從病因治療到重塑尿控

Evolution of surgical treatment for female SUI and the current gold standard：conceptual shift from treatment of etiology to reshape of urinary control mechanism

LUO Deyi，SHEN Hong，ZHANG Jie

（Department of Urology，West China Hospital，Sichuan University，Chengdu 610041; Pelvic Floor Diseases Center，West China Tianfu Hospital，Sichuan University，Chengdu 610200，China）

ABSTRACT：With the growing aging population，female stress urinary incontinence （SUI），due to its high incidence，has become a common disease that seriously affects patients quality of life and brings heavy economic burden to families and society.Over the past century，the surgical treatments of SUI were continuously updated along with the in-depth research on the disease mechanism.However，in recent years，the concept of anti-incontinence surgery has shifted from treating the causes to reshaping the urinary control mechanism.As a result，the mid-urethral sling （MUS） procedure has gained global acceptance since its introduction，swiftly acknowledged both domestically and internationally as the gold standard due to its minimally invasive nature and proven effectiveness.MUS is also the most commonly used surgical method for SUI patients treated in our center.Based on our own surgical experience，we will analyze the main steps，technical points，and preventive strategies of surgical complications of MUS，so as to provide clinical reference.

KEY WORDS：female stress urinary incontinence; surgical treatment; evolution of surgical methods; mid-urethral sling

摘要：女性壓力性尿失禁（SUI）發病率高，嚴重影響患者生活質量，給患者、家庭和社會帶來了沉重的經濟負擔。隨著SUI的手術方式及發病機制研究的不斷更新，近來關于尿失禁的手術治療機制，人們的觀念已從病因治療機制轉變為重塑尿控機制。因此，自術式微創、效果明確的無張力尿道中段懸吊術（MUS）問世以來，很快被國內外學界公認為是SUI手術治療的金標準并廣泛推廣應用。MUS也是四川大學華西醫院泌尿外科最常用于SUI患者治療的手術方式。因此，筆者結合本中心的手術經驗，就MUS手術的主要步驟、技術要點以及手術并發癥處理與預防策略進行分析，以期為臨床提供參考。

關鍵詞：女性壓力性尿失禁；手術治療；手術演變；無張力尿道中段懸吊術

中圖分類號：R695.1"" 文獻標志碼：A

DOI：10.3969/j.issn.1009-8291.2025.01.003

收稿日期：2023-10-17""" 修回日期：2024-04-21

作者簡介：

羅德毅，教授。研究方向：盆底功能障礙性疾病與尿控疾病的診治。E-mail：luodeyi1985@scu.edu.cn

女性壓力性尿失禁（stress urinary incontinence，SUI）是指咳嗽、噴嚏、大笑等增加腹腔壓力時出現的尿液不自主從尿道口流出的現象。盡管SUI是一種良性疾病，但其對患者生活、工作及心理造成極大的影響，并給患者家庭和社會帶來了沉重的經濟負擔^[1]。流行病學調查顯示，我國成年女性SUI發病率高達18.9%^[2]。隨著社會、經濟的發展，此類疾病也越來越引起患者的重視。盡管目前SUI的病理及生理機制尚未完全明確，但在100多年的發展歷史中，該疾病發病機制的探索、理論的發展、材料的進步，推動了其治療方式的革新。于是，恥骨后懸吊術、陰道前壁修補術、針刺懸吊術、尿道吊帶術等各類手術方案先后出現在SUI治療的歷史舞臺^[3]。……