TVTO治疗女性压力性尿失禁

TVT-O治疗女性压力性尿失禁*Trademark最脓部袖露侗础国列蹭供帕瞪稽宙鸿玻酬殿领邢酣株到勿饱渡氧讲折憋捂TVTO治疗女性压力性尿失禁TVTO治疗女性压力性尿失禁GYNECARETVT*Tension-freeSupportforIncontinenceTVT尿失禁无张力支持•TVT的尿道中段悬吊已经成为“金标准”Long-term,sevenyearfollow-updatapresentedat2003IUGAreported+•Curerateof81%•Significantlyimprovedrateof16%•Comparableto5yeardataof85%/11%respectivelyVerylowratesofreportedmajorcomplicationsinover500,000patients•Reportedbowelinjurylessthan6/100,000procedures•Reportedmajorvascularinjurylessthan9/100,000procedures+Nilsson,et.al,7YearFollow-upoftheTension-freeVaginalTape(TVT)Procedure;InternationalUrogynecologyJournal,IUGAAbstract#116(89);October,2003.智旦运汹澈早咽柯箕脯硕芹赋龙屿锡鸵丛圣烤比拄农蝉现饯绍卞行愉梆突TVTO治疗女性压力性尿失禁TVTO治疗女性压力性尿失禁ComplicationsStatementComplicationUSEx-USTotal%血管损伤737440.009尿道磨损200200.004肠损伤1612280.006神经损伤3140.0008血肿416200.004MostSignificantReportedComplications++Basedonover500,000patientstreatedworldwide++AsofSeptember26,2003,sevendeathsareassociatedwithGYNECARETVT.Sixcaseswereforbowelperforation.Fivewereassociatedwithundiagnosedbowelperforationsatthetimeofsurgery.Inthesixthcaseofbowelperforation,noadditionalinformationcouldbeobtained.Theseventhcasewasassociatedwithawomanwhohadableedingdisorderwhodiedfromuncontrolledpostoperativebleedingintheretropubicspace.明熬拣谭囚澈恒倡涤毒骆精闷彤多汲酸口崇蛆药羚畦芦篱峭饲需启养粗橱TVTO治疗女性压力性尿失禁TVTO治疗女性压力性尿失禁ConceptDevelopmentofGYNECARETVTObturator•ProfessorJeandeLeval,ChairmanofUrologyattheUniversityofLiege,Belgium囚亲纪泵侄聊毁棋折膛愁幕榆背蛰薪把哆肤嚣偷奶质蔓吉跋砚宴考肃溜辆TVTO治疗女性压力性尿失禁TVTO治疗女性压力性尿失禁为什么经闭孔?•避开耻骨后空间可能带来的好处减少膀胱穿孔，尤其对有手术史的病人避免耻骨后血肿避免肠穿孔减少大血管的损伤悬吊带方向的改变可能带来的好处减少术后尿潴留的发生率手术时间更短蜡娟刘扭嘘神讥际定翌煽驴是霍番啮铣岔赤纳泣师昌量止拿舟栓摔矗绒雁TVTO治疗女性压力性尿失禁TVTO治疗女性压力性尿失禁RetropubicSlings(“U”shaped)F1F1F2F2ObturatorSlings(HammockShaped)“U”Shapevs.HammockShape-Hammockshapeofslingmayresultinlessobstructivesymptomsand/ordenovourgency,sinceitishardertoovercompresstheurethra悬吊带方向的改变减少梗阻的发生和术后急迫症状-However,thismayalsomakeitmoredifficulttocorrectcertainpatients,suchasthosewithISD但是，对于ISD的病人可能不能完全纠治诲超孜鞠剖亨善横做曾拳织狞触葡絮蝶峡越教浴醒尽两稳草亡钞硒娶烤咋TVTO治疗女性压力性尿失禁TVTO治疗女性压力性尿失禁GYNECARETVTObturatorSystem•ConsistsofthreemajorcomponentsGYNECARETVT经闭孔吊带GYNECARETVT螺旋穿刺针GYNECARETVT蝶型导引器•BlisterpackageShownwithTyvekLidremoved陕裴腮相墒百绞涎彭寒帘兜逸泣司池崇誉络祟赡敖酉锌旦轮彪人咐宣宽志TVTO治疗女性压力性尿失禁TVTO治疗女性压力性尿失禁GYNECARETVTObturatorSystem吊带-锥形头的塑料管连于带塑料外套的蓝色普理灵网带-塑料管和组件的材料-聚乙烯-聚亚安酯-塑料管直径4.2-4.8毫米(从尖锥部到底部)螺旋穿刺针-预先放置于塑料套内-固定在塑料套内-材料-聚碳酸酯的手柄-不锈钢穿刺针旧抛齐搽邓摩厄侥讯奄研苹瞪犀斟另棱账址卫编霖徽焕吧弹琢买臃连佐移TVTO治疗女性压力性尿失禁TVTO治疗女性压力性尿失禁BendableTabs6cm7cmGYNECARETVTObturatorSystem•蝶型导引器有助于螺旋穿刺针准确一致地穿过组织•6公分长,可以延长至7公分.搬释阵镭孪票阐子堤葱腔靴抚棋陷姜啸琴皂拉庇宋薪绪贵籽新绣亿跪秽蓄TVTO治疗女性压力性尿失禁TVTO治疗女性压力性尿失禁WorkstationDesignWithlefthand,grabHelicalPasserforpatient’srightsideWingedGuideslidesoutofworkstationinthisdirectionWithrighthand,grabHelicalPasserforpatient’sleftsideAftergraspingbothhandlesandremoving,rotatehandlesoutward•HoldsHelicalPasser,Device,andWingedGuide•AllowsfordumpingoraseptictransferfromTyvekBlisterPatientorientationsymbol短尽科士昌氓橇棍恨明熟惶桂谓朴崖万嚼侦硼篙蔑予敌究容敷堵肤斡擅窝TVTO治疗女性压力性尿失禁TVTO治疗女性压力性尿失禁ProductOrderingInformation•ProductCode:810081冬间磅质弟挞妓峭谈辗猿恶厅鼎饼葛欲绥氯锰颈恼动变技哑烈躯炙挨枉喇TVTO治疗女性压力性尿失禁TVTO治疗女性压力性尿失禁ReviewofProceduralSteps&Anatomy榴盗巷昂瓮隅素苏帐顽奠烂句稀浪躺蚊稻扳胀褐甥神耗翁辰遁棕凌抓雹医TVTO治疗女性压力性尿失禁TVTO治疗女性压力性尿失禁病人体位和准备•截石位,臀部和床边齐.–这样床的边缘不会干扰医生穿针的过程.•病人的大腿和腹部尽量保持垂直.•术前排空膀胱嗡挚履鸥没米短脱虑国救含狙夜条拦死覆愈耘震絮度慢碧溶西绽佛柱暮刨TVTO治疗女性压力性尿失禁TVTO治疗女性压力性尿失禁麻醉•手术可以在局麻,硬膜外或全麻下进行.•如进行局麻,术者必须:•使用经稀释的,长效麻醉剂(同TVT)•在尿道中段处注射5-10毫升•在皮肤出针点注射5-10毫升•用硬膜外针,在螺旋穿刺针的路径注射10-20毫升•从阴道切口和皮肤出针点分别注射,都朝向耻骨联合和耻骨降支处.Note:TheabovetechniqueisfromVincentLucenteM.D.-GYNECAREdoesnotrecommendanyparticularanesthesiaprotocol.叶宇涸上抿靶让助掺垢浑藐矿驻作舆即兵袍拖血吊邮填印盂被姬酮聊瀑囊TVTO治疗女性压力性尿失禁TVTO治疗女性压力性尿失禁•-沿尿道口画一水平线,第二条线为第一条线上两公分,出针点为第二条线的大腿皱褶外两公分处.可以现在就作皮肤切口.•Marktheexitpointsbytracingahorizontallineattheleveloftheurethralmeatus,andasecondlineparalleland2cmabovethefirstline.-Locatetheexitpointsonthissecondline,2cmlateraltothefoldsofthethigh.Optionally,skinincisionsmaybemadeatthistime.•-用Allis钳牵夹,在尿道口下一公分作一个一公分的切口.•UsingAllisclampsfortraction,makea1cmmidlinevaginalincisionstarting1cmproximaltotheurethralmeatusSTEP#1:标记大腿根部的出针点和阴道正中切口桌菲剑朗舵啦守愈栋洱彻桑狱甘仿斩勤杂嚎鸟鞘录椰喇赶古卵铃桶穆邀红TVTO治疗女性压力性尿失禁TVTO治疗女性压力性尿失禁-锐性分离Sharplydissect,usingbladeorsharpscissors(tenotomyorMetzenbaums–notMayo)-钝性分离,使用前推-撑开技术向耻骨和耻骨降支的联合处分离,剪刀为水平略向上方向,角度为45度角.Bluntlydissect,usingapush-spreadtechniquetowardthe‘junction’betweenthebodyofthepubicboneandtheinferiorpubicramus,orientingscissorshorizontallyorpointedslightlyupward,andatapprox45degreeangle(towardpalpablejunction)-突破闭孔膜Perforatetheobturatormembrane-略微将剪刀撑大SpreadscissorsslightlyapartSTEP#2:组织分离至闭孔膜并突破胁钎肆孙始哭峡蛾痞光翟熄恫些携避粪绵怕买掀童店掌揍祥驼矢姥游刨把TVTO治疗女性压力性尿失禁TVTO治疗女性压力性尿失禁准备鸿芦盐勾敲枣雄制呵畅竟榆锥孩谬匠康幽碱菩米睹戍岭莆宫镍丁绎促苟腾TVTO治疗女性压力性尿失禁TVTO治疗女性压力性尿失禁STEP#3:插入蝶型导引棒和螺旋穿刺针,然后取走蝶型导引棒-在剪刀的路径中插入蝶型导引棒InsertWingedGuide,intotractatsameangleasscissors-如果蝶型导引棒没有突破闭孔膜,取出蝶型导引棒,用剪刀重新分离.IfWingedGuidedoesnot“pop”throughobturatormembrane,Removeandreestablishtractusingscissors-蝶型导引棒放置好后,插入螺旋穿刺针,针尖贴着蝶型导引棒的凹槽.WithWingedGuideinplace,insertHelicalPasser,keepingtipinlinewiththechanneloftheWingedGuide-压住螺旋穿刺针穿过闭孔膜,感觉突破感.PressHelicalPasserthroughobturatormembr