TVT治疗单纯性女性压力性尿失禁临床疗效的荟萃分析

Tension Free Vaginal Tape for the Treatment of Primary Female Stress Urinary Incontinence:Meta-Analysis of Randomized Controlled Trials

目的对经阴道无张力性尿道中段悬吊术(TVT)治疗女性压力性尿失禁的客观成功率和并发症发生率进行荟萃分析。方法计算机并配合手工检索PubMed、EMBASE及中国生物医学文献数据库(CBMdisc)、中国期刊全文数据库、万方数据库和相关会议中所有对比TVT和膀胱颈悬吊术(Burch)疗效的临床随机对照试验,进行质量评价后用RevMan4.2软件进行荟萃分析,主要分析客观成功率、并发症率。结果共纳入7个随机对照试验。Meta分析结果显示:1年以上,TVT客观成功率高于Burch(RR为1.12,95%可信区间1.02～1.22,P<0.05);术后1年以内,TVT和Burch客观成功率相似(RR为1.03,95%可信区间0.95～1.12,P>0.05)。TVT组客观成功率与“金标准”术式开腹Burch相似(RR为1.01,95%可信区间0.92～1.11,P>0.05),并发症率低于微创术式腹腔镜Burch(RR为0.49,95%可信区间0.31～0.77,P<0.05)。结论TVT是一种疗效可靠、并发症少的治疗女性压力性尿失禁的微创术式。

Objective To evaluate objective cure rate and perioperative complications of tension free vaginal tape （TVT） for the treatment of female primary stress urinary incontinence（SUI）. Method Literature search was conducted for all randomized controlled trials （RCTs） between 1994 and 2006, which compared TVT and Burch, using the RevMan4.2, and recommended each strategy, selection criteria, data collection and analysis, a meta-analysis was made. Main results In comparison with Burch, there was a similar objective cure rate after TVT within the first year after surgery （RR 1.03,95%CI 0.95 to 1.12, P 〉 0.05） and higher objective cure rate after the first year （RR 1.12, 95%CI 1.02 to 1.22, P 〈 0.05）. TVT shares similar objective cure rate with open Burch coposuspension （RR 1.01, 95%CI 0.92 to 1.11, P 〉 0.05）,while lower complication with laparoscopic Burch coposuspension （RR 0.49,95%CI 0.31 to 0.77, P 〈 0.05）. Conclusion The evidence available indicates that TVT is an effective and minilly invasive treatment for primary female stress urinary incontinence.