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目的系统评价膀胱不同部位注射A型肉毒素(BTA)治疗难治性膀胱过度活动症的有效性和安全性。方法计算机检索PubMed(1966~2015.2)、Cochrane Library(1996~2015.2)、Embase(1974~2015.2)、CNKI(1994~2015.2)、万方数据库(1989~2015.2)、CBM(1978~2015.2)数据库,按照纳入和排除标准选择随机对照试验(RCT),评价纳入文献质量并提取资料,采用RevMan 5.0软件进行Meta分析。结果共纳入5个RCT,包括248例患者,注射部位有三种:膀胱体、膀胱体+膀胱三角、膀胱三角。Meta分析结果显示:膀胱三角+膀胱体注射方式与膀胱体注射方式相比,治疗成功比[RR=1.57,95%CI(0.79,3.12),P=0.20]、尿失禁减少次数[WMD=-6.47,95%CI(-14.21,1.27),P=0.10]差异无统计学意义,对尿动力学参数中第一排尿感时膀胱容量(VFDV)变化前者效果优于后者[WMD=33.80,95%CI(3.27,64.340),P=0.03],但其余尿动力学参数两组差异无统计学意义。膀胱三角注射方式与膀胱体注射方式相比,治疗成功比[RR=0.52,95%CI(0.07,3.75),P=0.52]、尿失禁减少次数[WMD=1.03,95%CI(-0.35,5.11),P=0.62]、尿动力学参数两组差异均无统计学意义。纳入5篇文献中均未报道膀胱三角区注射导致新的膀胱输尿管反流的病例。结论肉毒素A膀胱体、膀胱体+膀胱三角和膀胱三角三种注射方式治疗难治性膀胱过度活动症的疗效和安全性无明显差异。
Objective To evaluate the efficacy and safety of injecting botulinum toxin A (BTA) in different parts of the bladder in the treatment of intractable bladder overactivity. Methods The databases of PubMed (1966 ~ 2015.2), Cochrane Library (1996 ~ 2015.2), Embase (1974 ~ 2015.2), CNKI (1994 ~ 2015.2), Wanfang Database (1989 ~ 2015.2) and CBM (1978 ~ 2015.2) Inclusion and Exclusion Criteria Randomized controlled trials (RCTs) were selected to assess the quality of the included literature and extract data for Meta-analysis using RevMan 5.0 software. Results A total of 5 RCTs were included, including 248 patients. There were three injection sites: bladder, bladder, bladder trigone and bladder trigone. Meta analysis showed that the success rate (RR = 1.57, 95% CI (0.79, 3.12, P = 0.20), reduction in urinary incontinence [WMD = - 6.47,95% CI (-14.21,1.27), P = 0.10] .There was no significant difference in urodynamic parameters between the former and the latter (WMD = 33.80, 95% CI (3.27, 64.340), P = 0.03]. However, there was no significant difference in the remaining urodynamic parameters between the two groups. Compared with bladder injection, the success rate (RR = 0.52, 95% CI, 0.07, 3.75, P = 0.52) and the reduction in urinary incontinence [WMD = 1.03,95% CI -0.35 5.11), P = 0.62]. There was no significant difference in urodynamic parameters between the two groups. Neither of the five articles included reports of bladder trigone lead to a new case of vesicoureteral reflux. Conclusion There is no significant difference in the efficacy and safety of three injection methods: Botox A Bladder, Bladder + Bladder Triangle and Bladder Triangle in the treatment of intractable bladder overactivity.