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目的:运用Meta分析评价Ajust单切口微尿道吊带术(Ajust术)对比标准尿道中段吊带术(TVTO/TOT)的近期疗效及不良反应,探讨Ajust术治疗女性压力性尿失禁(SUI)的优劣势和临床实用价值。方法:计算机配合手工检索2009~2014年各数据库及会议论文中Ajust术对比TVT-O/TOT术治疗女性SUI的对照试验研究文献,筛选后运用RevMan 5.2统计软件对治愈率、术后并发症等指标行Meta分析。结果:共5项对照试验纳入Meta分析,共625例患者,Ajust组332例,TVT-O/TOT组293例,纳入了低质量文献的统计需行敏感性分析。结果显示,两组手术近期治愈率基本相当[客观治愈率:RR=1.03,95%CI(0.94,1.13),P=0.51;主观治愈率:RR=1.02,95%CI(0.94,1.11),P=0.56];两组术中副损伤发生极少且差异无统计学意义[RR=2.08,95%CI(0.14,57.14),P=0.50];术后新发下尿路症状发生率差异无统计学意义[RR=0.51,95%CI(0.24,1.08),P=0.08];但术后疼痛程度及持续时间Ajust组明显优于TVT-O/TOT组[术后1天VAS评分Ajust低于TVT-O/TOT:MD=-2.26,95%CI(-2.88,-1.65),P<0.01;术后4天VAS评分Ajust组更低,MD=-1.09,95%CI(-1.67,-0.51),P=0.0002;术后3周腹股沟区疼痛发生率Ajust仍然更低,RR=0.45,95%CI(0.28,0.72),P=0.0009]。结论:Ajust术治疗女性压力性尿失禁安全有效,近期疗效与标准吊带术TVT-O/TOT基本相当,且具有术后疼痛困扰轻等优点,更有利于提高术后生活质量;但远期疗效仍有待进一步研究。
OBJECTIVE: To evaluate the short-term efficacy and adverse reactions of Ajust single incision urethral middle sling (TVTO / TOT) compared with Ajust single-incision micro-urethral sling (UTIA) using Meta-analysis and to explore the advantages and disadvantages of Ajust’s treatment of female stress urinary incontinence And clinical practical value. METHODS: A computer-assisted manual search of the literature comparing controlled trials of Ajust versus TVT-O / TOT for women with SUI in various databases and conference papers from 2009 to 2014 was conducted. After screening, the RevMan 5.2 statistical software was used to evaluate the cure rate, postoperative complications, etc. Indicators line Meta analysis. RESULTS: A total of 5 controlled trials were included in the meta-analysis of 625 patients, 332 in the Ajust group and 293 in the TVT-O / TOT group, incorporating the statistical required sensitivity of low-quality literature. The results showed that the two groups of surgery nearly the same cure rate [objective cure rate: RR = 1.03,95% CI (0.94,1.13), P = 0.51; subjective cure rate: RR = 1.02,95% CI (0.94,1.11) P = 0.56]. There were very few cases of secondary injury in the two groups and the difference was not statistically significant (RR = 2.08,95% CI (0.14,57.14), P = 0.50] No significant difference (RR = 0.51,95% CI (0.24,1.08), P = 0.08]; but postoperative pain and duration Ajust group was significantly better than TVT-O / TOT group [VAS score Ajust (P <0.01); VAS score was lower in Ajust group on day 4 postoperatively, MD = -1.09, 95% CI (-1.67), lower than TVT-O / TOT: MD = -2.26,95% CI , -0.51), P = 0.0002; Ajust was still lower at 3 weeks postoperatively in the groin area with RR = 0.45, 95% CI (0.28, 0.72), P = 0.0009]. Conclusion: Ajust is safe and effective in treating female stress urinary incontinence. The short-term effect is basically equivalent to that of standard sling TVT-O / TOT, and has the advantages of postoperative pain relief and light, which is more conducive to improving postoperative quality of life. However, long- Still needs further study.