经阴道修补手术与经腹骶骨阴道固定术治疗阴道顶端脱垂的meta分析

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摘要目的荟萃分析经阴道修补手术与经腹骶骨阴道固定术治疗阴道顶端脱垂的有效性及安全性,以期为临床决策提供证据。方法计算机检索Cochrane图书馆、PubMed、EMbase、SCI、Ovid、中国生物医学文献数据库、万方、维普和中国知网数据库,收集经阴道修补手术与经腹骶骨阴道固定术治疗阴道顶端脱垂的随机对照研究,限截至2016年11月。由两名评价者按照纳入与排除标准选择试验、提取资料和评价质量后,采用Revman5.3 软件进行荟萃分析。结果共纳入5项随机对照研究,共501名患者,Meta分析结果显示,经阴道修补手术术后2年内有脱垂症状者多[RR=2.11,95% CI=1.06~4.21,P=0.03],经阴道修补手术后2~4年因脱垂复发再次手术率比经腹骶骨阴道固定术高[RR=2.28,95％ CI=1.20~4.32,P=0.01],经阴道修补手术术后2~4年因尿失禁复发再次手术率与经腹骶骨阴道固定术无显著差异[RR=1.87,95％ CI=0.72~4.86,P=0.20],经阴道手术术后1~2年脱垂复发更为常见[RR=2.16,95% CI=1.45~3.23, P<0.010],两种手术术中膀胱损伤及直肠损伤无显著差异,经阴道手术术后客观失败率高[RR=4.98,95% CI=2.79~8.88,Z=5.43,P<0.01],经阴道手术较经腹骶骨阴道固定术出现性交困难更多[RR=2.53,95% CI=1.17~5.50,P=0.02],经阴道修补手术较经腹骶骨阴道固定术手术时间要少[MD=-21.49,95% CI=-28.00~-14.98,P<0.01],但住院时间及围手术期输血率无显著差异。结论与阴道修补手术相比,经腹骶骨阴道固定术更加有效和安全。由于纳入文献质量及数量的局限性,仍需要大样本、高质量的临床随机对照试验来进一步验证。

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关键词 ：顶端脱垂, 骶骨阴道固定术, 阴道修补手术, meta分析

Abstract：Objective To evaluate the safety and efficacy of transvaginal repair and transabdominal sacrovaginal fixation in the treatment of vaginal tip prolapse and to provide evidence for clinical decision. Methods Randomized controlled Trials (RCTs) about transvaginal repair and transabdominal sacrovaginal fixation in the treatment of vaginal tip prolapse were collected through several databases,including Cochrane Library,PubMed,EMbase,SCI,Ovid,CBM,WanFang Data Knowledge Service Platform,VIP Information,Chinese Science and China National Knowledge Infrastructure.The retrieval time span was from inception to November 2016.Two independent reviewers screened the trials,extracted the data and evaluated the quality according to the inclusion and exclusion criteria.RevMan 5.3 software was used for meta-analysis.ResultsA total of 501 patients in 5 RCTs were included in the meta-analysis. Results showed that awareness of prolapse symptoms were more common after vaginal repair procedures in 2 years [RR=2.11,95% CI=1.06~4.21,P=0.03] and rate of prolapse recurrence was more common [RR=2.16,95% CI=1.45~3.23,two P<0.010] comparing with sacral colpopexy; rate of prolapse recurrence reoperation was higher after vaginal repair procedures 2~4 years [RR=2.28,95％ CI=1.20~4.32,P=0.01]; urinary incontinence recurrence reoperation rate showed no significant difference between the two groups[RR=1.87,95%CI=0.72~4.86,P=0.20],bladder injury and rectal injury had no significant difference.The vaginal surgery showed higher objective failure rate of post-operation [RR=4.98 95%,CI=2.79~8.88,Z=5.43,P<0.01].Although dyspareunia was more common [RR=2.53,95% CI=1.17~5.50,P=0.02],while the fixation operation time is less [MD=-21.49,95% CI=-28.00~-14.98,P<0.01] in virginal repair group,hospitalization time and perioperative blood transfusion rate has no significant difference. Conclusion Compared with vaginal repair,transabdominal sacral vagina fixation is more effective and safer.Due to the limitations of the quality and quantity of the literature,large sample and high quality clinical randomized controlled trials are still needed to further verify.

Key words： apical vaginal prolapse sacral colpopexy vaginal repair meta-analysis

收稿日期: 2017-04-05

基金资助:湖北省医学领军人才培养工程(鄂卫生计生发(2013)4号)

通讯作者: 易村犍(cunjiany@163.com);王晓雯(1598562685@qq.com)

引用本文:

曾庆松, 易村犍, 陈克明, 凌晟荣, 王晓雯, 茅敏, 姜涛, 曹晓明, 黄庆. 经阴道修补手术与经腹骶骨阴道固定术治疗阴道顶端脱垂的meta分析[J]. 中国生育健康杂志, 2018, 29(2): 117-125.
ZENG Qingsong, YI Cunjian, CHEN Keming, LING Shengrong, WANG Xiaowen, MAO Min, JIANG Tao, CAO Xiaoming. Meta-analysis of vaginal repair procedure and sacral colpopexy for the treatment of apical vaginal prolapse. Chinese Journal of Reproductive Health, 2018, 29(2): 117-125.

链接本文:

http://cjrh.bjmu.edu.cn/CN/ 或 http://cjrh.bjmu.edu.cn/CN/Y2018/V29/I2/117

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