[1]黄晨玲子 林鑫子 罗新＊.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[J].中国微创外科杂志,2014,14(12):1128-1134.
　Huang Chenlingzi,Lin Xinzi,Luo Xin..A Comparative Study Between Mesh and Traditional Colporrhaphy for Pelvic Organ Prolapse: a Metaanalysis[J].Chinese Journal of Minimally Invasive Surgery,2014,14(12):1128-1134.
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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()
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《中国微创外科杂志》[ISSN:1009-6604/CN:11-4526/R]

卷:
14
期数:
2014年12期
页码:
1128-1134
栏目:
Meta分析
出版日期:
2014-12-20

文章信息/Info

Title:
A Comparative Study Between Mesh and Traditional Colporrhaphy for Pelvic Organ Prolapse: a Metaanalysis
作者:
黄晨玲子 林鑫子 罗新＊
暨南大学附属第一医院妇产科，广州510632
Author(s):
Huang Chenlingzi;  Lin Xinzi;  Luo Xin.
Department of Obstetrics and Gynecology, First Affiliated Hospital of Jinan University, Guangzhou 510632, China
关键词:
盆腔器官脱垂; 合成网片; 阴道修补术; meta分析
Keywords:
Pelvic organ prolapse; Synthetic mesh; Colporrhaphy; Metaanalysis
分类号:
R713.3
文献标志码:
A
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。
Abstract:
ObjectiveTo review systemically the effectiveness and safety of mesh versus traditional colporrhaphy for pelvic organ prolapse.MethodsThe 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 RevMan5.0 software. ResultsThere 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).ConclusionApllication 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.

参考文献/References:

[1]Kelly HA. Incontinence of urine in women. Urol Cutan Rev,1913,1（17）: 291.
[2]Le TH, Kon L, Bhatia NN, et al. Update on the utilization of grafts in pelvic reconstruction surgeries. Corropion Obstet Gynecol,2007,19(5):480-489.
[3]Parker MC，Philips RK. Repair of rectocele using Marlex mesh. Ann R Coll Engl,1993,75(3):193-194.
[4]Nguyen JN, Burchette RJ. A randomized comparison of polypropylene mesh surgery with sitespecific surgery in the treatment of cystocoele. Obstet Gynecol,2008,111(4):891-898.
[5]Carey M, Higgs P, Goh J, et al. Vaginal repair with mesh versus colporrhaphy for prolapse: a randomised controlled trial. BJOG,2009,116(10): 1380-1386.
[6]Nieminen K, Hiltunen R, Takala T,et al. Outcomes after anterior vaginal wall repair with mesh: a randomized, controlled trial with a 3 year followup. Am J Obstet Gynecol,2010,203(3):235.e1-e8.
[7]Iglesia CB, Sokol AI, Sokol ER,et al. Vaginal mesh for prolapse: A randomized controlled trial. Obstet Gynecol 2010,116(2): 293-303.
[8]Altman D, Vayrynen T, Engh ME, et al. Anterior colporrhaphy versus transvaginal mesh for pelvicorgan prolapse. N Engl J Med, 2011, 364(19): 1826-1836.
[9]Withagen MI, Milani AL, de Leeuw JW, et al. Development of de novo prolapse in untreated vaginal compartments after prolapse repair with and without mesh: a secondary analysis of a randomised controlled trial. BJOG,2012,119(3): 354-360.
[10]Sokol AI, Iglesia CB, Kudish BI, et al. Oneyear objective and functional outcomes of a randomized clinical trial of vaginal mesh for prolapse. Am J Obstet Gynecol,2012,206(1): 86.e81-e89.
[11]ElNazer MA, Gomaa IA, Ismail Madkour WA, et al. Anterior colporrhaphy versus repair with mesh for anterior vaginal wall prolapse: a comparative clinical study.Arch Gynecol Obstet,2012,286(4): 965-972.
[12]Delroy CA, Castro Rde A, Dias MM, et al. The use of transvaginal synthetic mesh for anterior vaginal wall prolapse repair: a randomized controlled trial. Int Urogynecol J,2013,24(11):1899-1907.
[13]Tamanini JT, Castro RC, Tamanini JM, et al. Treatment of anterior vaginal wall prolapse with and without polypropylene mesh: a prospective, randomized and controlled trial-Part Ⅱ. Int Braz J Urol,2013,39(4): 531-541.
[14]Gunsekera P, Sazaki J, Walker G.Pelvic organ prolapse: don’t forget developing countries. Lancet, 2007,369(9575):1789-1790.
[15]罗新.女性盆底重建外科手术面面观.中华妇幼临床杂志,2007,3(2):61-64.
[16]Shah AD, Kohli N, Rajan SS, et al. The age distribution, rate, and types of surgery for pelvic organ prolapse in the U.S. Int Urogynecol J Pelvic Floor Dysfunct, 2008,19(3):421-428.
[17]Shull BL, Capen CV, Riggs MW, et al. Preoperative and postoperative analysis of sitespecific pelvic support defects in 81 women treated with sacrospinous ligament suspension and pelvic reconstruction. Am J Obstet Gynecol, 1992,166(6):1764-1771.
[18]Paraiso MF, Ballard LA, Walters MD, et al. Pelvic support defects and visceral and sexual function in women treated with sacrospinous ligament suspension and pelvic reconstruction. Am J Obstet Gynecol,1996,175(6):1423-1431.
[19]Maher C, Baessler K. Surgical management of anterior vaginal wall prolapse: an evidence based literature review. Int Urogynecol J Pelvic Floor Dysfunct,2006,17(4):195-201.
[20]李亚兰，张晓红，王建六，等.补片在盆腔脏器脱垂全盆底重建术中应用的初步临床分析.中国妇产科临床杂志，2008,9(2):100-102.
[21]朱兰，郎景和，主编.女性盆底学.第1版. 北京:人民卫生出版社，2008.15-18.
[22]Julian TM. The efficacy of Marlex mesh in the repair of severe, recurrent vaginal prolapse of the anterior midvaginal wall. Am J Obstet Gynecol, 1996,175(6):1472-1475.

备注/Memo

备注/Memo:
基金项目：国家自然科学基金面上项目（81070459）；广东省科技厅科研基金项目（2007B06041054）;广东省自然科学基金博士科研启动项目(粤科基办字［2008］4号8451063201000290)；广东省医学科研基金立项课题（粤卫［2008］84号A2008364）;广东省医学科研基金项目（粤卫［2007］97号A2007338）；广东省院士工作站建设项目（粤财教［2012］397号2012B09050007）;广东省国际合作项目（2010B050100022）＊通讯作者，Email:tlu
更新日期/Last Update: 2014-12-20