网片对比骶棘韧带固定术治疗阴道顶端脱垂的系统评价

The Systematic Evaluation on Transvaginal Polypropylene Mesh versus Sacrospinous Ligament Fixation for Vaginal Vault Prolapse

目的系统评价网片(mesh)与骶棘韧带固定术(sacrospinous ligament fixation,SSLF)治疗阴道顶端脱垂的疗效和安全性。方法计算机检索中国知网、万方、维普、Cochrane Library、Pubmed等,检索时间截至2017年2月。检索词:sacrospinous ligament fixation、SSLF、POP、mesh、盆腔脏器脱垂、网片等。结果最终纳入6篇RCTs,共566例,其中mesh组285例,SSLF组281例。Meta分析结果显示:与SSLF相比,网片手术时间较长[MD=9.75,95%CI(3.09,16.41),P=0.004];未降低术中出血量[MD=-21.43,95%CI(-61.61,18.75),P=0.30];未减少输血人数[OR=0.94,95%CI(0.16,5.52),P=0.95];未提高客观治愈率[OR=0.56,95%CI(0.28,1.12),P=0.10];也未提高术后生活质量评价(CRADI-8、UDI-6、PISQ-12,P>0.05)。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)。结论与骶棘韧带固定术相比,应用网片治疗阴道顶端脱垂不能提高患者客观治愈率,并且手术时间较长,却能有效提高患者解剖复位,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,尚需经济学评价及高质量的前瞻性研究。

Objective To evaluate the effectiveness and safety of transvaginal polypropylene mesh versus sacrospinous ligament fixation for vaginal vault prolapse. Methods Cochrane Library、Pubmed、EMBASE、CNKI and CQVIP database were searched by computer for published randomised controlled trials（RCTs） from January 1980 to February 2017. The index words included sacrospinous ligament fixation,SSLF,POP and mesh. Two researchers extracted the data and evaluated the literature quality independently,to make a meta-analysis of surgery related data and clinical efficacy. Results A total of 6 randomized controlled trials were included,including overall 566 cases of female patients,in which 285 cases of synthetic mesh repair and 281 cases of sacrospinous ligament fixation. Meta-analysis showed that operation time was significantly longer in the mesh group than that in the SSLF group [MD = 9. 75,95% CI（3. 09,16. 41）,P = 0. 004]. It didn＇t decrease intraoperative blood loss [MD =-21. 43,95% CI（-61. 61,18. 75）,P = 0. 30]and the number of transfusion [OR = 0. 94,95% CI（0. 16,5. 42）,P = 0. 95]in the mesh group. It failed to the increase of objective cure rate [OR = 0. 56,95% CI（0. 28,1. 12）,P = 0. 10] or the quality of life（CRADI-8,UDI-6,PISQ-12,P〉0. 05） either. There were no statistic differences in perioperative complications between the synthetic mesh group and the sacrospinous ligament fixation group（P〉0. 05）.Conclusions Comparing with sacrospinous ligament fixation,the use of the synthetic mesh for the treatment of female vaginal vault prolapse can not increase the objective and subjective cure rate,or increase other postoperative complications. However the synthetic mesh repairs may result in the complications of mesh-related complications,such as mesh extrusion and erosion. Still economic evaluations and prospective studies are needed to guide clinical practices.