经阴道无张力尿道中段吊带术-TVT术

经阴道无张力尿道中段吊带术TVT术

仁济医院泌尿外科2021/3/29星期一1TVT微创伤手术1. 减少手术时间Reducesurgicaltime

2. 减少住院时间Reducelengthofhospitalization3. 减少并发症Reducecomplicationrates/risks

4. 复原快Allowquickerreturntonormal,dailyactivities5. 减少费用Lowercosts

2021/3/29星期一22021/3/29星期一3GYNECARETVTTension-freeSupportforIncontinence

TVT尿失禁的无张力支撑简介ITVT尿失禁的无张力支撑是一种创新的微创伤手术方法,它对张力性尿失禁治疗的有效性已得到了充分的临床证明

GYNECARETVTTension-freeSupportforIncontinenceisaninnovativeminimallyinvasivesurgicalalternativefortheeffectivetreatmentofstressurinaryincontinence,withprovenresults使用Prolene网带进行无张力尿道中段悬吊术TheplacementofapieceofPROLENEmesh(45cmx1.1cmx0.7mm)withouttension,atthemidurethra2021/3/29星期一4GYNECARETVTTension-freeSupportforIncontinence

TVT尿失禁的无张力支撑简介II局麻,阻滞/硬膜外Localanesthesia,sedation/regional经阴道进路，切口小,分离少

Minimalincisionsanddissection

网带无张力地置于尿道中段下Tapeplacedatmidurethrawithouttension

普理灵聚丙烯网带无需和任何组织固定

Nofixation术中使用膀胱镜Cystoscopyperformed

术后插尿管时间短

Infrequentuseofpost-opcatheters

可在门诊进行，当天出院Dischargehomethesameday

2021/3/29星期一5GoalofSurgery

手术目的1.修复和/或加强阴道尿道韧带

Restoreand/orreinforcethepubourethralligaments.

2. 修复和/或加强尿道下阴道吊筋膜

Restoreand/orreinforcethesuburethralvaginalhammock3. 加强尿道旁结缔组织

Reinforcetheparaurethralconnectivetissue

2021/3/29星期一6GYNECARETVTTension-freeSupportforIncontinenceIndications

TVT尿失禁的无张力支撑适应症适应于以下原因引起的女性张力性尿失禁IntendedtobeusedfortreatmentofFemaleStressUrinaryIncontinenceresultingfrom

尿道过度活动urethralhypermobility尿道括约肌损伤intrinsicsphincterdeficiency2021/3/29星期一7GYNECARETVTContraindications

TVT尿失禁的无张力支撑禁忌征怀孕病人Pregnantpatients

未完成发育的病人Patientswith

futuregrowthpotential计划要怀孕的病人Womenwithplansforfuturepregnancy2021/3/29星期一8GYNECARETVTTension-FreeSupportforIncontinenceSystem

TVT产品系列

TVT网带

GYNECARETVTDevice

推针器GYNECARETVTIntroducer

导引杆GYNECARETVTRigidCatheterGuide2021/3/29星期一9GYNECARETVTTension-freeSupportforIncontinence

Description:PROLENE*polypropylenemeshcoveredbyaplasticsheathProlene*网带:网状钩形编织,外面套有塑料膜2021/3/29星期一10Prolene*网带2021/3/29星期一11TVT网带

长45公分,宽一公分的网带,成分为聚丙烯网带的两侧边有特意编制的毛刺,增加其在腹壁中的摩擦力,将带子固定在腹壁中外面包有一层塑料套,塑料套在中间分开网带的两头分别为长30公分,直径为5毫米的针.手术中,针通过阴道前壁切口,带着网带穿过腹壁,使其置于尿道中段下网带的网眼大小适中,术后结缔组织会长在网眼中,加强盆底的组织2021/3/29星期一12Prolene普理灵特点惰性强组织相容性强/组织反应小有延展性表面光滑易于操作心血管吻合的专用缝线,在缝合材料中有“缝线之王”的称号2021/3/29星期一13GYNECARETVTIntroducer

推针器2021/3/29星期一14推针器

推针器的方形头部结在真的方形尾部,手术中,术者的手握住推针器的T形手柄,帮助针顺利穿过腹壁2021/3/29星期一15GYNECARETVTRigidCatheterGuide

导引杆2021/3/29星期一16导引杆导引杆在手术中的作用主要是推开膀胱,防止穿针过程中产生膀胱穿孔它从18号导尿杆进入膀胱,从左侧穿针,就将膀胱推向右侧,反之亦然2021/3/29星期一17GYNECARETVTPatientInformation

病人情况手术介绍Procedureoverview病人手术风险 Potentialrisks血肿

Bleeding-hematomaformation感染

Infection

膀胱穿孔

Bladderperforation尿潴留

Urinaryretention排斥反应

Mesherosionorrejection复原Recovery期望Expectations2021/3/29星期一18GYNECARETVT-PreOp

TVT术前

术前抗菌素Peri-operativeantibiotics停止使用抗凝剂Cessationofanti-coagulants2021/3/29星期一19InstrumentRequirements

手术需要的器械阴道重锤/拉钩弯剪-分蚊式钳-钳住塑料套,抽出.长的硬膜外针头-局麻70度膀胱镜-观察膀胱情况18号(单枪/双枪)导尿管2021/3/29星期一20GYNECARETVT-Procedure

手术过程病人准备Patientpreparation

切口Incisions分离，穿针，放置网带Dissection,needlepassageandtapeplacement

网带松紧度调整Tensionadjustment

结束手术Completingtheprocedure

2021/3/29星期一21PatientPosition

病人体位

截石位，膝盖与耻骨联合平行插18号导尿管,排空膀胱

Insert18frcatheterandemptybladder

2021/3/29星期一22Anesthetic

麻醉局麻+静脉加强LocalAnesthesiawithIVsedation,recommended骶麻或全麻RegionalorGeneralanesthesiapossible.

2021/3/29星期一23Anesthesia

麻醉

Abdomen腹部2021/3/29星期一24Anesthesia

麻醉

VaginalWall阴道前壁2021/3/29星期一25Incisions切口阴道前壁Vaginal在离尿道外口1cm处作1.5cm纵向切口腹部Abdominal

在耻骨联合上方，腹中线两侧各作一个0.5cm-1.0cm切口2incisionseachsideofmidline两切口相距最宽4-5公分justabovesymphysis4-5cmapartmax.2021/3/29星期一26VaginalWallIncision

阴道前壁切口在离尿道外口1cm处作1.5cm纵向切口2021/3/29星期一27AbdominalIncisions

腹部切口在耻骨联合上方，腹中线两侧各作一个0.5cm-1.0cm切口，两切口相距最宽4-5公分2021/3/29星期一28DissectionofAnteriorWall

阴道前壁分离

BluntDissectionsubandparaurethrally

在尿道旁和尿道下进行钝性分离2021/3/29星期一29InsertTVTRigidCatheterGuide

插入TVT导引杆2021/3/29星期一302021/3/29星期一31IntroductionoftheGYNECARETVTDevice

推入TVT网带通过阴道切口推入Introducethroughvaginalincision针头指向髂骨Aimtowardipsilateralshoulder绕过耻骨Hugthepubicbone(donotscrap从腹壁切口出Exitatabdominalincision2021/3/29星期一32IntroductionoftheGYNECARETVTDevice

推入TVT网带2021/3/29星期一33GuidetheNeedleTiptotheAbdominalIncision

将针头导向腹壁切口2021/3/29星期一342021/3/29星期一35针不要拔出2021/3/29星期一36Cystoscopy

膀胱镜针穿过后,使用膀胱镜确保膀胱完好Aftereachpassageoftheneedle,cystoscopyshouldbecompletedtoverifybladderintegrity将膀胱注液后使用膀胱镜Cystoscopyshouldbedonewithbladderhalf-full2021/3/29星期一37BladderPerforation膀胱穿孔2021/3/29星期一38BladderPerforation膀胱穿孔2021/3/29星期一39SecondPassageoftheGYNECARETVTDevice

第二根针的穿入重新插导尿管,排空膀胱Re-insertthecatheteranddrainthebladder重复第一次穿针的步骤Theoppositesideiscompletedinthesamemannerasthefirst

确保网带没有扭转Ensurethatthetapedoesnottwist再次使用膀胱镜CystoscopyafterthesecondpassoftheTVTneedle针从腹壁切口拉出PullTVTneedlethroughtheabdomenincision2021/3/29星期一40TapeAdjustment

调整网带在网带和尿道间放置一把剪刀或止血钳Placescissorsorhemostatbetweenthetapeandtheurethra拉腹壁端的网带,直到网带贴住剪刀Pulltheabdominalendsofthetapeuntilthereiscontactbetweentapeandinstrument将针剪去Separateneedlesfromthetape先不要拉出塑料薄膜Donotremovetheplasticsheath2021/3/29星期一41CoughTest

腹压测试膀胱注液250毫升Fillbladderwith250mlofsaline取出尿道下的剪刀/或止血钳Removeinstrumentundertheurethra取下阴道重锤Removevaginalspeculum要病人用力咳嗽Askpatienttocough调整网带松紧度AdjustTVTtape调整松紧度时,剪刀要置于网带和尿道之间Instrumentshouldbeplacedbetweenthetapeandtheurethraduringadjustment2021/3/29星期一42InitialCoughTest

初步腹压测试

2021/3/29星期一43AdjustTapewithInstrumentinPlace

器械放置在网带和尿道间,调整网带2021/3/29星期一442021/3/29星期一45CompletingtheProcedure

完成手术抽出塑料薄膜Removeplasticsheath

剪去腹壁上多余的网带CutProleneMesh缝合皮肤和阴道粘膜切口Closeskinandvaginalepithelium排空膀胱Emptybladder取出导尿管Removecatheter2021/3/29星期一46CompletingtheProcedure

完成手术

removingplasticsheath取出塑料薄膜2021/3/29星期一47CompletingtheProcedure完成手术

Trimmingthemesh剪去多余的网带2021/3/29星期一48GYNECARETVTPostoperativeAssessmentBeforeDischarge

出院前的术后评估出血/血肿Bleeding/hematoma

餐饮Eatinganddrinking排尿Voiding2021/3/29星期一49GYNECARETVTPostoperativeInstructions

术后要求术后排尿残留Postvoidresidual3-4天抗菌素Antibiotics3-4Days限制活动Activitylimitations

驾驶锻炼性生活工作2021/3/29星期一50GYNECARETVTPostoperativeCare

Follow-upappointments

随访3weeks6monthsYearly2021/3/29星期一51GYNECARETVTComplications&Treatment

并发症及其治疗方法尿潴留Urinaryretention2021/3/29星期一52GYNECARETVTComplications&Treatment

并发症及其治疗方法

膀胱穿孔Perforationofthebladder使用膀胱镜确认Cystoscopicidentification取出针,重新穿Removeneedleandreposition导尿管留置1-2天Indwellingcatheterx1-2days2021/3/29星期一53GYNECARETVTComplications&Treatment

并发症及其治疗方法

阴道出血/后腹膜血肿Vaginalbleeding/Retropubichematoma保守治疗Manageconservatively

阴道填塞Vaginalpacking引流Percutaneous