經恥骨后無張力陰道吊帶術治療女性壓力性尿失禁療效及安全性系統評價_《中國循證醫學雜志》

作者：

楊明根 ,  趙曉昆 , 吳志平 , 肖寧 , 呂晨 , 候軼

中南大學湘雅二醫院泌尿外科（長沙 410011）;

關鍵詞：

壓力性尿失禁經恥骨后無張力陰道吊帶術（TVT） Burch術系統評價 Meta分析

DOI：

10.7507/1672-2531.20080053

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目的　系統評價經恥骨后無張力陰道吊帶術（TVT）與Burch術治療女性壓力性尿失禁（SUI）的有效性與安全性。
方法　計算機檢索CENTRAL（2007年4月）、MEDLINE（1966～2007.10）、EMbase（1988～2007.10），納入TVT和Burch術比較治療SUI的隨機對照試驗（RCT），并追索已納入文獻的參考文獻。由兩位評價員獨立進行文獻篩查、質量評價和資料提取，并交叉核對，意見不一致時討論解決，或向專家咨詢解決。采用RevMan 4.2軟件進行Meta分析。
結果　共初檢出42篇文獻，最后納入10個RCT（1294例）進行分析。Meta分析結果顯示：TVT客觀成功率高于Burch術［OR=1.73，95%CI（1.26，2.38），P=0.0007］。TVT總的并發癥及膀胱/陰道損傷發生率高于Burch術［OR=1.39，95% CI（1.08，1.80），P=0.01］，而Burch術后再次手術率明顯較高［OR=0.29，95%CI（0.10，0.80），P=0.02］。會陰部血腫、尿路感染及下尿路癥狀兩組無明顯差異（P gt;0.2）。
結論　短期研究顯示，TVT是一種療效有限的治療SUI的微創術式，再次手術率雖小，但發生膀胱/陰道損傷危險性較高，其療效有待高質量的RCT并進行長期隨訪來進一步驗證。

引用本文： 楊明根,趙曉昆,吳志平,肖寧,呂晨,候軼. 經恥骨后無張力陰道吊帶術治療女性壓力性尿失禁療效及安全性系統評價. 中國循證醫學雜志, 2008, 08(4): 237-243. doi: 10.7507/1672-2531.20080053 復制

1.	川羅新, 朱亞飛. 女性壓力性尿失禁的手術治療和評價. 實用婦產科雜志, 2003, 21(2): 12-15.
2.	Tension-free vaginal tape (TVT) procedure. Tension-free vaginal tape (TVT) procedure. Int J Gynaecol Obstet, 2005, 91(3): 279-282.
3.	Novara G, Ficarra V, Boscolo-Berto R, et al. Tension-free midurethral slings in the treatment of female stress urinary incontinence: a systematic review and meta-analysis of randomized controlled trials of effectiveness. Eur Urol, 2007, 52(3): 663-678.
4.	Debodinance P, Delporte P, Engrand JB, et al. tension-free vaginal tape (TVT) in the treatment of urinary stress incontinence: 3 years experience involving 256 operations. Euro J Obstet Gynaecol, 2002, 105(1): 49-58.
5.	Mulrow CD, Oxman AD. The Cochrane Collaboration handbook, Issue 1, 2000, Oxford, Update Software.
6.	Liapis A, Bakas P, Creatsas G. Burch colposuspension and tension-free vaginal tape in the management of stress urinary incontinence in women. Eur Urol, 2002, 41(4): 469-473.
7.	Persson J, Teleman P, Eten-Bergquist C, et al. Cost-analyzes based on a prospective, randomized study comparing laparoscopic colposuspension with a tension-free vaginal tape procedure. Acta Obstet Gynecol Scand, 2002, 81(11): 1066-1073.
8.	Ward K, Hilton P, United Kingdom, et al. Prospective multicentre randomized trial of tension-free vaginal tape and colposuspension as primary treatment for stress incontinence. BMJ, 2002, 325(7355): 67.
9.	Ustun Y, Engin-Ustun Y, Gungor M, et al. Tension free vaginal tape compared with laparoscopic Burch urethropexy. J Am Assoc Gynecol Laparosc, 2003, 10(3): 386-389.
10.	Valpas A, Kivelä A, Penttinen J, et al. Tension-free vaginal tape and laparoscopic complications-A randomized clinical trail. Acta Obstet Gynecol Scand, 2003, 82(7): 665-671.
11.	Paraiso MF, Walters MD, Karram MM, et al. Laparoscopic Burch colposuspension versus tension-free vaginal tape: a randomized trial. Obstet Gynecol, 2004, 104(6): 1249-1258.
12.	Valpas A, Kivela A, Penttinen J, et al. Tension-free vaginal tape and laparoscopic mesh colposuspension for stress urinary incontinence. Obstet Gynecol, 2004, 104(1): 42-49.
13.	Ward KL, Hilton P, UK, et al. A prospective multicenter randomized trial of tension-free vaginal tape and colposuspension for primary urodynamic stress incontinence: two-year follow-up. Am J Obstet Gynecol, 2004, 190(2): 324-331.
14.	Bai SW, Sohn WH, Chung DJ, et al. Comparison of the efficacy of Burch colposuspension, pubovaginal sling, and tension-free vaginal tape for stress urinary incontinence. Int J Gynaecol Obstet, 2005, 91(3): 246-251.
15.	El-Barky E, El-Shazly A, El-Wahab OA, et al. Tension free vaginal tape versus Burch colposuspension for treatment of female stress urinary incontinence. Int Urol Nephrol, 2005, 37(2): 277-281.
16.	Fiori M, Gunelli R, Mercuriali M, Bercovich E. Tension-free vaginal tape and female stress incontinence: further evidence of effectiveness. Urologia Intemationalis, 2004, 72(4): 325-328.
17.	羅新. 女性壓力性尿失禁的診斷方法和評價(之二). 中國實用婦科與產科雜志, 2006, 22(10): 798-799.
18.	Devereaux PJ, Bhandari M, Clark M, et al. Need for expertise based randomized controlled trials. BMJ, 2005, 330(7488): 88.

1. 川羅新, 朱亞飛. 女性壓力性尿失禁的手術治療和評價. 實用婦產科雜志, 2003, 21(2): 12-15.
2. Tension-free vaginal tape (TVT) procedure. Tension-free vaginal tape (TVT) procedure. Int J Gynaecol Obstet, 2005, 91(3): 279-282.
3. Novara G, Ficarra V, Boscolo-Berto R, et al. Tension-free midurethral slings in the treatment of female stress urinary incontinence: a systematic review and meta-analysis of randomized controlled trials of effectiveness. Eur Urol, 2007, 52(3): 663-678.
4. Debodinance P, Delporte P, Engrand JB, et al. tension-free vaginal tape (TVT) in the treatment of urinary stress incontinence: 3 years experience involving 256 operations. Euro J Obstet Gynaecol, 2002, 105(1): 49-58.
5. Mulrow CD, Oxman AD. The Cochrane Collaboration handbook, Issue 1, 2000, Oxford, Update Software.
6. Liapis A, Bakas P, Creatsas G. Burch colposuspension and tension-free vaginal tape in the management of stress urinary incontinence in women. Eur Urol, 2002, 41(4): 469-473.
7. Persson J, Teleman P, Eten-Bergquist C, et al. Cost-analyzes based on a prospective, randomized study comparing laparoscopic colposuspension with a tension-free vaginal tape procedure. Acta Obstet Gynecol Scand, 2002, 81(11): 1066-1073.
8. Ward K, Hilton P, United Kingdom, et al. Prospective multicentre randomized trial of tension-free vaginal tape and colposuspension as primary treatment for stress incontinence. BMJ, 2002, 325(7355): 67.
9. Ustun Y, Engin-Ustun Y, Gungor M, et al. Tension free vaginal tape compared with laparoscopic Burch urethropexy. J Am Assoc Gynecol Laparosc, 2003, 10(3): 386-389.
10. Valpas A, Kivelä A, Penttinen J, et al. Tension-free vaginal tape and laparoscopic complications-A randomized clinical trail. Acta Obstet Gynecol Scand, 2003, 82(7): 665-671.
11. Paraiso MF, Walters MD, Karram MM, et al. Laparoscopic Burch colposuspension versus tension-free vaginal tape: a randomized trial. Obstet Gynecol, 2004, 104(6): 1249-1258.
12. Valpas A, Kivela A, Penttinen J, et al. Tension-free vaginal tape and laparoscopic mesh colposuspension for stress urinary incontinence. Obstet Gynecol, 2004, 104(1): 42-49.
13. Ward KL, Hilton P, UK, et al. A prospective multicenter randomized trial of tension-free vaginal tape and colposuspension for primary urodynamic stress incontinence: two-year follow-up. Am J Obstet Gynecol, 2004, 190(2): 324-331.
14. Bai SW, Sohn WH, Chung DJ, et al. Comparison of the efficacy of Burch colposuspension, pubovaginal sling, and tension-free vaginal tape for stress urinary incontinence. Int J Gynaecol Obstet, 2005, 91(3): 246-251.
15. El-Barky E, El-Shazly A, El-Wahab OA, et al. Tension free vaginal tape versus Burch colposuspension for treatment of female stress urinary incontinence. Int Urol Nephrol, 2005, 37(2): 277-281.
16. Fiori M, Gunelli R, Mercuriali M, Bercovich E. Tension-free vaginal tape and female stress incontinence: further evidence of effectiveness. Urologia Intemationalis, 2004, 72(4): 325-328.
17. 羅新. 女性壓力性尿失禁的診斷方法和評價(之二). 中國實用婦科與產科雜志, 2006, 22(10): 798-799.
18. Devereaux PJ, Bhandari M, Clark M, et al. Need for expertise based randomized controlled trials. BMJ, 2005, 330(7488): 88.

《中國循證醫學雜志》

經恥骨后無張力陰道吊帶術治療女性壓力性尿失禁療效及安全性系統評價

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《中國循證醫學雜志》

經恥骨后無張力陰道吊帶術治療女性壓力性尿失禁療效及安全性系統評價

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