阴道侧旁修补术治疗阴道前壁脱垂的Meta分析

Meta-Analysis of Paravaginal Repair in the Treatment of Anterior Vagina Prolapse

摘要: 目的：系统地评价阴道侧旁修补术对于治疗阴道前壁脱垂的有效性及安全性。方法：计算机检索中国知网、万方数据库、PubMed、Science Direct和MEDLINE等数据库从建库至2019年3月已发表的关于阴道侧旁修补术(Paravaginal repair, PVR)治疗阴道前壁脱垂的临床研究，按检索策略收集文献资料，对纳入的研究进行方法学质量评价，釆用RevMan.软件对临床对照研究资料进行连续性资料和二分类资料的Meta分析，采用R3.5.3软件对无对照临床研究资料进行有关阴道侧旁修补术后复发率及并发症的单个率Meta分析。结果：最终共纳入25个相关研究，其中2篇随机对照研究(RCT)、2篇队列研究、21篇无对照临床研究。对纳入数据进行Meta分析结果显示：1) 试验组(PVR组)与对照组在患者年龄、术前POP-Q评分(Ba点和C点)、手术时间及术中出血量均无显著差异(P > 0.05)；2) 两组患者术后POP-Q评分(Ba点)均较术前明显改善，两组间差异无统计学意义(P > 0.05)；3) 试验组的术后解剖学复发率低于对照组，差异具有统计学意义(OR = 0.57，95% CI为0.33~0.97，P = 0.04)；4) 阴道侧旁修补术后解剖学复发率为16% (95% CI为0.11~0.21)，围术期出血、输尿管膀胱损伤、术后尿潴留以及术后尿失禁的发生率分别为3% (95% CI为0.02~0.05)、4% (95% CI为0.02~0.06)、9% (95% CI为0.05~0.13)和8% (95% CI为0.04~0.13)。结论：阴道侧旁修补术能够有效恢复阴道解剖，术后复发率低，安全可靠，为阴道前壁脱垂的有效治疗方式。

Abstract: Objective: To evaluate the efficacy and safety of paravaginal repair in the treatment of anterior vaginal prolapse systematically. Methods: Keywords were searched in: CNKI, Wanfang Data, PubMed, Science Direct, MEDLINE, et al. Data up to 31 March 2019 were considered. Studies were collected and evaluated according to the inclusion and exclusion criteria. Quality evaluation of methodologies of all included studies was done. Meta-analysis of continuous data and dichotomous data in controlled data were conducted with RevMan 5.3 software, and a single rate meta-analysis of the anatomic recurrence rate and complications after paravaginal repair in controlled data was performed using R3.5.3 software. Results: A total of 25 studies were included, including 2 randomized controlled trials (RCT), 2 cohort studies, and 21 non-controlled studies. Meta-analysis results showed that: 1) There was no significant difference in the age, preoperative POP-Q score (Ba and C points), operation time, blood loss between the two groups (P > 0.05); 2) The postoperative POP-Q score (Ba point) was significantly better than before in the two groups, but there was no significant difference between the two groups (P > 0.05); 3) The postoperative recurrence rate of the paravaginal repair group was lower, and the difference was statistically significant (OR = 0.57, 95% CI: 0.33~0.97, P = 0.04); 4) Anatomic recurrence rate was 16% (95% CI: 0.11~0.21) after paravaginal repair, and the incidence of perioperative bleeding, vesicoureteral injury, urinary retention and stress urinary incontinence is 3% (95% CI: 0.02~0.05), 4% (95% CI: 0.02~0.06), 9% (95% CI: 0.05~0.13) and 8% (95% CI: 0.04~0.13) respectively. Conclusion: The paravaginal repair is a safe and effective method for the treatment of anterior vaginal prolapse.