目的:总结腹腔镜Davydov和Vecchietti方法创造新阴道的现有证据,并将这些技术与新阴道长度进行比较,性功能,手术时间,和并发症。
方法:使用Pubmed和Embase进行到2022年8月的系统电子搜索。
■获得了所有已发表的关于腹腔镜Davydov和腹腔镜Vecchietti手术作为在MRKH综合征女性中创造新阴道的手术技术的临床研究。遵循PRISMA准则。提取以下数据:手术时间,住院,主要早期并发症(术后3个月内),扩张疗法,新阴道长度,阴道分泌物,阴道狭窄,性活动的时间,性满意度,穿透性活动,性交困难,女性性功能指数(FSFI)和随访时间。纽卡斯尔渥太华量表用于访问文章的质量。
结果:新阴道长度,FSFI得分,手术时间,并发症结果:本系统综述共纳入1163篇文章,其中31项研究纳入.其中,12项研究(380名患者)与Davydov方法有关,Vecchietti方法的17项研究(804例患者)和2篇文章都涉及两者。研究质量存在临床异质性和多样性。19项研究包括在荟萃分析中。Davydov方法后12个月的平均新阴道长度为8.3cm(95CI8.1-8.6),与Vecchietti方法后8.7cm(95CI7.2-10.3)相比。Davydov方法后的平均FSFI评分为28.9(95CI26.8-31.1),与Vecchietti方法后的27.5(95CI25.0-30.1)相比。Davydov方法的手术时间为126分钟(95CI109-143),而Vecchietti方法为40分钟(95CI35-45)。
结论:手术产生了相当的新阴道长度,性功能,和并发症发生率。平均FSFI评分表明两组均无性功能障碍。Davydov方法的手术时间明显更长。其中一种手术技术在功能方面没有优势。
OBJECTIVE: To summarize the available evidence on the laparoscopic Davydov and Vecchietti methods to create a neovagina and to compare these techniques with a focus on neovaginal length, sexual function, operative time, and complications.
METHODS: A systematic electronic search up to August 2022 using PubMed and Embase is performed.
METHODS: Not applicable.
METHODS: Women with Mayer-Rokistansky-Küster-Hauser syndrome.
METHODS: All published clinical studies concerning the laparoscopic Davydov and laparoscopic Vecchietti procedures as a surgical technique to create a neovagina in women with Mayer-Rokistansky-Küster-Hauser syndrome were obtained. The guidelines for the preferred reporting items for systematic reviews and meta-analysis were followed. The following data were extracted: operative time, hospital stay, major early complications (within 3 months postsurgery), dilation therapy, neovaginal length, vaginal discharge, vaginal stenosis, time to sexual activity, sexual satisfaction, penetrative sexual activity, dyspareunia, score on the Female Sexual Function Index (FSFI), and duration of follow-up. The Newcastle Ottawa Scale was used to assess the quality of articles.
METHODS: Neovaginal length, FSFI scores, operative time, and complications.
RESULTS: A total of 1,163 articles were identified, of which 33 studies were included in this systematic review. Of these, 12 studies (380 patients) are related to the Davydov method, 19 studies (1,126 patients) to the Vecchietti method, and 2 articles concern both. There is clinical heterogeneity and variety in the quality of the studies. Eighteen studies were included in the meta-analyses. The mean neovaginal length 12 months after the Davydov method is 8.3 cm (95% confidence interval [CI] 8.1-8.6), vs. 8.7 cm (95% CI 7.2-10.3) after the Vecchietti method. The mean FSFI score after the Davydov method is 28.9 (95% CI 26.8-31.1), compared with 27.5 (95% CI 25.0-30.1) after the Vecchietti method. The operative time of the Davydov method is 126 minutes (95% CI 109-143), compared with 40 minutes (95% CI 35-45) of the Vecchietti method.
CONCLUSIONS: The operations yield comparable neovaginal length, sexual function, and complication rates. The mean FSFI scores indicate no sexual dysfunction in either group. The operative time of the Davydov method is significantly longer. There is no superiority shown for one of the surgical techniques in functional terms.