【摘要】：目的：收集相關(guān)RCT,通過Meta分析,評(píng)價(jià)補(bǔ)片用于陰道壁修補(bǔ)手術(shù)的有效性和安全性。 方法：計(jì)算機(jī)檢索Cochrane圖書館臨床對(duì)照試驗(yàn)資料庫(kù)、PubMed(1966～2012)、Embase(1980～2012)、CNKI (1994～2012)、VIP (1989～2012)、萬方數(shù)據(jù)庫(kù)網(wǎng)站(1978～2012),手工檢索相關(guān)專業(yè)雜志,并用Google等搜索引擎在互聯(lián)網(wǎng)上查找相關(guān)的文獻(xiàn)。追查已納入研究的參考文獻(xiàn)。與作者聯(lián)系追蹤文章的數(shù)據(jù),全文等。收集盆底功能障礙疾病(female pelvic floor dysfunction, FPFD)患者進(jìn)行傳統(tǒng)的陰道壁修補(bǔ)手術(shù)與添加補(bǔ)片的陰道壁修補(bǔ)手術(shù)對(duì)比的臨床隨機(jī)對(duì)照試驗(yàn)(Randomized controlled trials, RCT),文章語(yǔ)種不限,檢索時(shí)間截止至2012年1月。由兩名研究者按Cochrane系統(tǒng)評(píng)價(jià)方法,獨(dú)立納入試驗(yàn)、提取資料、評(píng)價(jià)納入研究的偏倚風(fēng)險(xiǎn),提取有效數(shù)據(jù)進(jìn)行Meta分析。 結(jié)果：納入符合標(biāo)準(zhǔn)的共18篇文獻(xiàn),均為RCT,共納入患者2443例。1.客觀脫垂復(fù)發(fā)率：(1)陰道前壁：添加補(bǔ)片進(jìn)行陰道前壁修補(bǔ)手術(shù)與傳統(tǒng)陰道前壁修補(bǔ)手術(shù)相比,使用補(bǔ)片能夠降低術(shù)后客觀脫垂復(fù)發(fā)率,其中合成不可吸收補(bǔ)片組與傳統(tǒng)組相比[RR=0.15,95%CI(0.11,0.21),P0.00001],效果顯著；生物補(bǔ)片組與傳統(tǒng)組相比[RR=0.44,95%CI(0.29,0.68),P=0.0002]；合成可吸收補(bǔ)片組與傳統(tǒng)組相比[RR=0.48,95%CI(0.26,0.87),P=0.01]；而各種補(bǔ)片之間相互對(duì)比,合成不可吸收補(bǔ)片術(shù)后脫垂復(fù)發(fā)率(13.1%,54/413)比生物補(bǔ)片復(fù)發(fā)率低(15.8%,46/292)。(2)陰道后壁：傳統(tǒng)的陰道后壁修補(bǔ)手術(shù)與添加生物補(bǔ)片或可吸收補(bǔ)片進(jìn)行的陰道后壁修補(bǔ)手術(shù)相比,補(bǔ)片的應(yīng)用并未能降低脫垂復(fù)發(fā)率。(3)陰道前壁+后壁：當(dāng)同時(shí)進(jìn)行陰道前壁+后壁修補(bǔ)時(shí),添加合成不可吸收補(bǔ)片進(jìn)行的陰道壁修補(bǔ)手術(shù)比傳統(tǒng)的陰道壁修補(bǔ)手術(shù)復(fù)發(fā)率低[RR=0.33,95%CI(0.12,0.85),P=0.02],而手術(shù)添加人工合成可吸收補(bǔ)片與傳統(tǒng)的陰道壁修補(bǔ)手術(shù)相比,并未能降低脫垂復(fù)發(fā)率。2.主觀癥狀改善：納入的研究中,大部分研究顯示,在主觀癥狀改善方面?zhèn)鹘y(tǒng)手術(shù)組與補(bǔ)片組之間無差別。3.手術(shù)相關(guān)并發(fā)癥及不良事件：使用合成不可吸收補(bǔ)片其周圍臟器損傷、新發(fā)尿失禁和再次手術(shù)率較不使用補(bǔ)片的傳統(tǒng)手術(shù)方式發(fā)生率高,同時(shí)合成不可吸收補(bǔ)片的補(bǔ)片侵蝕率(52/625,8.32%)較生物補(bǔ)片(9/387,2.33%)和可吸收補(bǔ)片(1/115,0.87%)發(fā)生率高。 結(jié)論：1.目前的研究證據(jù)支持使用合成不可吸收補(bǔ)片和生物補(bǔ)片進(jìn)行陰道前壁修補(bǔ)能夠降低術(shù)后客觀脫垂復(fù)發(fā)率,合成不可吸收補(bǔ)片效果更顯著；使用補(bǔ)片并不能改善患者主觀癥狀及生活質(zhì)量。2.陰道前壁+后壁修補(bǔ)使用合成不可吸收補(bǔ)片較傳統(tǒng)修補(bǔ)手術(shù)能夠降低術(shù)后脫垂復(fù)發(fā)率,但不能夠改善主觀癥狀。3.在單純陰道后壁修補(bǔ)手術(shù)中,傳統(tǒng)修補(bǔ)手術(shù)與使用生物補(bǔ)片和合成可吸收補(bǔ)片在主觀癥狀改善還是客觀脫垂復(fù)發(fā)方面均無差別。4.合成不可吸收補(bǔ)片的補(bǔ)片侵蝕率高于生物補(bǔ)片和合成可吸收補(bǔ)片。5.使用合成不可吸收補(bǔ)片其手術(shù)相關(guān)并發(fā)癥的發(fā)生率及再次手術(shù)的發(fā)生率較傳統(tǒng)手術(shù)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
【學(xué)位授予單位】：廣西醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2012
【分類號(hào)】：R713

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