Dean Nicola, Ellis Gaye, Herbison G Peter, Wilson Don, Mashayekhi Atefeh
Obstetrics & Gynaecology, York Hospitals NHS Foundation Trust, Wigginton Road, York, UK, YO31 8HE.
Cochrane Database Syst Rev. 2017 Jul 27;7(7):CD002239. doi: 10.1002/14651858.CD002239.pub3.
Stress urinary incontinence (SUI) imposes significant health and economic burden on society and the women affected. Laparoscopic colposuspension was one of the first minimal access operations for the treatment of women with SUI, with the presumed advantages of avoiding major incisions, shorter hospital stays and quicker return to normal activities.
To determine the effects of laparoscopic colposuspension for urinary incontinence in women.
We searched the Cochrane Incontinence Group Trials Register (searched 2 July 2009), and sought additional trials from other sources and by contacting study authors for unpublished data and trials.
Randomised or quasi-randomised controlled trials in women with symptomatic or urodynamic diagnosis of stress or mixed incontinence that included laparoscopic surgery as the intervention in at least one arm of the studies.
The review authors evaluated trials for methodological quality and their appropriateness for inclusion in the review. Two review authors extracted data and another cross checked them. Where appropriate, we calculated a summary statistic.
We identified 22 eligible trials. Ten involved the comparison of laparoscopic with open colposuspension. Whilst the women's subjective impression of cure seemed similar for both procedures, in the short- and medium-term follow-up, there was some evidence of poorer results of laparoscopic colposuspension on objective outcomes. The results showed trends towards fewer perioperative complications, less postoperative pain and shorter hospital stay for laparoscopic compared with open colposuspension, however, laparoscopic colposuspension was more costly.Eight studies compared laparoscopic colposuspension with newer 'self-fixing' vaginal slings. There were no significant differences in the reported short- and long-term subjective cure rates of the two procedures but objective cure rates at 18 months favoured slings. We observed no significant differences for postoperative voiding dysfunction and perioperative complications. Laparoscopic colposuspension had a significantly longer operation time and hospital stay. We found significantly higher subjective and objective one-year cure rates for women randomised to two paravaginal sutures compared with one suture in a single trial. Three studies compared sutures with mesh and staples for laparoscopic colposuspension and showed a trend towards favouring the use of sutures.
AUTHORS' CONCLUSIONS: Currently available evidence suggests that laparoscopic colposuspension may be as good as open colposuspension at two years post surgery. However, the newer vaginal sling procedures appear to offer even greater benefits, better objective outcomes in the short term and similar subjective outcomes in the longer term. If laparoscopic colposuspension is performed, the use of two paravaginal sutures appears to be the most effective method. The place of laparoscopic colposuspension in clinical practice should become clearer when there are more data available describing long-term results. A brief economic commentary (BEC) identified three studies suggesting that tension-free vaginal tape (TVT) may be more cost-effective compared with laparoscopic colposuspension but laparoscopic colposuspension may be slightly more cost-effective when compared with open colposuspension after 24 months follow-up.
压力性尿失禁（SUI）给社会及受影响的女性带来了巨大的健康和经济负担。腹腔镜阴道悬吊术是最早用于治疗女性SUI的微创手术之一，其优势在于避免大切口、缩短住院时间并能更快恢复正常活动。
确定腹腔镜阴道悬吊术治疗女性尿失禁的效果。
我们检索了Cochrane尿失禁组试验注册库（检索时间为2009年7月2日），并从其他来源及通过联系研究作者获取未发表的数据和试验，以寻找更多试验。
对有症状性或尿动力学诊断为压力性或混合性尿失禁的女性进行的随机或半随机对照试验，这些研究至少有一组将腹腔镜手术作为干预措施。
综述作者评估试验的方法学质量及其纳入综述的适宜性。两位综述作者提取数据，另一位进行交叉核对。在适当情况下，我们计算了汇总统计量。
我们确定了22项符合条件的试验。其中10项涉及腹腔镜阴道悬吊术与开放性阴道悬吊术的比较。虽然两种手术方式在女性对治愈的主观感受上似乎相似，但在短期和中期随访中，有一些证据表明腹腔镜阴道悬吊术在客观结果上较差。结果显示，与开放性阴道悬吊术相比，腹腔镜阴道悬吊术围手术期并发症更少、术后疼痛更轻、住院时间更短，但成本更高。8项研究将腹腔镜阴道悬吊术与新型“自固定”阴道吊带进行了比较。两种手术方式报告的短期和长期主观治愈率无显著差异，但18个月时的客观治愈率吊带更具优势。我们观察到术后排尿功能障碍和围手术期并发症无显著差异。腹腔镜阴道悬吊术的手术时间和住院时间明显更长。在一项单一试验中，我们发现随机接受两条阴道旁缝合的女性在主观和客观一年治愈率方面显著高于接受一条缝合的女性。3项研究比较了腹腔镜阴道悬吊术使用缝合线与网片和吻合器的情况，显示出倾向于使用缝合线的趋势。
现有证据表明，腹腔镜阴道悬吊术在术后两年的效果可能与开放性阴道悬吊术相当。然而，新型阴道吊带手术似乎能带来更大益处，短期内客观结果更好，长期内主观结果相似。如果进行腹腔镜阴道悬吊术，使用两条阴道旁缝合似乎是最有效的方法。当有更多描述长期结果的数据时，腹腔镜阴道悬吊术在临床实践中的地位将更加明确。一篇简短的经济评论（BEC）指出，三项研究表明，与腹腔镜阴道悬吊术相比，无张力阴道吊带（TVT）可能更具成本效益，但在24个月随访后，与开放性阴道悬吊术相比，腹腔镜阴道悬吊术可能略具成本效益。
