Department of Obstetrics and Gynecology, McGill University, and St. Mary's Research Centre, Montreal, Québec, and the Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, British Columbia, Canada.
Obstet Gynecol. 2021 Jun 1;137(6):1061-1073. doi: 10.1097/AOG.0000000000004393.
To systematically review objective and subjective success and complications of apical suspensions for symptomatic uterine or vaginal vault pelvic organ prolapse (POP).
MEDLINE, CENTRAL, ClinicalTrials.gov, and EMBASE (2002-2019) were searched using multiple terms for apical POP surgeries, including comparative studies in French and English.
From 2,665 records, we included randomized controlled trials and comparative studies of interventions with or without hysterectomy, including abdominal apical reconstruction through open, laparoscopic, or robotic approaches and vaginal apical reconstructions. Repairs using transvaginal mesh, off-the-market products, procedures without apical suspension, and follow-up less than 6 months were excluded.
TABULATION, INTEGRATION, AND RESULTS: Relative risk (RR) was used to estimate the effect of surgical procedure on each outcome. For each outcome and comparison, a meta-analysis was conducted to pool the RRs when possible. Meta-regression and bias tests were performed when appropriate. The GRADE (Grades for Recommendation, Assessment, Development and Evaluation) system for quality rating and PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) reporting were used. Sixty-two articles were included in the review (N=22,792) and 50 studies in the meta-analyses. There was heterogeneity in study quality, techniques used, and outcomes reported. Median follow-up was 1-5 years. Vaginal suspensions showed higher risk of overall and apical anatomic recurrence compared with sacrocolpopexy (RR 1.82, 95% CI 1.22-2.74 and RR 2.70, 95% CI 1.33-5.50) (moderate), whereas minimally invasive sacrocolpopexy showed less overall and posterior anatomic recurrence compared with open sacrocolpopexy (RR 0.59, 95% CI 0.47-0.75 and RR 0.59, 95% CI 0.44-0.80, respectively) (low). Different vaginal approaches, and hysterectomy and suspension compared with hysteropexy had similar anatomic success. Subjective POP recurrence, reintervention for POP recurrence and complications were similar between most procedures.
Despite variations in anatomic outcomes, subjective outcomes and complications were similar for apical POP procedures at 1-5 years. Standardization of outcome reporting and comparative studies with longer follow-up are urgently needed.
PROSPERO, CRD42019133869.
系统回顾治疗症状性子宫或阴道穹窿盆腔器官脱垂（POP）的顶悬术的客观和主观成功率及并发症。
使用法语和英语的多种术语，对顶 POP 手术的 MEDLINE、CENTRAL、ClinicalTrials.gov 和 EMBASE（2002-2019 年）进行了检索。
从 2665 条记录中，我们纳入了随机对照试验和有或无子宫切除术的干预措施的比较研究，包括经开放、腹腔镜或机器人入路的腹顶重建术和阴道顶重建术。排除了经阴道网片、非市场产品、无顶悬术和随访时间少于 6 个月的手术。
表格、综合和结果：使用相对危险度（RR）估计手术程序对每种结果的影响。对于每个结果和比较，如果可能，进行荟萃分析以汇总 RR。在适当的情况下进行了 meta 回归和偏倚检验。使用 GRADE（推荐评估、制定和评价等级）系统进行质量评级和 PRISMA（系统评价和荟萃分析的首选报告项目）报告。本综述纳入了 62 篇文章（N=22792）和 50 项荟萃分析研究。研究质量、所用技术和报告结果存在异质性。中位随访时间为 1-5 年。阴道悬带术与骶骨阴道固定术相比，总体和顶解剖复发的风险更高（RR 1.82，95%CI 1.22-2.74 和 RR 2.70，95%CI 1.33-5.50）（中等），而微创骶骨阴道固定术与开放骶骨阴道固定术相比，总体和后解剖复发的风险更低（RR 0.59，95%CI 0.47-0.75 和 RR 0.59，95%CI 0.44-0.80，分别）（低）。不同的阴道入路、子宫切除术和与子宫固定术相比的悬吊术在解剖学上有相似的成功率。大多数手术的主观 POP 复发、POP 复发再手术和并发症相似。
尽管解剖学结果存在差异，但 1-5 年内顶 POP 手术的主观结果和并发症相似。迫切需要标准化的结果报告和具有更长随访时间的比较研究。
PROSPERO，CRD42019133869。
