[1]潘慧仙①,吕坚伟,冷静,等.经阴道无张力尿道吊带术引起膀胱穿孔的原因分析及处理[J].中国微创外科杂志,2012,12(5):422-424.
　Pan Huixian,LüJianwei*,Leng Jing*,et al.Causes and Management of Bladder Perforation during TensionFree Vaginal Tape Procedure[J].Chinese Journal of Minimally Invasive Surgery,2012,12(5):422-424.
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经阴道无张力尿道吊带术引起膀胱穿孔的原因分析及处理()
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《中国微创外科杂志》[ISSN:1009-6604/CN:11-4526/R]

卷:
12
期数:
2012年5期
页码:
422-424
栏目:
出版日期:
2012-05-25

文章信息/Info

Title:
Causes and Management of Bladder Perforation during TensionFree Vaginal Tape Procedure
作者:
潘慧仙①; 吕坚伟; 冷静; 薄隽杰; 刘东明; 黄翼然
上海交通大学医学院附属仁济医院泌尿外科，上海200001
Author(s):
Pan Huixian;  LüJianwei*;  Leng Jing*;  et al.
*Department of Urology, Renji Hospital Affiliated to Medical College of Shanghai Jiao Tong University,Shanghai 200001,China
关键词:
经阴道无张力尿道吊带术; 膀胱穿孔; 原因分析
Keywords:
Tensionfree vaginal tape (TVT); Bladder perforation; Analysis of causes经阴道无张力尿道吊带术(tensionfree vaginal tape; TVT）
分类号:
R694+.6
文献标志码:
A
摘要:
目的探讨经阴道无张力尿道吊带术(tensionfree vaginal tape，TVT)中引起膀胱穿孔的原因和处理方法。方法回顾性分析上海交通大学附属仁济医院10年来（2000年3月～2010年7月）因压力性尿失禁(stress urinary incontinence，SUI)行TVT手术559例资料，发生膀胱穿孔33例(5.9%)。既往有盆腔手术史共29例(87.9%)，其中全子宫切除术15例，剖宫产术8例，子宫肌瘤剔除术4例，卵巢附件手术2例。结果膀胱全层穿孔28例，穿破膀胱肌层但未穿透黏膜5例。均退出穿刺针后再次穿刺，穿刺方向略偏向原穿刺路径的外侧，经膀胱镜检查确认无损伤后，留置导尿4~5天后拔管，痊愈出院。33例术后随访3~138个月，（68.5±32.8）月，均无继发性出血、尿漏及尿路感染等并发症。结论既往盆腔手术史使膀胱与周围组织粘连固定是TVT手术中引起膀胱穿孔的影响因素之一，手术前应引起术者重视。如术中发现膀胱穿孔，应及时退出穿刺针，调整穿刺方向，可以再次穿刺。
Abstract:
ObjectiveTo discuss the causes and therapeutics of bladder perforation occurred during tensionfree vaginal tape(TVT) procedure. MethodsSince March 2000 to July 2010, totally 559 patients with stress urinary incontinence (SUI) received TVT in Shanghai Renji Hospital. We analyzed the data of the patients retrospectively. In the patients, bladder perforation occurred in 33 cases (5.9%), 29 of them (87.9%) had history of pelvic surgery, including total hysterectomy (15 cases), cesarean section (8 cases), hysteromyomectomia (4 cases), and ovarian surgery (2 cases). ResultsAmong the 33 patients, 28 had complete bladder perforation, and the other 5 had partial bladder perforation (the mucosal layer was intact). They all received a second puncture via an approach lateral to the first one. Without any injury to the bladder confirmed by cystoscopy, we removed urinary catheter in 4 to 5 days. The patients were followed up for 3 to 138 months with a mean of (68.5±32.8)months, during which no patient had secondary hemorrhage, urinary leakage or infection. ConclusionsAdhesion between the perivesical tissues and bladder wall made by pelvic surgery is one of the causes of bladder perforation during TVT. When bladder perforation occurs, puncture needle should be withdrawn immediately so that to repuncture at another direction.

参考文献/References:

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备注/Memo

备注/Memo:
潘慧仙①吕坚伟通讯作者，Email:ljwass@126.com ①(浙江省兰溪市人民医院泌尿外科，兰溪321100)
更新日期/Last Update: 2013-04-03