Objective:The effectiveness and safety of tension-free vaginal tape-obturator technique(TVT-O) for femal stress urinary incontinence was assessed. Methods:105 patients in Peking University First Hospital from January,2006 to November,2008 who had TVT-O were recruited. The patients were followed up before and after operation by 1h pad test and incontinence quality of life questionnaire( I -QoL) and quali-ty of sexual life questionnaire (PISQ). Results:① The mean time of operation was 30.4 ± 10.2 minutes ( 15 ～ 60 min ), mean bleed loss was 33.8 ± 13.8 ml ( 10 ～ 50 ml). There were very few complications of the operation. ② The 1h pad test of 6 weeks,3 months,6 months and 1year after operation showed the leakage significantly decreased than those preoperatively( P < 0.01 ). The objective cure rates were 85.1% ,86.2%, 86.5% and 84% respectively. ③ The score of I -QoL was better postoperatively than preopratively( P < 0.01 ). ④The score of PISQ was no difference postoperatively (6 months and 1year) compared with preop-eratively(P>0.05). Concluslons:TVT-O is a surgery that is easy to operate. It has few complications, satis-fied short-term cure rate and quality of life. The impact on sexual life and long-term results still need further e-valuation.

Objective To investigate the complications of pelvic floor reconstructive surgery with graft and the managment of them. Methods A total of 176 patients with moderate to severe pelvic organ prolapse (POP) who underwent pelvic floor reconstructive surgery with graft at the Obstetrics and Gynecology Department of Peking University First Hospital from February 2006 to July 2009 were recruited in this study.The complications and treatments were analysed.Results ① There had no intraoperative complications occurred.② The incidence of short term postoperative complications was 2.27% (4/176),including 1 case of urinary tract infection (0.57%),1 case of hematoma in the right thigh deep beneath hip (0.57%) and 2 cases of fecal incontinence (1.14%).③ 151 cases of the 176 patients were under followe-up.Incidence of long-term complications after surgery was 35.76% (54/151).38 mesh erosion occurred (25.17%) in which 4 cases had re-erosion. There were two cases of vaginal lancinating (1.32%),three cases of thigh pain or discomfort (1.99%),one with vaginal adhesion (0.66%),three with urethral pain (1.99%),four with falling and inflation sense of anus (2.65%),two with difficult defecation(1.32%)and one with perineum pain (0.66%).④ Postoperative mesh erosion was not related with menopause,diabetes,operative time,blood loss and postoperative maximum body temperature (P0.05),but it was age-related (r=0.921,P=0.012). The high incident ages of erosion were 47~55 years and older than 63 years. Conclusion The pelvic floor reconstructive surgery with graft may bring some postoperative complications to patients. Surgical options should be carefully considered.

Objective To investigate the urination conditions in patients after the pelvic floor reconstructive surgery (PRS) for pelvic organ prolapse (POP),as well as effects of TVT-O used in the operation for urination conditions.Methods A prospective study on preoperative,postoperative urination conditions and qualities of life was conducted in 112 POP patients,with or without lower urinary tract symptoms (LUTS),underwent PRS.Results With preoperative questionnaires 73/86 (84.9%) presented with LUTS. For the 86 patients who are followed up for half a year,and 56 (76.7%) showed alleviated or eliminated symptoms. For the 47 who are followed up for one year,28 (59.6%)show alleviated. PFDI and UDI improved postoperatively with statistic significance (P<0.05). PRS alone was less effective than PRS and TVT-O to LUTS (P<0.05).Conclusions PRS could alleviate LUTS of patients with POP. RPS and TVT-O operations are more effective than PRS alone in treating the urination symptoms.

目的探讨经阴道无张力尿道中段吊带悬吊术(TVT)治疗女性压力性尿失禁的护理要点。方法对我院20例压力性尿失禁的女性患者进行经阴道无张力尿道中段吊带悬吊术,围手术期间,通过采用心理护理,术后加强尿管的护理及密切观察出血情况,预防出血和感染,以保证和促进术后疗效。结果20例患者术后临床症状明显好转或痊愈,随访4~26个月(平均15.1月),90%治愈,10%改善,未出现严重的术后并发症。结论TVT手术前后采取有效的护理措施和健康宣教,是提高经阴道无张力尿道中段吊带悬吊术治疗女性压力性尿失禁疗效的重要措施。

Objective To explore an effective method to prevent the postoperative shoulder pain after gynecologic laparoscopy. [Methods] Ninety-eight patients who underwent laparoscopic surgery in No.1 Gynecologic Ward of Peking University First Hospital from Jun.2004 to Aug.2004 were randomly divided into two groups with 49 cases each. The treatment group received intraperitoneal instillation of 2000 ml fluid, which was drained before suturing of the incision, at the conclusion of operative laparoscopy to assist the evacuation of residual intra-abdominal gas. The control group received traditional method to evacuation of residual intra-abdominal gas. The postoperative shoulder pain was evaluated by visual analog scores (VAS) 6 hours, 1 to 4 days after laparoscopy. [Results] The frequency of shoulder pain was significantly lower in the treatment group (36.7 %)compared with the control group (55.1, P 0.05). Among patients with shoulder pain, the ratio of double-side shoulder pain was also significantly lower in the treatment group (38.9%) compared with the control group(92.6%, P 0.001). The shoulder pain occurred commonly during the first 3 days in both groups. The pain persisted for an average of (1.8±1.3) days in the treatment group and (2.4±1.3) days in the control (P =0.056). The mean VAS score was (2.9±1.4) in the treatment group and (3.3±1.6) in the control (P 0.05). The mean days of hospitalization and recovery to work were similar between the 2 groups. There were no major postoperative complications in either group. The patient satisfaction rates were also similar in the two groups. [Conclusions] Postoperative shoulder pain frequently occurs following laparoscopic surgery. Intraperitoneal fluid instillation at the conclusion of operative laparoscopy to assist the evacuation of residual intra-abdominal gas decreases the the frequency of postoperative shoulder pain.