种经尿道中段手术，但有关吊带放置的数据迄今很少。本研究的目的是调查胶带的位置和流动性，并将其与术后膀胱功能障碍的症状相关联。141名TVT置入后5周至2.1年(平均0.66年)的妇女参加了一项前瞻性临床观察研究。预约包括标准化症状问卷、临床负荷试验流量计和经唇超声。主要观察指标为患者症状、主观满意度和治愈/改善情况。对连续、正态分布的参数进行配对t检验和方差分析。固定位置Valsalva联合上方30 mm~下方12.7 mm，上方15 mm~下方18.7 mm。胶带距耻骨联合的水平距离与复发性压力性尿失禁的相关性较弱(p=0.048)。颅带较多与急迫性尿失禁(p=0.03)、尿频(p=0.048)和排尿功能障碍症状(p=0.029)关系不大。磁带放置与患者满意度或主观治愈/改善之间没有关联。TVT的位置和活动度变化很大。这可能与不同程度的解剖、切口定位以及术前阴道前壁脱垂的程度有关。然而，不同的位置似乎对症状影响相对较小。
Background. The tension-free vaginal tape (TVT) is claimed to be a midurethral procedure, but data on sling placement are scarce to date. The aim of this study was to investigate tape position and mobility and correlate this with postoperative symptoms of bladder dysfunction.Methods. One hundred and forty-one women 5 weeks to 2.1 years (mean 0.66 years) after TVT placement took part in a prospective clinical observational study. Appointments consisted of standardized symptom questionnaire, clinical stress test flowmetry and translabial ultrasound. The main outcome measures were patient symptoms, subjective satisfaction and cure/improvement. Paired t-test and ANOVA statistics were employed for continuous, normally distributed parameters.Results. Tape position varied from 30 mm above to 12.7 mm below the symphysis at rest and between 15 mm above to 18.7 mm below the symphysis on Valsalva. The horizontal distance of the tape from the symphysis pubis was weakly associated with recurrent stress incontinence (p = 0.048). More cranial tapes were weakly associated with urge incontinence (p = 0.03), frequency (p = 0.048) and symptoms of voiding dysfunction (p = 0.029). There was no association between tape placement and patient satisfaction or subjective cure/improvement.Conclusions. Position and mobility of the TVT vary markedly. This may be explained by varying degrees of dissection, localization of incisions and the preoperative degree of anterior vaginal wall prolapse. However, variations in placement seem to have relatively little effect on symptoms.