移植材料治疗盆腔脏器脱垂的有效性和安全性的meta分析  

Efficacy and safety of adjuvant materials in the repair of pelvic organ prolapse: a meta analysis

作　　者：周博慧[1] 吴素慧[2] 尚海霞[2] 

机构地区：[1]山西医科大学附属大医院妇产科,太原030001 [2]山西医学科学院山西大医院妇产科

出　　处：《山西医科大学学报》2014年第9期861-868,共8页Journal of Shanxi Medical University

摘　　要：目的系统评价移植材料在治疗盆腔脏器脱垂疾病中的有效性和安全性。方法计算机检索MEDLINE、Embase、Cochrane Library和中国生物医学文献数据库,检索时限为建库至2013年10月。纳入所有比较移植材料盆底重建术和传统阴道壁修补术的随机对照试验,并对纳入文献进行质量评价。用RevMan 5.2软件进行meta分析。结果共纳入15个随机对照实验,纳入研究对象1 602例。meta分析结果显示,传统阴道前壁修补术较加用合成网片/生物补片阴道前壁修补术解剖学复发率高[OR=4.67,95%CI(3.59,6.07),P<0.000 01],主观失败率传统阴道前壁修补组高于网片组[OR=1.84,95%CI(1.31,2.61),P=0.000 5],传统组与生物补片组相比无统计学差异(P=0.96)。传统阴道后壁修补术解剖学复发率低于生物补片组[OR=0.40,95%CI(0.17,0.91),P=0.03],两组间主观失败率差异无统计学意义[OR=1.96,95%CI(0.71,5.44),P=0.20]。传统组术中失血量及周围脏器损伤的发生率均低于移植物组。合成网片总的暴露/侵蚀率为7.64%,生物补片为0.54%。结论盆底重建修补术中应用移植材料虽可降低术后客观复发率,但其解剖学优势可能被手术、移植物相关的并发症所抵消,同时结合主观症状的改善、生活质量的提高等方面综合考虑,还不能确定合成网片/生物补片的应用比传统修补术更有效。Objective To assess the efficacy and safety of adjuvant materials in the repair of pelvic organ prolapse.Methods MEDLINE,Embase,Cochrane Library and CBM （from inception to October 2013） were searched for randomized controlled trials （RCTs） on the repair with and without adjuvant material in treating pelvic organ prolapse.Then the quality of the included trials was assessed,and the data were extracted.A comprehensive meta-analysis was performed by RevMan 5.2 software.Results A total of 15 RCTs involving 1 602 participants were included.In anterior vaginal wall prolapse repair,the anatomy recurrence rate was higher in traditional anterior colporrhaphy group than in mesh/graft group [OR =4.67,95 ％ CI （3.59,6.07）,P ＜ 0.000 01].The subjective recurrence rate was lower in mesh group than in traditional group[OR =1.84,95％ CI（1.31,2.61）,P =0.000 5],and there was no statistically significant difference between biological graft group and traditional group （P =0.96）.In posterior repair,conventional posterior colporrhaphy showed lower objective failure rate than biological graft[OR =0.40,95％ CI（0.17,0.91）,P =0.03].For subjective cure rate,there was no statistically significant difference between traditional group and biological graft group[OR =1.96,95％ CI（0.71,5.44）,P =0.20].Nevertheless,the perioperative bleeding and the incidence of visceral injury were lower in traditional group than in adjuvant material group.The erosion rate of synthetic mesh was 7.64％,and that of biological graft was 0.54％.Conclusion The application of adjuvant materials in the repair of pelvic organ prolapse could reduce objective prolapse recurrence rates,but the complications will neutralize the anatomy advantage.Comprehensively considering the subjective symptoms and life quality,it is still not sure that the synthetic mesh/biological graft is more effective than the traditional repair.

关 键 词：移植材料 网片 补片 盆腔脏器脱垂 随机对照试验 META分析 

分 类 号：R711.2[医药卫生—妇产科学]