合成网片对比阴道修补术治疗女性盆腔器官脱垂的meta分析

摘要

目的：系统评价合成网片用于盆腔器官脱垂修补手术和阴道修补术的有效性和安全性。方法检索PubMed（1980～2013年）、Cochrane图书馆（1995～2013年）、Google Scholar（1980～2013年）、中国期刊网全文数据库（1980～2013年）、中国生物医学文献数据库（1980～2013年），纳入合成网片修补术和传统阴道修补术2种治疗方法的随机对照研究，并应用RevMan5．0软件进行统计分析。结果纳入10项随机对照试验，meta分析结果显示：合成网片组手术时间明显长于传统阴道修补组（WMD：16．57 min，95％CI：14．06～19．08 min，P＜0．00001），术中出血量明显多于传统阴道修补组（WMD：24．98 ml，95％CI：7．13～42．84 ml，P＝0．006），客观治愈率明显高于传统阴道修补组（OR：4．16，95％CI：3．10～5．58， P＜0．00001），主观治愈率明显高于传统阴道修补组（OR：2．13，95％CI：1．55～2．91，P＜0．00001），性交困难发生率明显低于传统阴道修补组（P＝0．04），术后再发尿失禁、术后再次手术率无统计学差异（P＝0．13，P＝0．06）。结论与传统阴道修补术相比，合成网片提高主、客观治愈率，提示合成网片应用于治疗盆腔器官脱垂有效，但仍需高质量前瞻性研究进一步证实。%Objective To review systemically the effectiveness and safety of mesh versus traditional colporrhaphy for pelvic organ prolapse . Methods The literature were retrieved from the PubMed ( 1980 -2013 ) , Cochrane ( 1995 -2013 ) , Google Scholar (1980-2013), CNKI (1980-2013), and SinoMed (1980-2013).The randomized controlled trials (RCT) were collected and compared, and the data were analyzed by using the RevMan 5.0 software. Results There were totally 10 randomized controlled trials collected .Meta-analysis showed that:the operation time was significantly longer in the mesh group than that in the colporrhaphy group [WMD:16.57 min, 95%CI:14.06-19.08 min, P<0.00001]; the intraoperative blood loss was significantly more in the mesh group than that in the colporrhaphy group [ WMD: 24.98 ml, 95%CI:7.13 -42.84 ml, P=0.006]; the mesh group was superior to colporrhaphy group in the increase of objective cure rate [OR:4.16, 95%CI:3.10-5.58,P<0.00001] and subjective cure rate [OR:2.13, 95%CI:1.55-2.91, P<0.00001]; as compared with all various relating operations , the incidence rate of dyspareunia was statistically significant (P=0.04), whereas there were no statistical differences in postoperative recurrence of urinary incontinence and re-operation (P=0.13, P=0.06). Conclusion Apllication of mesh for pelvic organ prolapse can improve the objective and subjective cure rates .Mesh may be usefully applied to the treatment of pelvic organ prolapse , and further high-quality prospective studies are needed .