TVT-O治療女性壓力性尿失禁

1、TVT-O治療女性壓力性尿失禁I. 盆底支持組織缺損A. 陰道尿道韌帶 Pubourethral ligamentsB. 尿道下陰道吊筋膜 Suburethral vaginal hammock (endopelvic fascia)C. 連接上述組織的結(jié)締組織(膠原纖維) Connective tissue (collagen fibers) interconnecting the above structuresD. 提肛肌 Levator ani muscles - tone/contractilityII. 尿道內(nèi)和外括約肌缺損 Defects in both intrinsic an

2、d extrinsic urethral function: A. DenervationB. DevascularizationC. Aging真性張力性尿失禁的病理特征真性尿失禁的傳統(tǒng)手術(shù)方式四類傳統(tǒng)性基本術(shù)式恥骨上膀胱尿道懸吊術(shù)：Burch手術(shù)經(jīng)陰道前壁修補(bǔ)術(shù)：尿道折疊術(shù)經(jīng)腹陰道聯(lián)合切口膀胱頸懸吊術(shù)：Stamey手術(shù)膀胱頸筋膜吊帶術(shù)：以生物腱膜做吊帶Albridge-Studiford術(shù)（聯(lián)合切口） Milllia-Read術(shù)（經(jīng)腹手術(shù)）根據(jù)病因選擇手術(shù)方法Hypermobility ISDBoth尿道活動(dòng)過(guò)度尿道內(nèi)括約肌損傷 合并述1. Abdominal RPU1. Injectio

3、ns1. Slings2. Needle2. Slings urethropexies3. Slings微創(chuàng)傷手術(shù)1. 減少手術(shù)時(shí)間 Reduce surgical time 2. 減少住院時(shí)間 Reduce length of hospitalization 3. 減少并發(fā)癥 Reduce complication rates/risks 4. 復(fù)原快 Allow quicker return to normal, daily activities5. 減少費(fèi)用 Lower costs GYNECARE TVT Tension-free Support for Incontinence TV

4、T尿失禁的無(wú)張力支撐使用Prolene網(wǎng)帶進(jìn)行無(wú)張力尿道中段懸吊術(shù)The placement of a piece of PROLENE mesh (45 cm x 1.1 cm x 0.7 mm) without tension, at the mid urethraGYNECARE TVT Tension-free Support for Incontinence TVT尿失禁的無(wú)張力支撐普理靈聚丙烯網(wǎng)帶 PROLENE* polypropylene mesh tape 無(wú)需和任何組織固定 No fixation經(jīng)陰道進(jìn)路 Trans-vaginal approach 組織分離少 Mini

5、mal tissue dissectionGYNECARE TVT Tension-free Support for Incontinence TVT尿失禁的無(wú)張力支撐局麻 Local anesthetic 導(dǎo)尿管使用時(shí)間短 Minimal catheter use 可在門診進(jìn)行 Out-patient GYNECARE TVT Tension-free Support for Incontinence Indications TVTO尿失禁的無(wú)張力支撐適應(yīng)癥適應(yīng)于以下原因引起的女性張力性尿失禁Intended to be used for treatment of Female Stress

6、 Urinary Incontinence resulting from 尿道過(guò)度活動(dòng) urethral hypermobility尿道括約肌損傷intrinsic sphincter deficiencyGYNECARE TVT Tension-free Support for Incontinence Contraindications TVT尿失禁的無(wú)張力支撐禁忌征懷孕病人 Pregnant patients 未完成發(fā)育的病人 Patients with future growth potential計(jì)劃要懷孕的病人 Women with plans for future pregnan

7、cyGYNECARE TVT Tension-free Support for Incontinence Description: PROLENE*polypropylene mesh covered by a plastic sheathProlene*網(wǎng)網(wǎng) 帶帶: 網(wǎng)網(wǎng) 狀狀 鉤鉤 形形 編編 織織 , 外外 面面 套套 有有 塑塑 料料 膜膜 Prolene 普理靈特點(diǎn) 惰性強(qiáng) 組織相容性強(qiáng)/組織反應(yīng)小 有延展性 表面光滑 易于操作心血管吻合的專用縫線,在縫合材料中有“縫線之王”的稱號(hào)GYNECARE TVT - Pre OpTVT 術(shù)前NPO 術(shù)前抗菌素 Peri-operative antibiotics停止使用抗凝劑 Cessation of anti-coagulants Postmenopausal patient should have estrogenized vaginal wall tissu