Departments of Obstetrics and Gynecology, Duke University, Durham, North Carolina, Columbia University Medical Center and Icahn School of Medicine at Mount Sinai, New York, New York, University of Texas Health Science Center, San Antonio, Texas, Henry Ford Health System, Detroit, Michigan, University of New Mexico, Albuquerque, New Mexico, University of Maryland Medical Center, Baltimore, Maryland, Hartford Hospital, Hartford, Connecticut, Summa Health System, Akron, Ohio, and Alpert Medical School of Brown University, Providence, Rhode Island; and the Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, Massachusetts.
Obstet Gynecol. 2015 Jan;125(1):44-55. doi: 10.1097/AOG.0000000000000570.
To systematically review outcomes after mesh sacrocolpopexy compared with native tissue vaginal repairs in women with apical prolapse.
We searched MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov through June 4, 2012.
For anatomic and functional analyses, we included studies comparing mesh sacrocolpopexy to native tissue vaginal repairs with at least 6 months follow-up. The primary outcome was anatomic "success" after surgery. Secondary outcomes were reoperation and symptom outcomes. We included large case series and comparative studies with shorter follow-up to increase power for adverse event analyses.
TABULATION, INTEGRATION, AND RESULTS: Evidence quality was assessed with the Grades for Recommendation, Assessment, Development and Evaluation system. Meta-analyses were performed when at least three studies reported the same outcome. We included 13 comparative studies for anatomic success, reoperation, and symptom outcomes. Moderate-quality evidence supports improved anatomic outcomes after mesh sacrocolpopexy; very low-quality evidence shows no differences in reoperation between sacrocolpopexy and native tissue vaginal repairs. Evidence was insufficient regarding which procedures result in improved bladder or bowel symptoms. Low-quality evidence showed no differences in postoperative sexual function. Adverse event data were compiled and meta-analyzed from 79 studies. When including larger noncomparative studies, ileus or small bowel obstruction (2.7% compared with 0.2%, P<.01), mesh or suture complications (4.2% compared with 0.4%, P<.01), and thromboembolic phenomena (0.6% compared with 0.1%, P=.03) were more common after mesh sacrocolpopexy compared with native tissue vaginal repairs.
When anatomic durability is a priority, we suggest that mesh sacrocolpopexy may be the preferred surgical option. When minimizing adverse events or reoperation is the priority, there is no strong evidence supporting one approach over the other.
系统回顾网片骶骨阴道固定术与阴道固有组织修复术治疗阴道顶端脱垂患者的结局。
我们检索了 MEDLINE、EMBASE、Cochrane 对照试验中心注册库和 ClinicalTrials.gov，检索时间截至 2012 年 6 月 4 日。
对于解剖学和功能分析，我们纳入了比较网片骶骨阴道固定术与阴道固有组织修复术且随访时间至少 6 个月的研究。主要结局是手术后的解剖学“成功”。次要结局是再次手术和症状结局。我们纳入了大病例系列和随访时间较短的比较研究，以增加对不良事件分析的能力。
列表、综合和结果：使用推荐、评估、开发和评价系统（Grades for Recommendation, Assessment, Development and Evaluation，GRADE）评估证据质量。当至少有 3 项研究报告了相同的结局时，我们进行了荟萃分析。我们纳入了 13 项比较研究，以评估解剖学结局、再次手术和症状结局。中等质量证据支持网片骶骨阴道固定术在解剖学结局方面的改善；极低质量证据表明骶骨阴道固定术与阴道固有组织修复术之间在再次手术方面没有差异。关于哪种手术能改善膀胱或肠道症状的证据不足。低质量证据表明术后性功能无差异。我们从 79 项研究中汇编和荟萃分析了不良事件数据。当纳入更大的非对照研究时，与阴道固有组织修复术相比，网片骶骨阴道固定术更常见的不良事件包括肠梗阻或小肠梗阻（2.7%比 0.2%，P<.01）、网片或缝线相关并发症（4.2%比 0.4%，P<.01）和血栓栓塞现象（0.6%比 0.1%，P=.03）。
当解剖学耐久性是首要考虑因素时，我们建议网片骶骨阴道固定术可能是首选的手术方法。当首要考虑最小化不良事件或再次手术时，没有强有力的证据支持一种方法优于另一种方法。
