补片用于阴道壁修补其有效性和安全性的系统评价

发布时间：2018-11-23 16:16

【摘要】：目的：收集相关RCT,通过Meta分析,评价补片用于阴道壁修补手术的有效性和安全性。方法：计算机检索Cochrane图书馆临床对照试验资料库、PubMed(1966～2012)、Embase(1980～2012)、CNKI (1994～2012)、VIP (1989～2012)、万方数据库网站(1978～2012),手工检索相关专业杂志,并用Google等搜索引擎在互联网上查找相关的文献。追查已纳入研究的参考文献。与作者联系追踪文章的数据,全文等。收集盆底功能障碍疾病(female pelvic floor dysfunction, FPFD)患者进行传统的阴道壁修补手术与添加补片的阴道壁修补手术对比的临床随机对照试验(Randomized controlled trials, RCT),文章语种不限,检索时间截止至2012年1月。由两名研究者按Cochrane系统评价方法,独立纳入试验、提取资料、评价纳入研究的偏倚风险,提取有效数据进行Meta分析。结果：纳入符合标准的共18篇文献,均为RCT,共纳入患者2443例。1.客观脱垂复发率：(1)阴道前壁：添加补片进行阴道前壁修补手术与传统阴道前壁修补手术相比,使用补片能够降低术后客观脱垂复发率,其中合成不可吸收补片组与传统组相比[RR=0.15,95%CI(0.11,0.21),P0.00001],效果显著；生物补片组与传统组相比[RR=0.44,95%CI(0.29,0.68),P=0.0002]；合成可吸收补片组与传统组相比[RR=0.48,95%CI(0.26,0.87),P=0.01]；而各种补片之间相互对比,合成不可吸收补片术后脱垂复发率(13.1%,54/413)比生物补片复发率低(15.8%,46/292)。(2)阴道后壁：传统的阴道后壁修补手术与添加生物补片或可吸收补片进行的阴道后壁修补手术相比,补片的应用并未能降低脱垂复发率。(3)阴道前壁+后壁：当同时进行阴道前壁+后壁修补时,添加合成不可吸收补片进行的阴道壁修补手术比传统的阴道壁修补手术复发率低[RR=0.33,95%CI(0.12,0.85),P=0.02],而手术添加人工合成可吸收补片与传统的阴道壁修补手术相比,并未能降低脱垂复发率。2.主观症状改善：纳入的研究中,大部分研究显示,在主观症状改善方面传统手术组与补片组之间无差别。3.手术相关并发症及不良事件：使用合成不可吸收补片其周围脏器损伤、新发尿失禁和再次手术率较不使用补片的传统手术方式发生率高,同时合成不可吸收补片的补片侵蚀率(52/625,8.32%)较生物补片(9/387,2.33%)和可吸收补片(1/115,0.87%)发生率高。结论：1.目前的研究证据支持使用合成不可吸收补片和生物补片进行阴道前壁修补能够降低术后客观脱垂复发率,合成不可吸收补片效果更显著；使用补片并不能改善患者主观症状及生活质量。2.阴道前壁+后壁修补使用合成不可吸收补片较传统修补手术能够降低术后脱垂复发率,但不能够改善主观症状。3.在单纯阴道后壁修补手术中,传统修补手术与使用生物补片和合成可吸收补片在主观症状改善还是客观脱垂复发方面均无差别。4.合成不可吸收补片的补片侵蚀率高于生物补片和合成可吸收补片。5.使用合成不可吸收补片其手术相关并发症的发生率及再次手术的发生率较传统手术方式高。
[Abstract]:Objective: To collect relevant RCT, and to evaluate the effectiveness and safety of patch for vaginal wall repair by a meta-analysis. Methods: The computer searched the Cochrane Library's clinical control test database, PubMed (1966 ~ 2012), Embase (1980 ~ 2012), CNKI (1994 ~ 2012), VIP (1989 ~ 2012), Wanfang database website (1978 ~ 2012), the relevant professional magazines were searched by hand, and the relevant search engine was found on the Internet by using the search engine, such as Google. Literature. Tracing of references that have been included in the study Literature. Contact the author to trace the data of the article, all The clinical and randomized controlled trial (RCT) of the traditional vaginal wall repair and the repair of the vaginal wall with the addition of the patch was performed in the patients with pelvic floor dysfunction (FPFD). The language of the article was not limited, and the retrieval time was up to 2012. In January, two investigators, according to the Cochrane system evaluation method, independently included the trial, extracted data, and evaluated the bias risk included in the study, and the effective data was extracted for Meta-analysis. Analysis. Results: 18 articles were included in the standard, all of which were RCTs and included in the patient 24 43. 1. The recurrence rate of the objective prolapse: (1) the recurrence rate of the anterior vaginal wall: (1) the anterior wall of the vagina: the repair of the anterior wall of the vagina by the addition of a patch can reduce the recurrence rate of the objective prolapse after operation, wherein the synthetic non-absorbable patch group is compared with the conventional group[RR = 0.15, 95% CI (0.11, 0.21), P0.001] The results showed that compared with the traditional group (RR = 0.44, 95% CI (0.29, 0.68), P = 0. 0002], compared with the traditional group (RR = 0.48, 95% CI (0.26, 0.87), P = 0.01), the recurrence rate of prolapse of the non-absorbable patch (13. 1%, 54/ 413) was lower than that of the bioprosthesis (15. 8%, 46%)./ 292). (2) Post-vaginal wall: The conventional post-vaginal wall repair procedure does not reduce the application of the patch compared to the post-vaginal wall repair procedure with the addition of a bioprosthesis or an absorbable patch Prolapse recurrence rate. (3) The anterior wall of the vagina + posterior wall: when the anterior wall of the vagina and the back wall were repaired at the same time, the repair of the vaginal wall by the addition of the synthetic non-absorbable patch was lower than that of the conventional vaginal wall repair (RR = 0.33, 95% CI (0.12, 0.85), P = 0. 02], and the addition of synthetic absorbable patch to the operation did not reduce the prolapsed time compared with the conventional vaginal wall repair procedure. relapse rate. 2. subjective symptom improvement: most of the studies have shown that between the conventional surgical group and the patch group in the improvement of subjective symptoms No distinction. 3. Procedure-related complications and adverse events: the use of synthetic non-absorbable patches for the injury of the surrounding organs, the new urinary incontinence, and the conventional surgical side where the rate of reoperation is less than that of the patch The incidence was high, while the rate of patch erosion (52/ 625, 8. 32%) of the non-absorbable patch was higher than that of the bioprosthesis (9/ 387, 2.33%) and the absorbable patch (1/ 115, 0.87%).) High incidence Conclusion: 1. The present research evidence supports the use of synthetic non-absorbable patch and bioprosthesis for the repair of the anterior wall of the vagina, which can reduce the recurrence rate of the objective prolapse, and the effect of the synthesis of the non-absorbable patch is more significant; the use of the patch does not improve the subjective symptoms of the patient. shape and quality of life. 2. The use of synthetic non-absorbable patch on the anterior wall of the vagina and the repair of the posterior wall can reduce the recurrence rate of the prolapsed prolapsed, but can't improve that subjective symptom. 3. in the repair of the posterior wall of the pure vagina, the traditional repair procedure and the use of the bioprosthesis and the synthetic absorbable patch can improve the subjective symptom or the recurrence of the objective prolapse. There is no difference in all aspects. 4. The patch erosion rate of the synthetic non-absorbable patch is higher than that of the bioprosthesis. The incidence of the procedure-related complications and the rate of re-operation with synthetic non-absorbable patch
【学位授予单位】：广西医科大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R713

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