TVT-O和TVT治疗单纯女性压力性尿失禁的远期疗效:立足随机对照试验的Meta分析(更新)  

The long term cure rates and complications of TVT-O versus TVT for female stress urinary incontinence:meta-analysis of randomized controlled trials(updating)

作　　者：朱亚飞[1] 高国兰 何林生[1] 刘丝荪[1] 陈庆科[3] 唐俊[4] 

机构地区：[1]南昌大学第一附属医院妇产科,南昌330006 [2]北京航空总医院妇产科 [3]南昌大学第一附属医院泌尿外科,南昌330006 [4]南昌大学公共卫生学院

出　　处：《现代妇产科进展》2011年第10期814-819,共6页Progress in Obstetrics and Gynecology

摘　　要：目的:更新系统评价经阴道-闭孔尿道中段无张力吊带术(trans-obturator va-ginal tape,TVT-O)和阴道无张力性尿道中段悬吊术(tention free vaginal tape,TVT)治疗女性压力性尿失禁的远期成功率和并发症。方法:计算机检索配合手工检索以下数据库:Cochrane图书馆CCRT(2000年至2010年11月),MEDLINE(1966年至2010年11月),EMBASE(1988年至2010年11月),中国生物医学文献数据库CMCC(1979年至2010年11月)等,同时查阅未发表文献(灰色文献),纳入比较TVT-O和TVT术治疗SUI的随机对照试验(RCT),两位评价员按照Cochrane协作网推荐的纳入标准,独立进行文献筛查、质量评价和资料提取。应用Review Manager 5.0软件对纳入研究进行综合定量评价,然后按GRADE系统对Meta分析各个结局指标进行分级推荐。结果:纳入20个随机对照试验。TVT-O与TVT的总"客观成功率"相似,相对危险度RR=0.99,95%CI(0.95～1.02),"1年客观成功率"[RR=1.03,95%CI(0.99～1.07)]、"2年客观成功率"[RR=0.97,95%CI(0.89～1.06)]和"2年以上客观成功率"[RR=1.00,95%CI(0.94～1.07)]均相似(P>0.05),以上结论为GRADE高级;"主观成功率"相似[RR=0.98,95%CI(0.93～1.04)],GRADE分级为中级。TVT-O术后"疼痛和不适感"发生率高于TVT[RR=2.35,95%CI(1.57～3.51)](P<0.01);TVT-O术后"血肿"概率低于TVT[RR=0.37,95%CI(0.16～0.86)](P<0.05);"尿路感染"[RR=1.14,95%CI(0.78～1.65)]相似(P>0.05);以上为GRADE中级。TVT-O"吊带排斥"[RR=0.90,95%CI(0.48～1.67)]、"尿路症状"[RR=1.60,95%CI(0.67～3.79)]、"尿潴留"[RR=0.96,95%CI(0.61～1.49)]、"重新留置尿管"[RR=0.93,95%CI(0.59～1.44)]和TVT相似(P>0.05),TVT-O"膀胱损伤"[RR=0.20,95%CI(0.09～0.45)]概率低于TVT(P<0.01),以上结论GRADE为高级证据。结论:TVT-O较TVT疼痛风险增加,特别是术后腹股沟区疼痛发生率增加,血肿和膀胱损伤的风险性减小,两术式远期成功率和其它并发症相似。Objective：To update meta-analysis for evaluation of complications and cure rates of Trans-obturator vaginal tape from inside-out（TVT-O）as compared with tension-free vaginal tapes（TVT）in female stress urinary incontinence（SUI）.Methods：A comprehensive literature search was conducted according to the cochrane.Collaboration methodology to identify randomized controlled clinical trials with no language restriction.Two authors（Zhu Yafei and He Linsheng）independently assessed papers for eligibility and methodological quality.Quality rating for each outcome of the meta-analysis and recommendations were performed by the Grading of Recommendations Assessment,Development,and Evaluation（GRADE）system.Results：Twenty randomized controlled trials met the inclusion criteria,and a pooled estimate of cure rates and complications was made.Relative risks with 95% confidence intervals for pooled effects under the fixed effects model were：0.99（0.95~1.02） for overall objective cure rate,1.03（0.99~1.07）for 1-year objective cure rate,0.97（0.89~1.06）for 2-year objective cure,1.00（0.94~1.07） for above 2 year objective cure rate,and 0.98（0.93~1.04） for subjective cure rate.For complications,pooled effects were：[2.35（1.57~3.51）] with P0.01 for postoperative pain,[0.37（0.16~0.86）] with P0.05 for haematoma,[1.14（0.78~1.65）] for urinary tract infection,[0.90（0.48~1.67）] for tape erosion,[1.60（0.67~3.79）] for lower urinary tract symptoms,[0.96（0.61~1.49）]for urinary retention,[0.93（0.59~1.44）] for recatheterication,and[0.20（0.09~0.45）] with P0.01 for bladder injury.Conclusions：TVT-O is associated with a reduced risk of bladder injury and hematoma but an elevated risk of postoperative pain.Other complications,including tape erosion,urinary tract infection,lower urinary tract symptoms,and recatheterization as well as objective and subjective cure rates are similar to those of TVT.

关 键 词：压力性尿失禁 经阴道闭孔尿道中段无张力吊带术 无张力性尿道中段悬吊术 META分析 随机对照试验 

分 类 号：R694.54[医药卫生—泌尿科学]