12、men 腹部,Anesthesia 麻醉Vaginal Wall 阴道前壁,Incisions 切口,阴道前壁 Vaginal 在离尿道外口1cm处作1.5 cm 纵向切口 腹部 Abdominal 在耻骨联合上方 ， 腹中线两侧各作一个0.5 cm - 1.0 cm切口 2 incisions each side of midline 两切口相距最宽4-5公分 just above symphysis 4 - 5 cm apart max,Vaginal Wall Incision 阴道前壁切口,在离尿道外口1cm处作1.5 cm 纵向切口,Abdominal Incisions 腹部切口,在耻 。

13、骨联合上方 ， 腹中线两侧各作一个0.5 cm - 1.0 cm切口 ， 两切口相距最宽4-5公分,Dissection of Anterior Wall 阴道前壁分离Blunt Dissection sub and paraurethrally在尿道旁和尿道下进行钝性分离,Insert TVT Rigid Catheter Guide 插入TVT导引杆,Introduction of the GYNECARE TVT Device推入TVT网带,通过阴道切口推入 Introduce through vaginal incision 针头指向髂骨 Aim toward ipsilateral shou 。

14、lder 绕过耻骨 Hug the pubic bone (do not scrap 从腹壁切口出 Exit at abdominal incision,Introduction of the GYNECARE TVT Device推入TVT网带,Guide the Needle Tip to the Abdominal Incision将针头导向腹壁切口,针不要拔出,Cystoscopy 膀胱镜,针穿过后, 使用膀胱镜确保膀胱完好 After each passage of the needle, cystoscopy should be completed to verify bladde 。

15、r integrity 将膀胱注液后使用膀胱镜 Cystoscopy should be done with bladder half-full,Bladder Perforation 膀胱穿孔,Bladder Perforation 膀胱穿孔,Second Passage of the GYNECARE TVT Device第二根针的穿入,重新插导尿管, 排空膀胱 Re-insert the catheter and drain the bladder 重复第一次穿针的步骤 The opposite side is completed in the same manner as the fi 。

16、rst 确保网带没有扭转 Ensure that the tape does not twist 再次使用膀胱镜 Cystoscopy after the second pass of the TVT needle 针从腹壁切口拉出 Pull TVT needle through the abdomen incision,Tape Adjustment 调整网带,在网带和尿道间放置一把剪刀或止血钳 Place scissors or hemostat between the tape and the urethra 拉腹壁端的网带, 直到网带贴住剪刀 Pull the abdominal en 。

【阴道|经阴道无张力尿道中段吊带术_TVT术】17、ds of the tape until there is contact between tape and instrument 将针剪去 Separate needles from the tape 先不要拉出塑料薄膜 Do not remove the plastic sheath,Cough Test 腹压测试,膀胱注液250毫升 Fill bladder with 250 ml of saline 取出尿道下的剪刀/或止血钳 Remove instrument under the urethra 取下阴道重锤 Remove vaginal speculum 要病人用力咳嗽 Ask p 。

18、atient to cough 调整网带松紧度 Adjust TVT tape 调整松紧度时, 剪刀要置于网带和尿道之间 Instrument should be placed between the tape and the urethra during adjustment,Initial Cough Test 初步腹压测试,Adjust Tape with Instrument in Place器械放置在网带和尿道间, 调整网带,Completing the Procedure完成手术,抽出塑料薄膜 Remove plastic sheath 剪去腹壁上多余的网带 Cut Prolene 。

19、 Mesh 缝合皮肤和阴道粘膜切口 Close skin and vaginal epithelium 排空膀胱 Empty bladder 取出导尿管 Remove catheter,Completing the Procedure 完成手术removing plastic sheath取出塑料薄膜,Completing the Procedure完成手术Trimming the mesh剪去多余的网带,GYNECARE TVT Postoperative Assessment Before Discharge出院前的术后评估,出血/血肿 Bleeding/hematoma 餐饮 Eatin 。

20、g and drinking 排尿 Voiding,GYNECARE TVT Postoperative Instructions术后要求,术后排尿残留 Post void residual 3-4天抗菌素 Antibiotics 3-4 Days 限制活动 Activity limitations 驾驶 锻炼 性生活 工作,GYNECARE TVT Postoperative CareFollow-up appointments随访,3 weeks 6 months Yearly,GYNECARE TVT Complications & Treatment并发症及其治疗方法,尿潴留 Urin 。

21、ary retention,GYNECARE TVT Complications & Treatment并发症及其治疗方法,膀胱穿孔 Perforation of the bladder 使用膀胱镜确认 Cystoscopic identification 取出针,重新穿 Remove needle and reposition 导尿管留置1-2天 Indwelling catheter x 1-2 days,GYNECARE TVT Complications & Treatment并发症及其治疗方法,阴道出血/后腹膜血肿 Vaginal bleeding / Retropubic hema 。

22、toma 保守治疗 Manage conservatively 阴道填塞 Vaginal packing 引流 Percutaneous drainage if necessary,GYNECARE TVT Complications & Treatment并发症及其治疗方法,Infection 感染 抗菌素- 口服/静脉用药 Oral / IV antibiotics,Clinical Results 临床报告总结,尿失禁是严重的健康问题 ， 但一般病人不知道可以用手术方法治愈 Incontinence is an enormous health care problem TVT手术是一种有效而 。

23、微创的手术 An ideal treatment is effective and noninvasive TVT 手术有一定的技术难度 ， 建议在独立操作手术以前先协助有经验的医生做几例,Warnings and Precautions 注意事项,不要进行抗凝治疗 No anticoagulation therapy 没有尿路感染 NO UTI 要有一定膀胱颈悬吊术的经验 Familiar with bladder neck suspension surgery 用最小的张力在尿道中段下放置TVT网带 TVT placed with minimal tension at mid urethra 使用膀胱镜观察确保膀胱完好 Cystoscopy to confirm bladder integrity 注意盆腔结构, 避免组织损伤 Attention to pelvic anatomy to avoid injuries to structures 出院前观察是否有耻骨后血肿 Observe for retropubic hematoma before discharge,谢谢 。

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标题：阴道|经阴道无张力尿道中段吊带术_TVT术( 二 )