TVT与TVT-O不同位置治疗老年女性压力性尿失禁的有限元分析

doi:10.13418/j.issn.1001-165x.2025.1.12

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中国临床解剖学杂志 ›› 2025, Vol. 43 ›› Issue (1) : 76-81. DOI: 10.13418/j.issn.1001-165x.2025.1.12

临床生物力学

TVT与TVT-O不同位置治疗老年女性压力性尿失禁的有限元分析

李伟君¹，周沂¹，吴建辉²，陈丽华³，刘海英⁴，翟丽东¹*

作者信息 +

Finite element analysis of different positions of TVT and TVT-O in the treatment of stress urinary incontinence in elderly women

Li Weijun¹, Zhou Yi¹, Wu Jianhui², Chen Lihua³, Liu Haiying⁴, Zhai Lidong¹*

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文章历史 +

摘要

目的用有限元分析的方法模拟老年女性压力性尿失禁(Stress urinary incontience, SUI)常见吊带手术：经耻骨后无张力尿道吊带（Tension-free vaginal tape, TVT）和经闭孔无张力尿道吊带（Tension-free vaginal tape-obturator, TVT-O），评估它们在尿道不同位置的治疗效果。方法根据一名无盆底疾病女性的磁共振（MRI）图像构建盆腔几何模型。将老年阴道组织薄弱认定为组织刚度降低，施加腹压模拟valsalva运动并分别在尿道近端、中远端、远端放置TVT与TVT-O，得出力学数据。结果尿道近端的吊带会导致α角与膀胱颈位移小于正常值。“漏斗”现象在吊带位于尿道近端与中远端时消失，位于尿道远端时依然存在；不同位置吊带与尿道之间的压强大小关系为：近端>中远端>远端。结论尿道近端（30%）的吊带容易导致尿道过紧，引起术后并发症；尿道远端（80%）的吊带治疗效果不佳；尿道中远端（60%）的吊带治疗效果好、术后并发症发生率低。尿道中远端放置TVT应该作为老年女性SUI手术的首选方法。

Abstract

Objective To simulate common sling surgeries for stress urinary incontinence (SUI) in elderly women using finite element analysis methods: tension-free vaginal tape (TVT) and tension-free vaginal tape - obturator (TVT-O), and to evaluate their therapeutic effects at different positions of urethra. Methods A pelvic geometry model was constructed based on magnetic resonance imaging (MRI) images of a woman without pelvic floor diseases. The thinning of elderly vaginal tissue was considered as a reduction in tissue stiffness. Abdominal pressure was applied to simulate valsalva maneuver, and TVT and TVT-O were placed at the proximal, mid-distal, and distal parts of urethra, respectively, to obtain mechanical data. Results The sling at the proximal part of urethra would lead to the α-angle and bladder neck displacement less than normal values. The "funnel" phenomenon disappeared when the sling was located at the proximal and mid-distal parts of urethra, but still existed when located at the distal part; the pressure magnitude between the sling and urethra at different positions was: proximal > mid-distal > distal. Conclusions The sling at the proximal part of urethra (30%) is prone to cause excessive tightness of urethra, leading to postoperative complications, the sling at the distal part of urethra (80%) has poor therapeutic effect, the sling at the mid-distal part of urethra (60%) has a good therapeutic effect and a low incidence of postoperative complications. The placement of TVT at the mid-distal part of urethra should be the preferred surgical method for elderly women with SUI.

导出引用

李伟君, 周沂, 吴建辉, 陈丽华, 刘海英, 翟丽东. TVT与TVT-O不同位置治疗老年女性压力性尿失禁的有限元分析[J]. 中国临床解剖学杂志. 2025, 43(1): 76-81 https://doi.org/10.13418/j.issn.1001-165x.2025.1.12

Li Weijun, Zhou Yi, Wu Jianhui, Chen Lihua, Liu Haiying, Zhai Lidong. Finite element analysis of different positions of TVT and TVT-O in the treatment of stress urinary incontinence in elderly women[J]. Chinese Journal of Clinical Anatomy. 2025, 43(1): 76-81 https://doi.org/10.13418/j.issn.1001-165x.2025.1.12

中图分类号： R318.01

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