Department of Obstetrics and Gynaecology, Amsterdam Reproduction & Development Research Institute, Amsterdam UMC-Location AMC, University of Amsterdam, Amsterdam, The Netherlands.
Department of Research Support, Medical Library, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
Neurourol Urodyn. 2022 Jan;41(1):115-126. doi: 10.1002/nau.24819. Epub 2021 Oct 13.
To determine the effects of oestrogen or oestrogen deprivation on vaginal wound healing. Impaired wound healing following prolapse surgery may increase the risk of recurrent prolapse in the future. Vaginal oestrogen therapy may improve wound healing, hereby possibly improving surgical outcomes.
A systematic search of OVID MEDLINE, OVID Embase, and Web of Science was conducted up to January 28, 2020. We included original studies comparing wound healing-related outcomes of oestrogen exposed subjects (female animals and women) to hypo-oestrogenic subjects after vaginal surgery. Data on wound healing-related outcome measures were extracted. For each individual comparison, the standardised mean difference (Hedges' g; SMD) and 95% confidence interval (CI) were calculated.
Of the 1474 studies reviewed, 14 studies were included for review, and 11 provided data for meta-analysis. Oestrogen improves neovascularisation (SMD: 1.13, 95% CI: 0.67-1.60), microscopic wound closure (SMD: 0.98, 95% CI: 0.66-1.29), collagen synthesis (SMD: 1.08, 95% CI: 0.42-1.74), and tissue strength (SMD: 1.26, 95% CI: 0.53-1.99) in animals. Oestrogen increases granulation (SMD: 1.67, 95% CI: 0.54-2.79) and accelerates macroscopic wound closure (SMD: 1.82, 95% CI: 1.22-2.42) in women and animals. Oestrogen decreases the inflammatory response (SMD: -0.58, 95% CI: -1.14 to -0.02) in women and animals and reduces levels of transforming growth factor (TGF)-β1 (SMD: -1.68, 95% CI: -2.52 to -0.83) in animals. All results were statistically significant.
Oestrogen therapy has a positive effect on vaginal wound healing. Future studies should determine whether oestrogen therapy has the potential to improve surgical outcomes.
确定雌激素或雌激素剥夺对阴道伤口愈合的影响。脱垂手术后伤口愈合受损可能会增加未来复发脱垂的风险。阴道雌激素治疗可能会改善伤口愈合，从而可能改善手术结果。
对 OVID MEDLINE、OVID Embase 和 Web of Science 进行了系统检索，检索时间截至 2020 年 1 月 28 日。我们纳入了比较阴道手术后雌激素暴露受试者（雌性动物和女性）与低雌激素受试者之间与伤口愈合相关结局的原始研究。提取与伤口愈合相关的结局测量数据。对于每一个单独的比较，计算标准化均数差（Hedges' g；SMD）和 95%置信区间（CI）。
在回顾的 1474 项研究中，有 14 项研究被纳入综述，其中 11 项提供了用于荟萃分析的数据。雌激素可改善血管新生（SMD：1.13，95%CI：0.67-1.60）、微观伤口闭合（SMD：0.98，95%CI：0.66-1.29）、胶原合成（SMD：1.08，95%CI：0.42-1.74）和组织强度（SMD：1.26，95%CI：0.53-1.99）。雌激素增加肉芽组织形成（SMD：1.67，95%CI：0.54-2.79）并加速女性和动物的宏观伤口闭合（SMD：1.82，95%CI：1.22-2.42）。雌激素减少女性和动物的炎症反应（SMD：-0.58，95%CI：-1.14 至-0.02）和动物中转化生长因子-β1（TGF-β1）的水平（SMD：-1.68，95%CI：-2.52 至-0.83）。所有结果均具有统计学意义。
雌激素治疗对阴道伤口愈合有积极影响。未来的研究应确定雌激素治疗是否有可能改善手术结果。
