Abstract：
OBJECTIVE: Uterosacral ligament suspension (USLS) is one of the most frequently used operations for the restoration of apical support in women with uterovaginal prolapse. However, existing studies are inconclusive as to whether and which surgical access route is superior. The aim of the present meta-analysis is tentatively to compare the efficiency and the postoperative complications of laparoscopic USLS (L-USLS) and vaginal USLS (V-USLS), highlighting that current evidence remains inconclusive regarding the superiority of either surgical access route.
METHODS: We performed a systematic literature review of 5 major databases (Medline, Scopus, Google Scholar Cochrane Central Register of Controlled Trials and Clinicaltrials.gov) from inception till April 2023.
METHODS: No language restrictions were applied. All comparative studies that compared L-USLS and V-USLS for the management of women with uterovaginal prolapse were included.
RESULTS: Data from 6 retrospective cohort studies on 856 patients were extracted and analyzed. The methodological quality of the included studies was assessed using the risk of bias in nonrandomized studies of interventions tool and ranged between moderate to serious. The pooled results suggest that L-USLS was associated with a potentially decreased incidence of ureteral compromise (odds ratio [OR], 0.19; 95% confidence interval [CI] 0.04-0.89; p = .04) and seemingly lower objective (OR 0.47; 95% CI 0.23-0.97; p = .04) and subjective recurrence rates (OR 0.46; 95% CI 0.23-0.92; p = .03). There were no significant differences between the rates of postoperative pain from USLS sutures, postoperative pelvic hematomas, the suture exposure/granulation tissue formation, and the prolapse recurrence retreatment among the 2 groups.
CONCLUSIONS: The present meta-analysis indicates that L-USLS is possibly associated with significantly fewer ureteral compromise rates and decreased subjective and objective recurrences rates compared to V-USLS. Nevertheless, given the limitations in data quality and heterogeneity of the included studies, these findings should be interpreted with caution. Large-scale randomized studies are essential to more definitively determine the relative merits of the laparoscopic versus vaginal approach.
METHODS: We performed a systematic literature review of 5 major databases (Medline, Scopus, Google Scholar Cochrane Central Register of Controlled Trials and Clinicaltrials.gov) from inception till April 2023.
METHODS: No language restrictions were applied. All comparative studies that compared L-USLS and V-USLS for the management of women with uterovaginal prolapse were included.
RESULTS: Data from 6 retrospective cohort studies on 856 patients were extracted and analyzed. The methodological quality of the included studies was assessed using the risk of bias in nonrandomized studies of interventions tool and ranged between moderate to serious. The pooled results suggest that L-USLS was associated with a potentially decreased incidence of ureteral compromise (odds ratio [OR], 0.19; 95% confidence interval [CI] 0.04-0.89; p = .04) and seemingly lower objective (OR 0.47; 95% CI 0.23-0.97; p = .04) and subjective recurrence rates (OR 0.46; 95% CI 0.23-0.92; p = .03). There were no significant differences between the rates of postoperative pain from USLS sutures, postoperative pelvic hematomas, the suture exposure/granulation tissue formation, and the prolapse recurrence retreatment among the 2 groups.
CONCLUSIONS: The present meta-analysis indicates that L-USLS is possibly associated with significantly fewer ureteral compromise rates and decreased subjective and objective recurrences rates compared to V-USLS. Nevertheless, given the limitations in data quality and heterogeneity of the included studies, these findings should be interpreted with caution. Large-scale randomized studies are essential to more definitively determine the relative merits of the laparoscopic versus vaginal approach.
摘要：
目的：子宫骶韧带悬吊术（USLS）是子宫阴道脱垂女性最常用的根尖支撑修复手术之一。然而,关于手术入路是否以及哪种手术入路更优越，现有研究尚无定论。本荟萃分析的目的是初步比较腹腔镜子宫骶韧带悬吊术（L-USLS）和阴道子宫骶韧带悬吊术（V-USLS）的疗效和术后并发症。强调目前的证据仍然没有关于两种手术入路的优越性的定论。
方法：我们对5个主要数据库进行了系统的文献综述(Medline，Scopus,谷歌学者Cochrane受控试验和临床试验中央登记册.gov)从成立到2023年4月。
方法：没有语言限制。包括所有比较L-USLS和V-USLS治疗子宫阴道脱垂妇女的比较研究。
结果：对856例患者的6项回顾性队列研究数据进行提取和分析。使用非随机干预研究（ROBINS-I）工具评估纳入研究的方法学质量，范围为中度至重度。合并的结果表明，L-USLS与输尿管损害的潜在发生率降低有关（OR，0.19；95%CI0.04至0.89；p=.04）和看似较低的客观复发率（OR0.47；95%CI0.23至0.97；p=.04）和主观复发率（OR0.46；95%CI0.23至0.92；p=.03）。USLS缝合术后疼痛的发生率之间没有显着差异，术后盆腔血肿，缝线暴露/肉芽组织形成，两组脱垂复发再治疗。
结论：目前的荟萃分析表明，与V-USLS相比，L-USLS可能与显著降低的输尿管损害率和降低的主观和客观复发率相关。然而，鉴于纳入研究的数据质量和异质性的局限性，这些发现应谨慎解释.大规模随机研究对于更明确地确定腹腔镜与阴道方法的相对优点至关重要。
方法：我们对5个主要数据库进行了系统的文献综述(Medline，Scopus,谷歌学者Cochrane受控试验和临床试验中央登记册.gov)从成立到2023年4月。
方法：没有语言限制。包括所有比较L-USLS和V-USLS治疗子宫阴道脱垂妇女的比较研究。
结果：对856例患者的6项回顾性队列研究数据进行提取和分析。使用非随机干预研究（ROBINS-I）工具评估纳入研究的方法学质量，范围为中度至重度。合并的结果表明，L-USLS与输尿管损害的潜在发生率降低有关（OR，0.19；95%CI0.04至0.89；p=.04）和看似较低的客观复发率（OR0.47；95%CI0.23至0.97；p=.04）和主观复发率（OR0.46；95%CI0.23至0.92；p=.03）。USLS缝合术后疼痛的发生率之间没有显着差异，术后盆腔血肿，缝线暴露/肉芽组织形成，两组脱垂复发再治疗。
结论：目前的荟萃分析表明，与V-USLS相比，L-USLS可能与显著降低的输尿管损害率和降低的主观和客观复发率相关。然而，鉴于纳入研究的数据质量和异质性的局限性，这些发现应谨慎解释.大规模随机研究对于更明确地确定腹腔镜与阴道方法的相对优点至关重要。
