Shepherd Jonathan P, Lowder Jerry L, Jones Keisha A, Smith Kenneth J
Department of Obstetrics, Gynecology, and Reproductive Sciences, Division of Urogynecology and Reconstructive Pelvic Surgery, University of Pittsburgh Medical Center, Magee Women's Hospital, Pittsburgh, PA, USA.
Int Urogynecol J. 2010 Jul;21(7):787-93. doi: 10.1007/s00192-010-1121-5. Epub 2010 Feb 26.
The objective of this paper is to compare retropubic (RP) and transobturator (TO) midurethral slings using decision analysis techniques.
A decision analysis was constructed including efficacy and complication data. Probability of complication-free surgery and overall utility were analyzed using two models: ALL (all 42 trials) and RCT (seven randomized controlled trials with higher quality data, but missing data on some complications).
Surgery was complication-free more frequently with TO approach with 83.7% vs. 55.7% (ALL) and 70.9% vs. 62.8% (RCT). One-year overall utility favored TO in the ALL model (0.943 vs. 0.895). Conversely, the RCT model favored RP (0.936 vs. 0.910). These differences were both less than published minimally important differences (MID) for utilities. Multiple one-way sensitivity analyses confirmed robustness of results.
The difference between the two surgeries in both utility-based models was less than the MID. Therefore, the separate approaches are highly comparable with similar overall utility. Complications are more frequent with the retropubic approach.
本文旨在运用决策分析技术比较耻骨后（RP）和经闭孔（TO）两种尿道中段吊带术。
构建了一个包含疗效和并发症数据的决策分析模型。使用两种模型分析无并发症手术的概率和总体效用：ALL（所有42项试验）模型和RCT（七项数据质量较高但部分并发症数据缺失的随机对照试验）模型。
TO手术方式无并发症的频率更高，在ALL模型中分别为83.7%和55.7%，在RCT模型中分别为70.9%和62.8%。在ALL模型中，TO的一年总体效用更优（0.943对0.895）。相反，RCT模型中RP更优（0.936对0.910）。这些差异均小于已公布的效用最小重要差异（MID）。多项单向敏感性分析证实了结果的稳健性。
在基于效用的两种模型中，两种手术方式的差异均小于MID。因此，两种不同手术方式具有高度可比性，总体效用相似。耻骨后手术方式并发症更常见。
