采用聚丙烯网片的阴道前壁修补术治疗阴道前壁脱垂临床效果的荟萃分析

Clinical efficacy of the application of polypropylene mesh in the anterior vaginal wall prolapse:a meta analysis

目的:比较聚丙烯网片和传统的前壁修补术对阴道前壁脱垂患者的临床效果及并发症。方法:通过Pubmed数据库、Cochrane图书馆数据库、荷兰医学文摘(EMBASE)、OVID数据库,收集国外已发表的1990年至2013年符合要求的英文随机对照实验,按纳入和排除标准进行筛选和质量评估,采用RevMan 5.2对手术失败率、术后新增压力性尿失禁、新增的性交困难、术后尿储留进行meta分析。结果:经筛选,共纳入10篇符合要求的随机对照文献,共1288例受试者。与传统的前壁修补术比较,使用聚丙烯网片能明显降低手术的失败率(P<0.01,RR=0.37,95%CI为0.31~0.45),术后新增的压力性尿失禁和性交困难则无显著差异(P=0.10,RR=1.52,95%CI为0.93~2.48;P=0.16,RR=1.99,95%CI为0.97~4.08),术后尿储留网片发生率较高(P<0.05,RR=2.31,95%CI为1.10~4.83)。结论:使用聚丙烯网片能显著降低手术的失败率和术后复发率,但在术后并发症上无特殊优势,并且术后尿储留的发生率略高。

Objective:To evaluate the clinical efficiency and complication in treatment of anterior vaginal wall prolapse by the pelvic floor reconstruction surgery with polypropylene mesh.Methods:The published articles of English randomized controlled trial(RCT) from 1990 ~ 2013 searched from Pubmed database,Cochrane library,EMBASE and Ovid databases were screened and evaluated under inclusion and exclusion criteria.Meta analyses were conducted to compare anatomy failure rate,de novo stress urinary incontinence,de novo dyspareunia and urinary retention between polypropylene mesh repair group and traditional colporrhaphy group with revman 5.2 analysis software.Results:A total of 10 randomized controlled trials including 1288 patients were screened.In comparison with traditional colporrhaphy group,patients in the polypropylene mesh group showed lower anatomy failure rate(P < 0.01,RR = 0.37,95% CI 0.31 ~ 0.45),and higher urinary retention rate(P < 0.05,RR = 2.31,95% CI 1.10 ~ 4.83).The comparisons in the de novo stress urinary and dyspareunia had no significant differences(P = 0.10,RR = 1.52,95% CI 0.93 ~ 2.48 and P = 0.16,RR = 1.99,95% CI 0.97 ~ 4.08).Conclusions:Pelvic floor reconstruction with polypropylene is superior to traditional colporrhaphy group,but shows no advantages in the complications.Mesh group has a higher incidence of urinary retention than traditional colporrhaphy group.