经耻骨后无张力阴道吊带术治疗女性压力性尿失禁疗效及安全性系统评价_《中国循证医学杂志》

作者：

杨明根 ,  赵晓昆 , 吴志平 , 肖宁 , 吕晨 , 候轶

中南大学湘雅二医院泌尿外科（长沙 410011）;

关键词：

压力性尿失禁经耻骨后无张力阴道吊带术（TVT） Burch术系统评价 Meta分析

DOI：

10.7507/1672-2531.20080053

视频：

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摘要 全文 图表 视频 参考文献 施引文献 补充材料

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RevMan 4.2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 gt;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。

引用本文： 杨明根,赵晓昆,吴志平,肖宁,吕晨,候轶. 经耻骨后无张力阴道吊带术治疗女性压力性尿失禁疗效及安全性系统评价. 中国循证医学杂志, 2008, 08(4): 237-243. doi: 10.7507/1672-2531.20080053 复制

1.	川罗新, 朱亚飞. 女性压力性尿失禁的手术治疗和评价. 实用妇产科杂志, 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.	罗新. 女性压力性尿失禁的诊断方法和评价(之二). 中国实用妇科与产科杂志, 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. 川罗新, 朱亚飞. 女性压力性尿失禁的手术治疗和评价. 实用妇产科杂志, 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. 罗新. 女性压力性尿失禁的诊断方法和评价(之二). 中国实用妇科与产科杂志, 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.

《中国循证医学杂志》

经耻骨后无张力阴道吊带术治疗女性压力性尿失禁疗效及安全性系统评价

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《中国循证医学杂志》

经耻骨后无张力阴道吊带术治疗女性压力性尿失禁疗效及安全性系统评价

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