摘要
目的系统评价经耻骨后无张力阴道吊带术(TVT)与Burch术治疗女性压力性尿失禁(SUI)的有效性与安全性。方法计算机检索CENTRAL(2007年4月)、MEDLINE(1966～2007.10)、EMbase(1988～2007.10),纳入TVT和Burch术比较治疗SUI的随机对照试验(RCT),并追索已纳入文献的参考文献。由两位评价员独立进行文献筛查、质量评价和资料提取,并交叉核对,意见不一致时讨论解决,或向专家咨询解决。采用RevMan4.2软件进行Meta分析。结果共初检出42篇文献,最后纳入10个RCT(1294例)进行分析。Meta分析结果显示:TVT客观成功率高于Burch术[OR=1.73,95%CI(1.26,2.38),P=0.0007]。TVT总的并发症及膀胱/阴道损伤发生率高于Burch术[OR=1.39,95%CI(1.08,1.80),P=0.01],而Burch术后再次手术率明显较高[OR=0.29,95%CI(0.10,0.80),P=0.02]。会阴部血肿、尿路感染及下尿路症状两组无明显差异(P>0.2)。结论短期研究显示,TVT是一种疗效有限的治疗SUI的微创术式,再次手术率虽小,但发生膀胱/阴道损伤危险性较高,其疗效有待高质量的RCT并进行长期随访来进一步验证。
Objective To evaluate the effectiveness and safety of tension-free vaginal tapes （TVT） compared with Burch colposuspension for female stress urinary incontinence （SUI）. Methods We searched MEDLINE （1966 to October 2007）, EMBASE （1988 to October 2007）, Cochrane Central Register of Controlled Trials （1993 to October 2007）, CMCC （1979 to October 2007） and CNKI （January 1979 to October 2007）. We collected randomized controlled trials （RCTs） comparing TVT with Burch colposuspension in the treatment of SUI. Data were extracted and evaluated by two reviewers independently. The Cochrane Collaboration＇s RevMan 4.2 was used for data analyses. Results Ten RCTs reporting data on effectiveness and safety of TVE versus Burch colposuspension were included. Meta-analyses showed that TVT was superior to Butch colposuspension as measured by the overall cure rate （OR 1.73; 95%CI 1.26 to 2.38; P=0.000 7）, negative stress test （OR 2.54; 95%CI 1.71 to 3.78; P〈0.000 01） and negative pad test （OR 1.67; 95%CI 1.16 to 2.41; P=0.006）. The total complication rate was higher after TVT （OR 1.39; 95% CI 1.08 to 1.80; P=0.01）, while the reoperation rate was significantly higher after Burch colposuspension （OR 0.29; 95%CI 0.10 to 0.80; P=0.02）. The incidences of haematoma （OR 1.06; 95% CI 0.39 to 2.84; P=0.91）, urinary tract infection （OR 1.27; 95% CI 0.64 to 2.52; P=0.50） and lower urinary tract symptoms （OR 1.20; 95% CI 0.89 to 1.62; P=0.23） were similar after TVT and Burch colposuspension. Conclusion The evidence for short-term superiority of TVT is currently limited. Although the re-operation rate is lower, the risk of bladder or vaginal injury is higher with TVT. Methodologically sound and adequately powered RCTs with long-term follow-up are needed.
出处
《中国循证医学杂志》
CSCD
2008年第4期237-243,共7页
Chinese Journal of Evidence-based Medicine
