TVT及TVTO术后并发症处理

单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,TVT,及,TVT-O,术后并发症处理,临床资料,时间：,2002,年,6,月,2005,年,5,月,手术分组：,TVT,组：,58,例，连硬外麻醉,39,例，局部麻醉,19,例,TVT-O,组：,23,例，连硬外麻,22,例，局部麻醉,1,例,疗效,：,治愈,改善,无效,TVT,组,52,例（,89.7,）,4,例（,6.9,）,2,例（,3.4,）,TVT-O,组,22,例（,95.7,）,1,例（,4.3,）,0,例（,0,）,陈忠等,.,中华泌尿外科杂志,.2006,27(5),321-323,并发症及处理（,TVT,组）,术中发生膀胱穿刺损伤,3,例，,1,例终止手术，余者延长术后留置导尿管时间治愈,耻骨后血肿,1,例，经保守治疗后康复,3,例术后仍有漏尿，术后,7,9,天经腹壁切口上提调整吊带后,2,例达到完全控尿，,1,例显著改善,6,例发生不同程度膀胱排空困难，,5,例术后,5,7,天经阴道前壁切口作松解术，,1,例延长导尿管留置时间，,2,周后缓解,陈忠等,.,中华泌尿外科杂志,.2006,27(5),321-323,2,例术后发生排尿困难，于术后第,4,、,7,天经阴道前壁切口作松解后排尿通畅,3,例术后头,2,天双下肢活动功能障碍，平卧可以水平移动，但不能上举，经卧床休息后自行缓解,2,例诉术后大腿根部吊带出皮肤处有间断隐痛感,并发症及处理（,TVT-O,组）,陈忠等,.,中华泌尿外科杂志,.2006,27(5),321-323,TVT,术中并发症,主要表现为脏器或血管的穿刺损伤,Abouassaly,等总结,241,例,TVT,术后并发症，术中发生膀胱穿孔,14,例（,5.8,）、失血大于,500ml 6,例（,2.5,）,Debodinance,报道,256,例,TVT,手术，膀胱损伤,5.5%,，尿道损伤,0.4,，耻骨后血肿,0.4,。,Abouassaly R,et al.BJU Int,2004,94:110-113.,Debodinance P,et al.Eur J Obstet Gynecol Reprod Biol,2002,105:49-58,Complications Statement,Complication US Ex-US Total%,Vascular injury 7 37 44 0.009,Urethral erosion 20 0 20 0.004,Bowel perforation 16 12 28 0.006,Nerve injury 3 1 4 0.0008,Hematoma formation 4 16 20 0.004,Most Significant Reported Complications,+,Based on over 500,000 patients treated worldwide,+As of September 26,2003,seven deaths are associated with GYNECARE TVT.Six cases were for bowel perforation.Five were associated with undiagnosed bowel perforations at the time of surgery.In the sixth case of bowel perforation,no additional information could be obtained.The seventh case was associated with a woman who had a bleeding disorder who died from uncontrolled postoperative bleeding in the retropubic space.,Costa,报道,183,例,TOT,手术，其中包括,26,例含,TVT,术等抗尿失禁手术后失败病例，术中仅有,1,例发生膀胱穿孔、,2,例尿道穿孔、,1,例阴道侧壁穿孔,DeLeval,报道,107,例,TVT-O,手术，平均手术时间仅,14,分钟，没有膀胱和尿道损伤，没有神经损伤，也没有伴有血肿形成或大出血的血管损伤。,Costa P,et al.Eur Urol,2004,46:102-107,DeLeval J.Eur Urol,2003,44:724-730,TOT,及,TVT-O,术中并发症,obturator nerve(,O,),Anterior(,V,)and,posterior(,P,)branches of obturator nerve,adductor brevis muscle(,M,),TVT,术后排空障碍的发生率,术后膀胱不同程度的排空障碍是最常见的并发症，文献报道为,2,20%,。,Abouassaly,等报道的,241,例术后,48,例（,19.7,）术后发生的尿潴留,Debodinance,报道,256,例术后有,13,例（,5.1,）患者发生暂时性尿潴留,Klutke,报道,600,例术后,17,例（,2.8,）表现为不同程度排尿困难，甚至尿潴留,Abouassaly R,et al.BJU Int,2004,94:110-113.,Debodinance P,et al.Eur J Obstet Gynecol Reprod Biol,2002,105:49-58,Klutke C,et al.Urology,2001,58:697-701,轻度术后排尿障碍常系术中膀胱尿道水肿、痉挛、感染等引起，不需特殊处理,术后发生尿潴留者,推荐进行耻骨上膀胱造瘘引流,严重术后排尿困难、尿潴留,经保守治疗无效者,可经阴道行吊带松解术,TVT,术后排空障碍原因及处理,金讯波,钟景琦,.,山东医药,.2005,45(21),76-77,术后排空障碍的发生率及处理,金讯波,：,TVT,组有,1/22,（,4.5,）例出现排尿困难,经尿道扩张后好转,金辛良：,TVT,组,42,例，,4,例（,9.5,）发生急性尿潴留,1,例作松解术,3,例留置导尿管,2,周,拔管后经尿道扩张排尿恢复正常,金讯波,等,.,中华泌尿外科杂志,.2006,27(5),318-320,金辛良,等,.,中华泌尿外科杂志,.2006,26(5),337-339,术后排空障碍的发生率及处理,方祖军：,TVT,组,114,例，术后,1,个月内有排尿不畅者,9,例,(8.2%),拔除导尿管后,1,周内予尿道扩张治疗,1,2,次,术后,6,个月复查,7,例症状逐渐缓解,最大尿流率和剩余尿与术后早期相比也有明显改善，仅,2,例症状无明显改善；尿潴留者,1,例,(0.9%),，反复尿潴留患者经保守治疗无效，最终将吊带切断，术后随访,30,个月仍完全尿控。,方祖军等,.,中华泌尿外科杂志,.2006,27(5),324-327,TV T,术中咳嗽试验的意义,前期,27,例严格按照,Ulmsten,的方法进行手术,根据咳嗽试验调整吊带的张力：,2,例出现尿潴留,2,例发生排尿困难,在半蹲位排尿时减轻。,苟欣等,.,重庆医科大学学报,.2006,31(1),132-133,后期,18,例则不进行咳嗽试验,只是把吊带无张力的放在尿道的下方：无,1,例排尿困难,结论,:TVT,术中利用咳嗽试验调整吊带张力的方法会增加术后尿潴留或者排尿困难的发生率。,谢谢大家,