应用人工合成网片治疗女性阴道前壁膨出的Meta分析

The Use of Synthetic Mesh for the Treatment of Female Anterior Vaginal Wall Prolapse:Meta-Analysis of Randomized Controlled Trails

目的：系统评价应用人工合成网片治疗女性阴道前壁膨出的疗效及安全性。方法：计算机全面检索Pubmed、OVID、Embase等数据库,检索国内外于1980年1月至2014年1月已发表的应用人工合成网片加固的阴道前壁修补术（人工合成网片组）与传统阴道前壁修补术（传统阴道前壁修补组）的随机对照试验（RCT）,按选择标准收集资料,并对两种术式的手术相关指标及临床疗效进行Meta分析。结果：最终纳入11个随机对照试验,共1292例,其中人工合成网片组655例,传统阴道前壁修补组637例。Meta分析结果显示：人工合成网片组较传统阴道前壁修补组手术时间较长（WMD 12.05分钟,95%CI 0.77~23.33,P=0.0400）,术中出血量较多（WMD 49.73 ml,95%CI18.70~80.77,P=0.0020）,客观治愈率（OR4.92,95%CI 3.70~6.55,P=0.0000）及主观治愈率（OR1.85,95%CI 1.31~2.63,P=0.0005）均明显高于传统阴道前壁修补组。而两组手术相关并发症发生率比较,差异均无统计学意义（P〉0.05）。493例应用人工合成网片修补的患者中有39例发生了补片侵蚀及暴露（OR11.21,95%CI 4.01~31.33,P=0.0000）。结论：应用人工合成网片的阴道前壁修补术能有效改善阴道前壁膨出患者脱垂程度、缓解脱垂相关症状,且不会带来更多的其他术后并发症,但存在网片侵蚀及暴露的问题。

Objective： To make a systematic analysis of the efficacy and safety of synthetic mesh for female anterior vaginal wall prolapse. M ethods： Pubmed、OVID、Embase database were searched by computer for published randomised controlled trials（ RCTs） from Jan 1980 to Jan 2014,concerning the comparison of the use of synthetic mesh or traditional surgery for the treatment of female anterior vaginal wall prolapse. Trials were collected and evaluated according to the inclusion and exclusion criteria,to make a meta-analysis of surgery related data and clinical efficacy. Results： A total of 11 randomised controlled trials were included,including overall 1292 cases of female patients,655 cases of synthetic mesh repair and 637 cases of traditional anterior colporrhaphy. Meta-analysis results showed that compared to traditional surgery group,in synthetic mesh repair group,surgery time was longer（ WMD 12. 05 min,95% CI 0. 77- 23. 33,P = 0. 0400） and blood loss during surgery was much more（ WMD 49. 73 ml,95% CI 18. 70- 80. 77,P = 0. 0020）; objective cure rate were significantly higher in synthetic mesh repair（ OR4. 92,95% CI 3. 70- 6. 55,P = 0. 0000）,as well as subjective cure rate（ OR1. 85,95% CI 1. 31-2. 63,P = 0. 0005） with significant differences; there were no statistic differences in perioperative complications（ P 0. 05） between synthetic mesh repair and traditional anterior colporrhaphy. 39 cases in 493 of synthetic mesh repair happened the complications of mesh extrusion and erosion（ OR11. 21,95% CI 4. 01- 31. 33,P = 0. 0000）.Conclusions： The use of synthetic mesh for the treatment of female anterior vaginal wall prolapse results in better objective and subjective cure compared with nonmesh repairs,without more other postoperative complications.However the synthetic mesh repairs may result in the complications of mesh extrusion and erosion.