应用辅助材料行修补术治疗阴道前壁脱垂的有效性及安全性的Meta分析

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、手术时间、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2313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。

Meta-analysis of efficacy and safety of application of adjuvant materials in the repair of anterior vaginal wall prolapse

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 inthe incidence of complications in anterior repair with adjuvant materials and repair without adjuvant materials.