女性盆腔器官脱垂手术对男性伴侣性功能影响的荟萃分析

A Meta-analysis of the effect of female pelvic organ prolapse surgery on sexual function of the male partner

目的:探讨女性盆腔器官脱垂(pelvic organ prolapse,POP)手术对男性伴侣性功能的影响。方法:在PubMed、Cochrane图书馆、Medline、Embase、科学引文索引、社会科学引文索引、中国期刊网全文数据库、中国生物医学文献数据库、维普医学数据库、万方医学数据库中,检索涉及女性POP患者手术前后男性伴侣性功能变化的对比性研究,包括随机对照研究、队列研究和病例对照研究。女性POP手术方式包括阴道前壁和(或)后壁修复术、阴式子宫全切除术、曼氏手术、阴道封闭术、改良全盆底重建术。本研究中排除女性POP手术中尿失禁手术的文献。使用RevMan 5.3软件对检索获得数据进行Meta分析。结果:检索共获得318篇相关文献,其中3篇系统评估了女性POP手术前后男性伴侣性功能的变化。研究共包括134对夫妻,2种评分标准均显示:女性POP手术前后,勃起功能无明显改变(MD=-0.04,95%CI=-0.57～0.49,P=0.89;MD=-0.59,95%CI=-2.60～1.42,P=0.57),射精功能无明显改变(MD=-0.08,95%CI=-0.48～0.33,P=0.72;MD=-0.21,95%CI=-1.20～0.78,P=0.68),男性伴侣的性冲动无明显改善(MD=-0.86,95%CI=-2.43～0.70,P=0.28),整体性满意度无明显改善(MD=-0.93,95%CI=-2.65～0.79,P=0.29;MD=0.05,95%CI=-1.60～1.70,P=0.95)。结论:女性POP患者进行手术治疗,对勃起功能、射精功能、性冲动和整体性满意度均无明显影响。此外,本研究也存在以下缺陷:纳入相关原始研究较少,在男性性功能评价测量方法等方面存在一定异质性。

Objective:To investigate the effect of female pelvic organ prolapse(POP) surgery on the sexual function of male partners. Methods:A comparative study of sexual function changes in male partners between before and after female POP surgery,including randomized controlled trials,cohort studies,and case-control studies,was performed on the basis of information retrieval from PubMed,the Cochrane Library,Medline,Embase,the Science Citation Index,the Social Science Citation Index,the Chinese Journal Full-text Database,the Chinese Biomedical Literature Database,the VIP Medical Database,and the Wanfang Medical Database. Female POP surgery methods include anterior and/or posterior vaginal wall repair,vaginal hysterectomy,Manchester operation,vaginal closure,and modified pelvic floor reconstruction. Literature on female POP accompanying urinary incontinence was excluded. A metaanalysis of the retrieved data was performed using the RevMan 5.3 software. Results:Of the 318 related articles retrieved,three were systematically evaluated for changes in the sexual function of the male partner between before and after female POP surgery. In this study,134 couples were included. The following were the scoring criteria used:no significant changes in erectile function (median,95% confidence interval[CI]:-0.04,-0.57 to 0.49,P=0.89 vs. -0.59,-2.60 to 1.42,P=0.57),ejaculation function(-0.08,-0.48 to 0.33,P=0.72 vs. -0.21,-1.20 to 0.78,P=0.68),sexual desire(-0.86,-2.43 to 0.70,P=0.28),and overall sexual satisfaction(-0.93,-2.65 to 0.79,P=0.29 vs. 0.05,-1.60 to 1.70,P=0.95) for male partners from before to after female POP surgery. Conclusion:Surgical treatment for female POP does not significantly improve the erectile and ejaculation functions,sexual desire,and overall sexual satisfaction of male partners. This study has the following limitations:limited number of related original studies and some heterogeneity in the measurement and evaluation of male sexual function.