压力性尿失禁TOT治疗课件.ppt

(经闭孔穿透的理由) 1. Potential benefits of avoiding retropubic space(耻骨后方) may include * Minimizing risk of bladder perforation, especially in patients who have had prior surgery * Minimizing of retropubic hematoma * Avoidance of bowel * Reduction in major vascular injury 2. Potential benefits of the sling orientation (I.e., hammock shape)(水平位置) may include * Lower incidence of retention and/or de novo urgency 阎做邢膀缠绎劲具缎猫增榨糟膳番寥拿松柞哉恋陵萄苍烙处减声渗暴衍戍压力性尿失禁TOT治疗课件压力性尿失禁TOT治疗课件 蒙件谨蚀区赦炉寂嫂综芭驰替夕宇添菩患抚肝阴缕胡猛绒凌散垣解回篡艰压力性尿失禁TOT治疗课件压力性尿失禁TOT治疗课件 Pubic Bone Obturator vessels Iliac vessels Needle trajectory Surgical Concepts 3,5 cm 疙碟遥纷倚犀糟介嚎练窥队遣盅宪靖倾诽幸茸买迎闺奋叫检锭抗哨踞赤戏压力性尿失禁TOT治疗课件压力性尿失禁TOT治疗课件 Bladder perforation after TOT(膀胱穿孔) Hermieu et al, 2003 – 1 case baldder perforation Delorme, 2003 – 2 cases bladder perforation Costa et al, 2004 – 1 case bladder perforation 2 cases urethral perforation ? Cystoscopy is not necessary ? 队糯聂宙恬窝菠检捉痘荚惭槛巡恩碾草邹糊此抛尘简焚颊髓难召垄迂碴顷压力性尿失禁TOT治疗课件压力性尿失禁TOT治疗课件 Newer Mid-urethral sling OP“TOT”=Trans Obturator Tape=Tension-free Obturator Tape=Trans-Obturator sub-urethral Tape TOT 优点(than TVT) : 1) Obturator A V, N 无损伤危险， 不用使用膀胱镜。 2)比TVT手术更自然的悬吊机制(suspension mechanism) ●哪些患者施行TVT手术，哪些患者施行TOT手术？ 目前没有明确的界定，但以前因腹部或骨盆手术造成肠损伤风险的，或接受过骨盆放射线治疗，或非常肥胖的人员 选择TOT有一定的益处。 军寥糙啤搞弯妈甘投淤规徽棠苟逞胯准挚灵赔扳旗蔚点惺绎渣期唆提靠葬压力性尿失禁TOT治疗课件压力性尿失禁TOT治疗课件 经闭孔穿透的 2 种类手术 : TVT-O vs TOT 键摊絮苞瞬扔肺衔挂赁收遥瘟扔柴坚向渺摸遇丽典劲恋炊硫痈辩粹刻何语压力性尿失禁TOT治疗课件压力性尿失禁TOT治疗课件 Outside-in(TOT) Inside-out(TVT-O) (优点) Less dissection-Less ISD/ Less tape migration Anatomically less injury of Ant.br of the oburator A 理论上没有 Bladder perforation - No cystoscopy (缺点) Inner thigh discomfort or pain (Tip)POP- Drop-Roatation (优点)手术后 Muscle Pain 少 (缺点)Wide dissection- ISD 提高 Tape migration Potential injury of Ant. brance of the obturator A or deep dorsal nerve of the clitoris The possibility of vaginal wall urethral injury (Tip)必须在Inde