CAJ | 학술논문

目的研究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.方法计算机检索Pubmed、Embase、Ovid数据库1980年至2012年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、手术时问、术中出血量、周围脏器损伤及术后盆腔痛、泌尿系感染、材料暴露、材料侵蚀、新发生的尿失禁及新发生的性生活困难共10项行Meta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231 3例,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膨出相比,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＜0.01,RR =0.51,95％ CI:0.41～0.64)、(P＜0.01,加权均数差=16.25,95％ CI:8.07 ～24.43)、(P=0.01,加权均数差=35.00,95％ CI:6.90 ～63.11)及(P=0,03,RR=0.51,95％CI: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差异无统计学意义,P值分别为0.07、0.58、0.54及0.67,辅助材料暴露及突出的平均发生率分别为4.37％ (27/618)及7.69％(24/312).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.
목적 연구응용보조재료행분저수보술치료음도전벽탈수적유효성급안전성.방법 계산궤검색Pubmed、Embase、Ovid수거고1980년지2012년부합조건적영문수궤대조시험적문헌,진행질량평고,병대해부학실효솔、수술시문、술중출혈량、주위장기손상급술후분강통、비뇨계감염、재료폭로、재료침식、신발생적뇨실금급신발생적성생활곤난공10항행Meta분석.결과 공검색도부합조건적20편수궤대조문헌,납입수시자공231 3례,평균수방시간3～36개월.경Meta분석,응용보조재료적수보술여불응용보조재료적수보술치료음도전벽팽출상비,보조재료조표현위경저적해부학실효솔、경장적수술시간、경다적술중출혈량급경저적비뇨계감염발생솔,효응량분별위(P＜0.01,RR =0.51,95％ CI:0.41～0.64)、(P＜0.01,가권균수차=16.25,95％ CI:8.07 ～24.43)、(P=0.01,가권균수차=35.00,95％ CI:6.90 ～63.11)급(P=0,03,RR=0.51,95％CI:0.28 ～0.93)；단량조재주위장기손상、술후동통、신발생적뇨실금급신발생적성생활곤난적비교차이무통계학의의,P치분별위0.07、0.58、0.54급0.67,보조재료폭로급돌출적평균발생솔분별위4.37％ (27/618)급7.69％(24/312).결론 보조재료재음도전벽수보수술중적응용능개선술후복발솔,단병발증적발생총체상여단순수보술상비미견명현차이.
Objective To search the literature of randomized controlled trials on 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.Methods Searches were made in the databases of Pubmed,Embase and Ovid for randomized controlled trials from 1980 to 2012 on the treatment of anterior vaginal wall prolapse with adjuvant materials.Comprehensive meta-analyses were conducted with Revman 5.1 analysis software to compare vaginal wall anatomy failure rate,operative duration,intraoperative bleeding volume,postoperative visceral injury,pelvic pain,urinary infection,material exposure,material erosion,de novo urinary incontinence and de novo dyspareunia in the adjuvant materials repair and repair without adjuvant materials groups.Results A total of 20 randomized controlled trials including 2313 participants were retrieved.The shortest average follow-up period was 3 months and the longest 36 months.Compared with repair without adjuvant materials,the application of adjuvant materials in anterior vaginal wall repair reduced vaginal front wall prolapse anatomy failure rate lower anatomy failure rate,had a longer operating duration,more peri-operative bleeding and lower urinary tract infection rate.The comprehensive effects were as follows:P＜0.01,RR =0.51,95％CI:0.41-0.64;P ＜0.01,weighted mean differenece (WMD) =16.25,95％ CI:8.07-24.43;P =0.01,WMD =35.00,95％ CI:6.90-63.11 ;P =0.03,RR =0.51,95％ CI:0.28-0.93,respectively,but the comparison of two groups around in visceral injury,postoperative pain,de novo stress urinary incontinence and de novo dyspareunia had no significant differences (P =0.07,0.58,0.54 and 0.67) and the average materiale exposure and rosion rate were 4.37％ (27/618) and 7.69％ (24/312) respectively.Conclusions The application of adjuvant materials in anterior vaginal wall repair can improve the postoperative recurrence.But no obvious differences exist in the incidence of complications in anterior repair with adjuvant materials and repair without adjuvant materials.