TVT-O和TVT治疗单纯女性压力性尿失禁的疗效对比:立足随机对照试验的Meta分析  

The efficacy of trans-obturator vaginal tape and tension free vaginal tape for the treatment of primary urodynamic female urinary incontinence :Meta analysis of 10 randomized controlled trials

作　　者：朱亚飞[1] 何林生[1] 刘丝荪[1] 

机构地区：[1]南昌大学第一附属医院妇产科,南昌330006

出　　处：《现代妇产科进展》2007年第10期760-764,共5页Progress in Obstetrics and Gynecology

摘　　要：目的：系统评价经阴道无张力尿道中段悬吊带术（闭孔路径）（TVT—O）和经阴道无张力尿道中段悬吊带术（TVT）治疗女性压力性尿失禁的客观成功率和并发症发生率。方法：计算机配合手工检索1994年1月～2007年6月各数据库和灰色文献中TVT-O和TVT疗效的随机对照试验（RCT），用Revman4，2．2软件，对两种术式的客观成功率、并发症发生率进行Meta分析。结果：共纳入10个随机对照试验。TVT—O组553例，TVT组575例。Meta分析显示，TVT—O客观成功率、主观成功率均与TVT相似[P〉0．05，OR 0．78，95％可信区间（CI）：0．47～1．30；P〉0．05，OR 0．93，95％CI：0．51～1．68）]，TVT—O的”膀胱损伤”发生率低于TvT（P〈0．01，OR0．16，95％CI：0．05～0．49），TVT—O的”尿路症状”发生率与TVT相似（P〉0．05，OR0．90，95％CI：0．61～1．34）。因文献的异质性和结论的高敏感性，不能确定TVT—O“术后疼痛”发生率是否增高。结论：TVT—O术是一种疗效确切的无张力阴道吊带术，与TVT术的成功率、尿路症状相似而膀胱损伤的风险减少。但须进一步研究确证”术后疼痛”发生率是否增加。Objective：To compare the efficacy and lberioperative complications of TVT- O and TVT for primary female stress urinary incontinence systematically. Methods：The published articles selected for this study were obtained by a computerized Medline, EMBASE and China Biological Medicine Disk search of the literature and a manual search of the bibliographies of relevant articles. Articles meeting the inclusion criteria were reviewed systematically, and the reported data were aggregated using the statistical techniques of meta-analysis. Results： Ten randomized controll trims were included, including 553 cases of TVT-O and 575 cases of TVT. Overall objective cure rates were 310/347 for TVT-O and 335/366 for TVT respectively. TVT-O shared similar objective cure（ P 〉 0.05, OR 0.78,95 % C1：0.47 - 1.30） and subjective cure （ OR 0.93,95 % CI ： 0.51 - 1.68 ） with TVT. Similar risk of postoperative lower urinary symptom （P 〉 0.05, OR 0.90,95 % CI：0.61 - 1.34）, as well as significantly lower risk of blad- der perforation （ P 〈 0.01, OR 0.16,95 % C1：0.0 5 - 0.49 ） was found, higher risk of postoperative pain for TVT-O was suspected due to great heterogeneity and sensitivity（ P = 0.05, OR 4. 36,95% CI：I. 02 -18.70 ）. Conclusion ：The evidence available indicates that TVT -0 is an effective treatment for female stress urinary incontinence with similar objective, subjective cure rates and postoperative lower urinary symptom as well as singnificantly lower risk of bladder perforation comparing with TVT. Further studies are needed to vertify whether there is a trend for higher rate of postoperative pain for TVT -O.

关 键 词：尿失禁 压力性 经阴道无张力尿道中段悬吊带术(闲孔路径) 经阴道无 张力尿道中段悬吊带术 荟萃分析 随机对照试验 

分 类 号：R711.71[医药卫生—妇产科学]