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1、经阴道无张力尿道中段吊带术 TVT术,上 海 第 二 医 科 大 学 附 属 仁 济 医 院 泌 尿 外 科,TVT微创伤手术,1. 减少手术时间 Reduce surgical time 2. 减少住院时间 Reduce length of hospitalization 3. 减少并发症 Reduce complication rates/risks 4. 复原快 Allow quicker return to normal, daily activities 5. 减少费用 Lower costs,GYNECARE TVT Tension-free Support for Inconti
2、nence TVT尿失禁的无张力支撑简介 I,TVT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 GYNECARE TVT Tension-free Support for Incontinence is an innovative minimally invasive surgical alternative for the effective treatment of stress urinary incontinence, with proven results 使用Prolene网带进行无张力尿道中段悬吊术 The placemen
3、t of a piece of PROLENE mesh (45 cm x 1.1 cm x 0.7 mm) without tension, at the mid urethra,GYNECARE TVT Tension-free Support for Incontinence TVT尿失禁的无张力支撑简介 II,局麻, 阻滞/硬膜外Local anesthesia,sedation/regional 经阴道进路，切口小, 分离少 Minimal incisions and dissection 网带无张力地置于尿道中段下Tape placed at mid urethra without
4、 tension 普理灵聚丙烯网带无需和任何组织固定 No fixation 术中使用膀胱镜 Cystoscopy performed 术后插尿管时间短 Infrequent use of post-op catheters 可在门诊进行，当天出院 Discharge home the same day,Goal of Surgery 手术目的,1. 修复和/或加强阴道尿道韧带 Restore and/or reinforce the pubourethral ligaments. 2. 修复和/或加强尿道下阴道吊筋膜 Restore and/or reinforce the subureth
5、ral vaginal hammock 3. 加强尿道旁结缔组织 Reinforce the paraurethral connective tissue,GYNECARE TVT Tension-free Support for Incontinence Indications 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Intended to be used for treatment of Female Stress Urinary Incontinence resulting from 尿道过度活动 urethral hypermobility 尿道括约肌损伤i
6、ntrinsic sphincter deficiency,GYNECARE TVT Contraindications TVT尿失禁的无张力支撑禁忌征,怀孕病人 Pregnant patients 未完成发育的病人 Patients with future growth potential 计划要怀孕的病人 Women with plans for future pregnancy,GYNECARE TVT Tension-Free Support for Incontinence System TVT产品系列,TVT 网带 GYNECARE TVT Device 推针器 GYNECARE
7、TVT Introducer 导引杆 GYNECARE TVT Rigid Catheter Guide,GYNECARE TVT Tension-free Support for Incontinence,Description: PROLENE*polypropylene mesh covered by a plastic sheath Prolene*网 带: 网 状 钩 形 编 织 , 外 面 套 有 塑 料 膜,Prolene*网 带,TVT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
8、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,Prolene 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,GYNECARE TVT Introducer 推针器,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,GYNECARE TVT Rigid Catheter Guide 导引杆
9、,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,GYNECARE TVT Patient Information 病人情况,手术介绍 Procedure overview 病人手术风险 Potential risks 血肿 Bleeding-hematoma formation 感染 Infection 膀胱穿孔 Bladder perforation 尿潴留 Urinary retention 排斥反应 Mesh erosion or rejection 复原 Recovery 期望 Expe
10、ctations,GYNECARE TVT - Pre Op TVT 术前,术前抗菌素 Peri-operative antibiotics 停止使用抗凝剂 Cessation of anti-coagulants,Instrument Requirements 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,GYNECARE TVT - Procedure 手术过程,病人准备 Patient preparation 切口 Incisions 分离，穿针，放置网带 Dissection
11、, needle passage and tape placement 网带松紧度调整 Tension adjustment 结束手术 Completing the procedure,Patient Position 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 Insert 18 fr catheter and empty bladder,Anesthetic 麻醉,局麻 +静脉加强 Local Anesthesia with IV sedation, recommended 骶麻或全麻 Regional or General anesthesia possible.,
12、Anesthesia 麻醉 Abdomen 腹部,Anesthesia 麻醉 Vaginal Wall 阴道前壁,Incisions 切口,阴道前壁 Vaginal 在离尿道外口1cm处作1.5 cm 纵向切口 腹部 Abdominal 在耻骨联合上方，腹中线两侧各作一个0.5 cm - 1.0 cm切口 2 incisions each side of midline 两切口相距最宽4-5公分 just above symphysis 4 - 5 cm apart max.,Vaginal Wall Incision 阴道前壁切口,在离尿道外口1cm处作1.5 cm 纵向切口,Abdomin
13、al Incisions 腹部切口,在耻骨联合上方，腹中线两侧各作一个0.5 cm - 1.0 cm切口，两切口相距最宽4-5公分,Dissection of Anterior Wall 阴道前壁分离 Blunt Dissection sub and paraurethrally 在尿道旁和尿道下进行钝性分离,Insert TVT Rigid Catheter Guide 插入TVT导引杆,Introduction of the GYNECARE TVT Device 推入TVT网带,通过阴道切口推入 Introduce through vaginal incision 针头指向髂骨 Aim
14、toward ipsilateral shoulder 绕过耻骨 Hug the pubic bone (do not scrap 从腹壁切口出 Exit at abdominal incision,Introduction of the GYNECARE TVT Device 推入TVT网带,Guide the Needle Tip to the Abdominal Incision 将针头导向腹壁切口,针不要拔出,Cystoscopy 膀胱镜,针穿过后, 使用膀胱镜确保膀胱完好 After each passage of the needle, cystoscopy should be c
15、ompleted to verify bladder integrity 将膀胱注液后使用膀胱镜 Cystoscopy should be done with bladder half-full,Bladder Perforation 膀胱穿孔,Bladder Perforation 膀胱穿孔,Second Passage of the GYNECARE TVT Device 第二根针的穿入,重新插导尿管, 排空膀胱 Re-insert the catheter and drain the bladder 重复第一次穿针的步骤 The opposite side is completed in
16、 the same manner as the first 确保网带没有扭转 Ensure that the tape does not twist 再次使用膀胱镜 Cystoscopy after the second pass of the TVT needle 针从腹壁切口拉出 Pull TVT needle through the abdomen incision,Tape Adjustment 调整网带,在网带和尿道间放置一把剪刀或止血钳 Place scissors or hemostat between the tape and the urethra 拉腹壁端的网带, 直到网带贴住剪刀 Pull the abdominal ends of the tape until there is contact between tape and instrument 将针剪去 Separate needles from the tape 先不要拉出塑料薄膜 Do not remove the plastic sheath,Cough Test 腹压测试,膀胱注液25
