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| 發表人 | 討論主題 | 發表時間 | 討論數 |
| 陳欣宏 | 經恥骨後(TVT)及經閉鎖孔(TVT-O)無張力性陰道吊帶術之臨床比較 | 2007/5/9 下午 10:44:39 | 1 |
| 原 文 | 題 目 | Retropubic compared with transobturator tape placement in treatment of urinary incontinence: a randomized controlled trial |
| 作 者 | Laurikainen E, Valpas A, Kivela A, Kalliola T, Rinne K, Takala T, Nilsson CG | |
| 出 處 | Obstet Gynecol. 109(1):4-11 | |
| 出版日期 | 2007 January | |
| 評 論 |
自1994年Ulmsten及Petros提出TVT概念，治療婦女應力性尿失禁以來，其短、中、長期的成功率大約為84％至95％之間。而de Laval在2003年發表的TVT-O，強調 “inside-out”的經閉鎖孔路徑的手術方式，則提供了另一種尿道懸吊的觀念。 當時TVT-O被認為可以大大降低膀胱或腹部內器官穿刺危險性，及改善術後復原的時間等優點，然而事實是如何呢？ 本文乃是一篇集合芬蘭七家醫學中心共267位尿失禁患者的研究，將病患任意分成2組分別接受TVT及TVT-O手術，然後探討兩者的差異性。兩組皆是以局部麻醉方式進行手術，術後都沒有置放導尿管；手術後2個月回診評估，包括cough stress test、殘尿量測量及尿液分析。結果發現兩者成功率分別為98.5%（TVT）及95.4%（TVT-O）；但住院日、術後疼痛 (例如groin pain)、及回復正常排尿（殘尿少於100cc）等指標皆發現TVT優於TVT-O，且TVT並沒有產生較多的併發症。可見改良式的手術方式並不保證就有較佳的臨床效果。 而根據筆者有限的經驗看來，對於這兩種手術方式，只要選對合適的病患再加上熟悉手術步驟，所得到的效果也似乎相差不大。 |
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| abstract | OBJECTIVE: To compare the intraoperative and immediate postoperative performance of the retropubic tension-free vaginal tape (TVT) procedure with that of the transobturator tension-free vaginal tape (TVT-O) procedure as primary treatment for female urinary stress incontinence. METHODS: Randomized multicenter comparative trial including four university hospitals and three central hospitals in Finland. Assessment preoperatively and 2 months postoperatively included a cough stress test and the following condition-specific quality of life questionnaires: the Urinary Incontinence Severity Score (UISS), the Detrusor Instability Score, the Incontinence Impact Questionnaire-Short Form, the Urogenital Distress Inventory-Short Form, and a visual analog scale (VAS). Operation time, theater time, hospital stay, intraoperative and immediate postoperative complications were recorded. RESULTS: Of the 273 originally randomized patients, 267 underwent the allocated operation, 136 in the TVT group and 131 in the TVT-O group. No significant differences in objective or subjective cure rates were detected. Patients in the TVT-O group had a significantly longer hospital stay, needed significantly more postoperative opiate analgesia and had significantly more complications than the patients in the TVT group. Patients in both groups had a significant postoperative improvement in quality of life, as indicated by the results of all the questionnaires used, with no difference between the groups. CONCLUSION: The TVT and the TVT-O procedures perform equally in terms of objective and subjective cure. The statistically significant higher complication rate in the TVT-O group is not regarded as clinically significant. | |
| 回覆發表 | 回覆討論主題內容 | 最後發表 |
| 王炯珵 |
I agree that 改良式的手術方式並不保證就有較佳的臨床效果 in the treatment of stress urinary incontinence。 Only we can do is to choose the operative method that we free easy to perform. |
2007/6/6 上午 07:31:01 |