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李香瑩 陰道雷射應用於女性應力性尿失禁的治療效果 2017/1/26 上午 09:22:30 0
原 文 題  目 Treatment of female stress urinary incontinence with Erbium-YAG laser in non-ablative mode
作  者 Pardo JI, Solà VR, Morales AA
出  處 European Journal of Obstetrics & Gynecology and Reproductive Biology
出版日期 2016. 9
評 論 女性應力性尿失禁是一個高盛行率的疾病,尤其常見於中老年婦女。治療分為非手術和手術治療。非手術治療有行為治療包括減重、飲食控制、戒菸、骨盆底肌肉訓練等,手術治療包括經陰道尿道中段懸吊手術等。雖然手術的效果很好,但還是要注意發生併發症的可能,例如出血、膀胱穿孔、尿道受傷、感染、疼痛、網膜外露等。因為還是會有病人不適合開刀或是擔心發生併發症,所以學者們研究是否有其他較非侵入性的治療替代方法,而陰道雷射就是其中一種選擇。此文章收集智利42位女性應力性尿失禁病人接受非切除模式的陰道雷射治療,評估治療前後尿失禁問卷調查(International Consultation on Incontinence Questionnaire – Urinary Incontinence Short Form (ICIQ-UI SF))的分數差異和病人主觀滿意度。結果顯示約78.6%的病人尿失禁症狀有改善,66.7%的病人表示高滿意度,85.7%的病人表示會推薦此種治療方式,76.2%表示會願意再次接受治療。以此篇結果來看,非切除模式的陰道雷射或許是治療應力性尿失禁的另一個選擇,但因為追蹤時間短,收集的個案數太少,沒有對照組,所以還需要更多的研究來評估其療效和效果持續的時間。
abstract

摘要
Objective: To evaluate the efficacy of laser photothermal therapy in a group of Chilean women with SUI. Material and methods: Longitudinal prospective study based on 42 women with mild-to-severe SUI, intervened with non ablative Er:YAG laser, between July 2014 and October 2015, in Santiago, Chile. The therapy efficacy was evaluated through the difference between every patient’s scores obtained, before and after treatment, with the International Consultation on Incontinence Questionnaire – Urinary Incontinence Short Form (ICIQ-SF), at a confidence level of 95%. Also, the patient satisfaction with treatment was reported through an ordinal scale. Results: ICIQ-SF median score was 11 before treatment and 3 after 6 months, with a significant difference per patient (p < 0.001). 78.6% (n = 33) reported improvement and 38.1% (n = 16), a complete healing of SUI at follow up. 66.7% (n = 28) reported high satisfaction and 81.8% (n = 27) of sexually active women, also reported improvement of sexual gratification. Only mild pain during the procedure was reported as adverse effect. Conclusions: Based on this short-term pilot study, non-ablative Er:YAG laser procedure seems to be a safe and efficacious alternative for patients with SUI. Further controlled studies will help to validate the use of non-ablative Er:YAG for treatment of SUI.

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