TVT及TVT-O治疗女性压力性尿失禁疗效的Meta分析

目的 评估无张力尿道悬吊带术(TVT)及无张力尿道吊带术-闭孔系统(TVT-O)治疗压力性尿失禁(SUI)的疗效.方法 以"TVT,TVT-O,TOT,SUI,RCT"及"无张力尿道中段吊带术,经闭孔无张力尿道中段吊带术,压力性尿失禁"等为检索词,在MEDLINE,PUBMED,EMBASE,Google Scholar,CNKI,万方数据库检索2001年1月至2007年3月,国内外公开发表的中英文关于TVT及TVT-O手术疗效及其并发症的研究文献,选取其中病例数＞30例的随机对照实验进行Meta综合定量分析,根据固定效应模型和随机效应模型计算结果的一致程度及失效安全系数进行敏感性分析.结果共有6篇文献入选,TVT及TVT-O术后1～17个月的疗效差异无统计学意义(OR=0.67;95%CI 0.40,1.13).TVT-O术膀胱损伤(OR=0.15;95% CI 0.03,0.66)的发生率低于TVT,而术后疼痛(OR=8.61;95% CI 3.03,24.52)的发生率高于TVT,其他并发症如术后尿急(OR=1.16;95% CI 0.54,2.47)、尿潴留(OR=0.54;95% CI 0.24,1.20)、尿路感染(OR=1.07;95% CI 0.61,1.87)的发生率均差异无统计学意义.结论 TVT和TVT-O两种术式的疗效相近,而术后并发症,TVT-O组未报道膀胱穿孔的发生,但术后疼痛多见,其他并发症的发生率没有明显差异.

Therapeutic effects of tension-free vaginal tape and tension-free vaginal tape obturator in women with stress urinary incontinence:meta analysis

Objective To assess the effectiveness of tension-free vaginal tape obturator tape(TVT-O)as treatment of SUI by means of a systematic review and meta analysis.Methods Using the search terms"TVT,TVT-O,SUI,RCT,TOT",the literature in Chinese and English from January 2001 tO March 2007 on the difference of TVT and TVT-O was searched from MEDLINE,PUBMED,EMBASE,Google Scholar,CNKI,WAN FANG DATA,and criteria randomized controlled trials(RCTs)were studied by Meta-analysis in RevMan 4.2.At the same time,Ors of randomized model and fixed model were calculated tO evaluate the sensitivity.Results There were six RCTs that compared TVT-O with TVT.When compared by Subjective cure,TVT-O at 1-17 months were no better than TVT(OR 0.67;95% CI 0.40,1.13).Adverse events such as bladder injuries (OR 0.15;95% CI 0.03,0.66)was less common,where as groin/thigh pain(OR 8.61;95% CI3.03,24.52)was more common;but there were rio significant difference in de novo urgency(OR=1.16;95% CI 0.54,2.47),urinary retention(OR=0.54;95% CI 0.24,1.20)or urinary tract infection(OR=1.07;95% CI 0.61,1.87)between the tWO groups.Conclusions There is no significant difference between TVT and TVT-O.TVT-O group had no bladder injuries complications,but groin/thigh pain was more common.