Campbell Patrick, Cloney Louise, Jha Swati
Urogynaecology Subspecialty Trainee.
Medical Student.
Obstet Gynecol Surv. 2016 Aug;71(7):435-42. doi: 10.1097/OGX.0000000000000335.
Sacrocolpopexy (SC) is considered the criterion-standard treatment for management of vaginal vault prolapse (VVP), and laparoscopic SC (LSC) has become a popular alternative to the abdominal approach. However, there are limited definitive data comparing the 2 procedures. The aim of this meta-analysis is to compare the abdominal sacrocolpopexy (ASC) with the LSC for the management of VVP. Electronic searches of MEDLINE, EMBASE, PubMed, Cochrane Register of Controlled Trials, Cochrane Database of Systematic Reviews, CINAHL, and Google scholar were performed. A systematic review and meta-analysis of studies comparing ASC and LSC for the management of VVP were performed. Seven studies were included with a total of 1461 patients: 589 in the LSC group and 872 in the ASC group. The conversion rate for LSC to ASC was 3% (17 cases). One LSC and 1 ASC were each converted to vaginal procedures. The operative time was significantly greater with LSC (mean difference, 25 minutes; 95% confidence interval [CI], 5.43-45.07 minutes); however, ASC had significantly greater intraoperative blood loss (mean difference, 107 mL; 95% CI, -139.59 to -73.73 mL), longer hospital stay (mean difference, 1.71 days; 95% CI, -2.21 to -1.22 days), and increased risk of postoperative ileus/small bowel obstruction (odds ratio, 2.88; 95% CI, 1.31-6.33). There was no significant difference in rate of bladder injury, bowel injury, mesh exposure, or repeat prolapse surgery. Laparoscopic SC takes longer but is associated with less intraoperative blood loss, shorter hospital stay, and reduced postoperative ileus/small bowel obstruction and hence is a suitable alternative to the abdominal technique.
骶骨阴道固定术（SC）被认为是治疗阴道穹窿脱垂（VVP）的标准治疗方法，而腹腔镜骶骨阴道固定术（LSC）已成为腹部手术方法的一种流行替代方案。然而，比较这两种手术的确定性数据有限。本荟萃分析的目的是比较腹部骶骨阴道固定术（ASC）和LSC治疗VVP的效果。我们对MEDLINE、EMBASE、PubMed、Cochrane对照试验注册库、Cochrane系统评价数据库、CINAHL和谷歌学术进行了电子检索。对比较ASC和LSC治疗VVP的研究进行了系统评价和荟萃分析。纳入了7项研究，共1461例患者：LSC组589例，ASC组872例。LSC转为ASC的转化率为3%（17例）。1例LSC和1例ASC分别转为阴道手术。LSC的手术时间明显更长（平均差异25分钟；95%置信区间[CI]，5.43 - 45.07分钟）；然而，ASC的术中失血量明显更多（平均差异107 mL；95%CI，-139.59至-73.73 mL），住院时间更长（平均差异1.71天；95%CI，-2.21至-1.22天），术后肠梗阻/小肠梗阻的风险增加（比值比，2.88；95%CI，1.31 - 6.33）。膀胱损伤、肠损伤、网片暴露或再次脱垂手术的发生率无显著差异。腹腔镜SC手术时间更长，但术中失血量更少，住院时间更短，术后肠梗阻/小肠梗阻减少，因此是腹部手术技术的合适替代方案。
