Zhang C-Y, Sun Z-J, Yang J, Xu T, Zhu L, Lang J-H
Department of Obstetrics and Gynaecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China.
Department of Epidemiology and Biostatistics, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences, Beijing, China.
BJOG. 2021 Jan;128(1):14-23. doi: 10.1111/1471-0528.16324. Epub 2020 Jun 15.
The use of mesh is controversial in the treatment of female pelvic organ prolapse.
To systematically review the outcomes of sacrocolpopexy compared with transvaginal mesh surgery and to provide evidence-based suggestions.
The MEDLINE, EMBASE, Cochrane Library and clinicaltrials.gov databases were searched on 21 November 2018.
Randomised controlled trials and prospective and retrospective cohort studies were included.
Data were extracted by one reviewer and examined by a second reviewer for accuracy. Odds ratios and 95% CI were calculated using random-effects models.
Twenty comparative studies were included. The meta-analysis was performed with subgroups. The summary odds ratios of the randomised controlled group were 1.84 (95% CI 0.79-4.29, I = 75%) for anatomical success, 1.41 (95% CI 0.47-4.24, I = 38%) for subjective success, 0.42 (95% CI 0.18-0.98, I = 0%) for mesh complications, 0.61 (95% CI 0.20-1.91, I = 0%) for prolapse reoperation and 0.44 (95% CI 0.23-0.88, I = 0%) for de novo dyspareunia. The mean differences were 0.77 (95% CI 0.31-1.23, I = 66%) for total vaginal length and -1.28 (95% CI -2.00 to -0.55, I = 66%) for point C after surgery.
Very-low-quality evidence indicated that the anatomical and subjective success rates of sacrocolpopexy were similar to those of transvaginal mesh surgery; sacrocolpopexy might be more beneficial than transvaginal mesh surgery in terms of mesh-related complication rates, prolapse recurrence and de novo dyspareunia. However, additional high-quality randomised trials with long-term follow-up durations are needed.
Sacrocolpopexy is beneficial after surgical anatomical changes and has decreased rates of mesh-related complications and dyspareunia.
网片在女性盆腔器官脱垂治疗中的应用存在争议。
系统评价骶骨阴道固定术与经阴道网片手术的疗效，并提供循证建议。
于2018年11月21日检索MEDLINE、EMBASE、Cochrane图书馆和clinicaltrials.gov数据库。
纳入随机对照试验以及前瞻性和回顾性队列研究。
由一名评价者提取数据，另一名评价者检查数据准确性。采用随机效应模型计算比值比和95%置信区间。
纳入20项比较研究。进行亚组的荟萃分析。随机对照组的汇总比值比为：解剖学成功为1.84（95%置信区间0.79 - 4.29，I² = 75%），主观成功为1.41（95%置信区间0.47 - 4.24，I² = 38%），网片相关并发症为0.42（95%置信区间0.18 - 0.98，I² = 0%），脱垂再次手术为0.61（95%置信区间0.20 - 1.91，I² = 0%），新发性交困难为0.44（95%置信区间0.23 - 0.88，I² = 0%）。手术前后总阴道长度的平均差值为0.77（95%置信区间0.31 - 1.23，I² = 66%），C点的平均差值为 -1.28（95%置信区间 -2.00至 -0.55，I² = 66%）。
极低质量证据表明，骶骨阴道固定术的解剖学成功率和主观成功率与经阴道网片手术相似；在网片相关并发症发生率、脱垂复发率和新发性交困难方面，骶骨阴道固定术可能比经阴道网片手术更有益。然而，需要更多长期随访的高质量随机试验。
骶骨阴道固定术在手术解剖学改变后有益，且降低了网片相关并发症和性交困难的发生率。
