应用网片或移植物治疗阴道前壁脱垂效果及不良反应的荟萃分析.docVIP

PAGE PAGE 26 应用网片或移植物治疗阴道前壁脱垂效果及不良反应的荟萃分析 【摘要】目的：研究应用与不应用辅助材料行盆底修补术治疗阴道前壁脱垂的有效性及安全性；方法：计算机搜索Pubmed、Embase、Ovid数据库1980年至2012年2月符合条件的英文随机对照试验的文献，进行质量评估，并对解剖学失效率、手术时间、术中出血量、周围脏器损伤及术后盆腔痛、泌尿系感染、新发生的尿失禁及新发生的性生活困难共八项行荟萃分析；结果：共检索到符合条件的20篇随机对照文献，纳入受试者共2313人，平均随访时间3～36个月。经meta分析，应用辅助材料的修补术与不应用辅助材料的修补术治疗阴道前壁脱垂相比，辅助材料组表现为更低的解剖学失效率、更长的手术时间、更多的术中出血量及更低的泌尿系感染发生率，效应量分别为（P＜0.00001，RR=0.51，95％CI为0.41，0.64）、（P＜0.00001，MD=16.25，95％CI为8.07～24.43）、（P=0.01，MD=35.00，95％CI为6.90～63.11）及（P=0.03，RR=0.51，95％CI为0.28～0.93），但两组在周围脏器损伤、术后疼痛、新发生的尿失禁及新发生的性生活困难的比较无明显差异，P值分别为：0.07、0.58、0.54及0.99。结论：辅助材料在阴道前壁修补手术中的应用能改善术后复发率，但并发症的发生总体上与单纯修补术相比未见明显差异，值得临床推广。 关键词: 阴道前壁脱垂 修补术 辅助材料 有效性 安全性 Meta-analysis of the efficacy and safety of the application of adjuvant material in the repair of anterior vaginal wall prolapse Abstract Purpose：to search published randomized controlled trials relevant to the treatment of anterior vaginal wall prolapse with adjuvant materials, and compare the efficacy and safety of anterior vaginal wall prolapse repair with and without adjuvant materials. Method: electrically searched in Pubmed、Embase、Ovid databse for published randomized controlled trials from 1980 to February 2012 on treatment of anterior vaginal wall prolapse with adjuvant materials, and carried on comprehensive meta-analysis applying Revman5.1 analysis software, and compare vaginal wall anatomy failure rate, operative time, intraoperative bleeding and postoperative visceral injury, pelvic pain, urinary infection, material exposure, material erosion, de novo urinary incontinence and de novo dyspareunia in the adjuvant materials repair group and repair without adjuvant materials group. Result: A total of 20 randomized controlled trials including 2313 participants were recognized in the study, the shortest average follow-up period was 3 months, and the longest was 36 months.Compared with repair without adjuvant materials, the application of the adjuvant materials in anterior vaginal wall repair totally r