Department of Urogynaecology, Women's and Newborn Services, Royal Brisbane and Women's Hospital, Brisbane, Australia.
The University of Queensland, Saint Lucia, QLD, Australia.
Int Urogynecol J. 2022 Jul;33(7):1813-1826. doi: 10.1007/s00192-022-05217-2. Epub 2022 May 10.
Levator ani muscle avulsion as a risk factor for prolapse recurrence is not well established. This systematic review was aimed at evaluating the correlation between levator ani avulsion and postoperative prolapse recurrence with meta-analysis, specifically, the risk of subjective or objective prolapse recurrence and reoperation.
The protocol was registered in the International Prospective Register of Systematic Reviews (registration number CRD42021256675). A systematic literature search was conducted using PubMed, EMBASE and Cochrane Database of Systematic Reviews to identify all peer-reviewed studies that described levator avulsion in women and investigated operative and postoperative outcomes. All peer-reviewed, English-language cohort studies in those with and without levator avulsion with a minimum of 3 months' follow-up were included. Pooled unadjusted and adjusted odds ratios were calculated for subjective recurrence, objective recurrence and rates of re-operation. The Cochrane Collaboration Risk of Bias In Non-Randomized Studies (RoBINS) and The Grading of Recommendations Assessment, Development and Evaluation (GRADE) tools were used to assess the quality of the studies included.
Twelve studies with a total of 2,637 subjects and a follow-up period 0.3-6.4 years were identified. There were insufficient data to report a pooled adjusted risk for subjective recurrence and reoperation. On low to moderate quality-adjusted data, the pooled odds of objective recurrence was not significantly associated with levator ani avulsion (aOR 1.68; 95% CI 0.78-3.66).
Levator ani avulsion has not been confirmed as a risk factor for objective prolapse recurrence. Further evidence is needed to investigate the correlation between levator ani avulsion and the risk of subjective recurrence and reoperation.
肛提肌撕裂是否是脱垂复发的危险因素尚未得到充分证实。本系统评价旨在通过荟萃分析评估肛提肌撕裂与术后脱垂复发之间的相关性，具体为主观或客观脱垂复发和再次手术的风险。
该方案已在国际前瞻性系统评价登记处（注册号 CRD42021256675）注册。使用 PubMed、EMBASE 和 Cochrane 系统评价数据库对所有描述女性肛提肌撕裂并调查手术和术后结果的同行评审研究进行了系统文献检索。纳入所有具有和不具有肛提肌撕裂且随访时间至少为 3 个月的同行评审、英语队列研究。计算了主观复发、客观复发和再次手术率的未调整和调整后比值比。使用 Cochrane 协作非随机研究偏倚风险（RoBINS）和推荐评估、制定与评估（GRADE）工具评估纳入研究的质量。
确定了 12 项研究，共 2637 名受试者，随访时间为 0.3-6.4 年。没有足够的数据报告主观复发和再次手术的调整后风险的汇总数据。在经过质量调整的低至中度数据中，客观复发的汇总优势比与肛提肌撕裂无显著相关性（aOR 1.68；95%CI 0.78-3.66）。
肛提肌撕裂尚未被确认为客观脱垂复发的危险因素。需要进一步的证据来研究肛提肌撕裂与主观复发和再次手术风险之间的相关性。
